Voss Jan Oliver, Thieme Nadine, Doll Christian, Hartwig Stefan, Adolphs Nicolai, Heiland Max, Raguse Jan-Dirk
Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany.
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany.
Craniomaxillofac Trauma Reconstr. 2018 Sep;11(3):172-182. doi: 10.1055/s-0038-1642035. Epub 2018 Apr 24.
Penetrating foreign bodies of different origins in the head and neck are rare and potentially dangerous injuries, which might pose problems for their detection, primary care, and final treatment. Depending on the severity of the underlying trauma, some injuries present a higher risk for the presence of foreign bodies. Minor wounds, including common lacerations, are likely to be contaminated with loose gravel debris or dental fragments, and need to be distinguished from severe wounds caused by impalement, shootings, stabbings, and explosions. Blast injuries resulting from terror attacks are challenging recent therapeutic concepts. Even though these injury patterns are uncommon, they carry the risk of impacted objects with dramatic consequences. Despite improving medical imaging techniques, detection remains a challenge as it is dependent on the material of the foreign body, the affected anatomical site, and the injury severity. Therefore, a detailed history of the circumstances leading to trauma is essential when foreign objects are not visible during clinical examination. Precise detection of the foreign body, its anatomical position, and the affected surrounding structures are vital, especially for impalement injuries of the head and neck area. Therefore, an interdisciplinary planning approach is essential prior to removal of the foreign object. Finally, tension-free anatomical adaptation of the corresponding structures is crucial for maintaining and restoring aesthetic and function. Here, we give an overview of the diagnosis and treatment of cases of foreign body injuries encountered in our department.
头颈部不同来源的穿透性异物是罕见且潜在危险的损伤，其检测、初步处理及最终治疗都可能存在问题。根据潜在创伤的严重程度，一些损伤存在异物存留的较高风险。轻微伤口，包括普通撕裂伤，可能被松散的沙砾碎片或牙齿碎片污染，需要与由穿刺、枪击、刺伤和爆炸导致的严重伤口相区分。恐怖袭击造成的爆炸伤对当前治疗理念构成挑战。尽管这些损伤模式不常见，但它们存在异物嵌入的风险，后果严重。尽管医学成像技术不断进步，但检测仍具挑战性，因为这取决于异物的材质、受影响的解剖部位以及损伤的严重程度。因此，当临床检查中看不到异物时，详细了解导致创伤的情况至关重要。精确检测异物及其解剖位置以及受影响的周围结构至关重要，尤其是对头颈部区域的穿刺伤。因此，在取出异物之前，跨学科的规划方法必不可少。最后，相应结构的无张力解剖学适配对于维持和恢复美观及功能至关重要。在此，我们概述了本部门遇到的异物损伤病例的诊断和治疗情况。
