Stirnhöhlenfraktur: aktuelle Kontroversen zur Therapie

Zusammenfassung

Die Therapie von Stirnhöhlenfrakturen war für lange Zeit von der Furcht vor Spätfolgen geprägt. Meningitis und Mukozelen sollten durch Kranialisation und Obliteration vorgebeugt werden. Diese Therapiekonzepte haben sich bis heute weitgehend unverändert als Therapiestandard gehalten, während die Möglichkeit der endoskopischen Nasennebenhöhlenchirurgie, die Qualität der Bildgebung und das chirurgische Instrumentarium sich in den vergangenen zwei Jahrzehnten erheblich verbesserten und verbreitet haben. Nun stellen die verfeinerten Techniken der endoskopischen Stirnhöhlenchirurgie, die Verbreitung von Navigationssystemen und die multiplanare hochauflösende Computertomografie, sowie neuere Daten über postoperative Komplikationen den Wert der Kranialisation und Obliteration als Standardtherapie zunehmend in Frage. Diese Übersicht fasst die aktuelle Diskussion in der Behandlung der Stirnhöhlenfrakturen anhand der aktuellen Literatur unter Berücksichtigung der vorhandenen Evidenz zusammen.

Abstract

Current Controversies in the Treatment of Frontal Sinus Fractures

The surgical treatment of frontal sinus fractures is foreshadowed by fears of late complications. Complications such as meningitis and mucoceles should be prevented by cranialization or obliteration of the frontal sinus. These procedures are still standard treatment despite of recent developments over the last two decades in endoscopic sinus surgery, in medical imaging and surgical instrumentation. Nowadays the role of cranialization and obliteration is challenged by refined endoscopic frontal sinus surgery techniques, the widely-used image-guided systems and the multiplanar high-resolution computed tomography along with new data about postoperative complications.

This overview summarizes the current literature, taking into account the existing evidence in the treatment of frontal sinus fractures.

Schlüsselwörter

Stirnhöhlenfraktur - Kranialisation - Obliteration - Mukozele - Osteosynthese - endoskopische Reposition - endoskopische Stirnhöhlenchirurgie

Key words

frontal sinus fracture - cranialization - obliteration - mucocele - osteosynthesis - endoscopic reposition - endoscopic frontal sinus surgery

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