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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Korrespondenzadresse
Ralph Litschel
Hals-Nasen-Ohrenklinik
Kantonsspital St. Gallen
Rorschacher Straße 95
9007 St. Gallen
Schweiz
Email: Ralph.Litschel@kssg.ch
