汶川大地震后送伤员耳鼻咽喉头颈部伤情分析与处理

目的 调查分析汶川大地震后送伤员涉及耳鼻咽喉头颈部伤情的特点以及救治原则.方法 对汶川大地震中的206例进行耳鼻咽喉专科拉网式筛查及检诊,调查耳鼻咽喉头颈部伤情、致伤原因,并及时予以救治.结果 206例伤员中,收入院伤员165例,伤员中合并耳鼻咽喉头颈部伤37例(22.4%),主要包括:耳廓及外耳道外伤10例(27%),鼓室积血2例(5.4%);鼓膜破裂出血1例(2.7%);外耳道异物4例(10.8%);鼻出血4例(10.8%);鼻骨骨折及蝶骨、筛骨骨折6例(16.2%);蝶骨、筛骨骨折合并脑脊液鼻漏1例(2.7%);颧部外伤感染伴脓肿形成1例(2.7%);下颌骨及颧骨骨折4例(10.8%);口唇黏膜撕裂伤2例(5.4%);声音嘶哑2例(5.4%).致伤原因以摔伤及踩踏伤居多.所有患者处理全身其他合并伤同时,对专科情况给予适当处理,均取得良好效果.结论 地震伤救治后送伤员大部分为多发伤,耳鼻咽喉头颈部损伤多为全身其他部位的并发伤,容易被忽略,专科医生应及早对伤员进行全面检查诊断并及时治疗.     

汶川地震后部分地区耳鼻咽喉头面部伤情调查与分析

目的 调查分析强烈地震灾害造成的耳鼻咽喉头面部的伤情及救治.方法 对2008年5月12日四川汶川地震后第二军医大学医疗队所在安县、茂县、江油县及汶川县三江镇收治的、及巡诊的受伤人数进行调查,重点对伤员的耳鼻咽喉、颌面及头颈部的伤情、致伤原因、救治方法进行分析.结果 本组患者为地震3 d后存活人群中的耳鼻咽喉头面部伤227例,多是轻伤或伴有复合伤,其中185例头面部软组织伤,13例鼻骨或鼻窦骨折,18例鼻出血,7例颅底骨折,4例耳廓撕裂伤.根据救护所及医院的不同医疗条件进行诊断和治疗,对软组织损伤采用清创换药缝合,骨折尽可能复位.对伴有复合伤的危重伤员急救稳定后送至有条件的医院进一步治疗.救护所救治的46例中除3例复合伤或可疑视神经损伤的重伤员后送外,43例5～10 d痊愈.医院救治181例中除3例有颅底骨折的复合伤转院后送外,住院31例至5月26日痊愈出院26例,留院治疗的5例均为复合伤未愈者;147例未留院患者中除1例耳廓撕裂伤感染再次清创延期愈合外,146例软组织伤痊愈并拆,骨折患者在愈合中,未见并发症.结论 对地震后的耳鼻咽喉头面部伤应尽早清创缝合、骨折复位,注意合理用药,危重伤员及时后送,可以减少并发症的发生,降低死亡率.     

耳鼻咽喉科处理地震伤急诊病人的体会

绵阳地区是5.12汶川大地震的重灾区,灾害发生后大量地震伤患者送来我院.此时,面对大量以复杂性外伤为主的地震伤员,外科医师严重短缺.为了让广大伤员在第一时间获得基本医疗救助,我院耳鼻咽喉科在医院领导的统一部署下,担当了大量专科和非专科伤员的紧急救治工作.     

耳鼻咽喉科医师对地震伤的处理策略

5.12汶川大地震是建国以来破坏性最强、波及范围最广、救灾难度最大的一次地震。绵阳市中心医院做为重灾区最大的一所综合性医院,在短时间内收治了大量的地震伤伤员,主要来自北川、安县和平武等重灾区,伤员大多为各种骨折伤,但因骨科病区无法接收如此大量伤员,故除专科伤员外,耳鼻咽喉科还收治了大量骨伤伤员,共计89例,现报道如下。     

汶川大地震头颈伤调查与处置对策探讨

5.12汶川大地震发生后,成都军区总医院先后收治地震伤伤员2000多例,为了解地震伤伤员头颈伤的发病情况及探讨其处置对策,地震10天后,我们对住院的地震伤伤员306例进行了调查分析,报道如下。     

耳鼻喉—头颈自伤,自杀的防治（附55例报告）

自伤和自杀，在现实生活中并不少见，原因复杂，方式多样，与耳鼻咽喉科有关，如处理不当或不及时可引起一系列并发症和较严重的后遗症，甚至死亡。由于伤情危急，治疗上有时难以取得患者的合作，放在耳鼻咽喉科创伤处理方面颇具特点，现将我院1962年～1977年55例报告如下。临床资料伤病分类：见附表l刎颈为咽喉切割伤的主要原因，常伴颈部其他器官的严重损伤，利器以菜刀和剪刀居多。大部分有精神病史，亦有为恶性肿瘤病而轻生者。症状以喉阻塞、咯血及失血性休克为主，损伤情况有喉、气管洞穿，喉麻痹和气管食管凌等。处理上除防止空』巨…     

武警部队耳鼻咽喉头颈外科专业学术委员会简介

武警部队耳鼻咽喉头颈外科专业学术委员会隶属于武警部队总部卫生部主管,主任委员单希征(武警总医院耳鼻咽喉头颈外科),副主任委员王天生(武警浙江总队医院),委员包括:陈仁物(武警福建总队医院)、蔡华成(武警四川总队医院)、苏法仁(武警山东总队医院)、张旭东(武警河南总队医院)。武警部队系统66家医院耳鼻咽喉头颈外科加入学术委员会,其中三级医院32家,每个省、直辖市、自治区均建有武警总队医院,是一个规模庞大的医疗系统,负责武警官兵及地方百姓的医疗保障工作,还组建国际紧急救援组织(SOS)中国救援医疗基地。     

头颈外科

980449下领、颈部巨大金属异物1例/董 武…//耳鼻咽喉一头颈外科一1997,4(4)一2 19980450异位甲状腺1例/李宪明产耳鼻咽喉一头颈外科一1997,4(4)一223980451颈动脉钝性损伤(综述)/刘兵…//中国耳鼻咽喉颅底外科杂志一1997,3(2)一1 16~1 19 颈动脉钝性损伤是头颈创伤中一类较罕见的血管伤,常造成中枢神经系统的严重损害,预后较差。本文综述其发病机理、致伤因素、损伤类型、临床表现及诊断治疗。参14(原提要)980452颈部穿透伤伴颈部大血管急性破裂的诊断及处理/陶泽璋…//临床耳鼻咽喉科杂志一1997,11(8)一359~360 报告颈部穿透伤伴颈部大血…     

姜泗长院士百年诞辰学术研讨会纪实

秋兰飘香时节,由《中华耳鼻咽喉头颈外科杂志》主办,解放军总医院耳鼻咽喉头颈外科医院、解放军耳鼻咽喉研究所承办,中华医学会耳鼻咽喉头颈外科分会、全军耳鼻咽喉头颈外科专业委员会、北京医师协会耳鼻咽喉专科医师分会、中国听力医学发展基金会专家委员会及《中华耳科学杂志》编辑部协办的姜泗长院士百年诞辰学术研讨会在北京远望楼宾馆召开。会议为期2天,邀请了姜老的亲属及来自全国耳鼻咽喉头颈外科及相关学科的300余位医师参会。     

2013年全国喉癌、下咽癌诊治学术大会会议通知

由中华医学会耳鼻咽喉头颈外科分会、中国残疾人康复协会无喉者康复专业委员会、中国抗癌协会头颈肿瘤专业委员会主办,浙江省肿瘤医院、浙江省抗癌协会耳鼻咽喉肿瘤专业委员会承办的"2013年全国喉癌、下咽癌诊治学术大会"定于2013年5月23～26日在杭州召开。本次大会主题为"喉癌、下咽癌的功能保全与康复",大会将邀请国内著名的头颈肿瘤外科、耳鼻咽喉科、放化疗科等方面的专家进行专题学术报告及专业示教。会议内容将突出喉癌、下咽癌的功能保全及康复,围绕早期喉癌、下咽癌治疗的选     

Maxillofacial trauma of pediatric patients in Malaysia: a retrospective study from 1999 to 2001 in three hospitals

OBJECTIVE: Maxillofacial trauma in children is not common worldwide. Domestic injuries are frequently seen in younger children while older children are mostly involved in motor vehicle accidents (MVA). The objective of this study was to analyze the pattern of maxillofacial injuries in pediatric patients referred to three government main hospitals in different areas of West Malaysia. METHODS: Patients' records of three selected hospitals in Malaysia (National University of Malaysia Hospital, Kajang Hospital and Seremban Hospital) from January 1999 to December 2001 were reviewed. Data associated with demographics, etiology of injury in relation to age group, type of injuries whether soft tissues of hard tissue in relation to age group and treatment modalities were collected. RESULTS: A total of 521 pediatric patients' records were reviewed. Malays made up the majority of patients with maxillofacial injuries in the three hospitals. Males outnumbered females in all the three hospitals. Injuries commonly occur in the 11-16 years old. MVA was the most common etiology followed by fall and assault. Soft tissue injuries were the most common type of injuries in all the hospitals. In relation to fractures, mandible was the most common bone to fracture with condyle being the most common site. Orbital fracture was the most common fracture in the midfacial area. Most of the fractures were managed conservatively especially in the younger age groups. Open reduction with or without internal fixation was more frequently carried out in the 11-16 years old group. CONCLUSION: Children exhibit different pattern of clinical features depending on the etiology and stage of their bone maturation. A dedicated team, who is competent in trauma and aware of the unique anatomy, physical and psychological characteristics of children, should manage pediatric patient with trauma.     

Frontal sinus fractures in children

OBJECTIVE: To review the epidemiologic characteristics, clinical course, and management of pediatric patients with frontal sinus fractures. METHODS: Retrospective review of 120 patients with maxillofacial fractures who presented to a tertiary children's hospital from 1998 to 2003 revealed 11 patients with frontal sinus fractures. RESULTS: The study group included 9 males and 2 females with a mean age of 9.7 (range 4-14) years. The most common mechanisms of injury were unrestrained motor vehicle accident and all-terrain vehicle accident. All patients suffered concomitant orbital fractures. Other maxillofacial fractures included sphenoid (4), naso-orbitoethmoid (3), midface (2), and mandible (1). Seven (63.6%) patients sustained significant intracranial injuries including intraparenchymal hemorrhage, expanding pneumocephalus, and subdural hematoma. The average age of patients with intracranial injury was younger than those without intracranial injury (8.1 vs. 12.8 years, P = .025). Four patients had a total of six sites of cerebrospinal fluid (CSF) leak. The most common sites of dural injury were the cribriform area (4) and frontal region (2). All patients with CSF leaks had significant intracranial injuries and required bifrontal craniotomy. CONCLUSIONS: Pediatric frontal sinus fractures are likely to involve other maxillofacial injuries, particularly involving the orbit. Frontal sinus fractures in children are associated with increased risk of serious intracranial injury and CSF leak when compared with adults. The most common site of dural injury was the cribriform area. A multidisciplinary approach is necessary to manage concomitant injuries, obtain separation of the sinonasal tract from intracranial contents, and to restore cosmesis to the brow.     

Injuries of the nasofrontal orifices in frontal sinus fractures

Disruption of the nasofrontal ostia or ducts is an important factor in the development of immediate and delayed complications following frontal sinus fractures. Thorough evaluation of 50 consecutive patients with frontal sinus injuries caused by blunt trauma revealed several fracture patterns that frequently include injury to the drainage system. Anterior table fractures, even when displaced, do not produce such injuries unless associated with a fracture of the supraorbital rim or nasoethmoidal complex. Combined fractures of the anterior and posterior tables are almost always accompanied by injuries to the orifices. Severity of these injuries is variable but can be predicted from the sinus wall fracture patterns. Although CT scanning is incapable of directly imaging involvement of the ostia or ducts, it will give sufficient information to allow for accurate prediction of disruption of the drainage system.     

鼻骨骨折急诊期的诊断和整复

目的 :提高急诊期鼻骨骨折的诊治效果。方法 :对 30 4例本病患者行鼻骨骨折整复术 16 1例 ,鼻骨骨折整复加鼻中隔矫正术 118例 ,鼻骨骨折整复加鼻窦骨折整复术 13例。结果 :除自动出院 7例外 ,治愈 2 79例 ,好转 18例。结论 :详细检查并酌行 CT扫描 ,注意发现鼻中隔骨折、颅脑损伤及鼻窦骨折的存在 ;严重复合伤按常规救治原则处理 ,伴鼻中隔骨折者可同时行鼻中隔矫正术。     

Dental injuries due to miniplate osteosynthesis. Classification, treatment management, complications, and prognosis]

BACKGROUND: In spite of a monocortical design, miniplate osteosynthesis can injure dental roots directly as well as damage dental substance indirectly by interrupting the apical blood stream. PURPOSE: The present retrospective study classifies different types of dental root trauma caused by monocortical screws, suggests therapeutic options based on diagnosis, and documents survival probability and prognosis after tooth trauma. PATIENTS AND METHODS: During a period of 11 years, 380 patients with permanent dentition underwent miniplate osteosynthesis for the treatment of mandibular fractures, 29 of whom sustained dental root trauma caused by drilling failure. These patients were clinically and radiographically examined for a follow-up time of not less than 38 months. RESULTS: The 29 patients could be classified into four different types of dental root trauma: 13 pulp injuries above the apical third of the root (type Ia), 6 pulp injuries in the apical third of the root or extradental lesions interrupting the apical blood stream (type Ib), 4 lesions to the central radicular dentin without pulp injury (type II), and 6 lesions to the peripheral radicular dentin and root cementum (type III). Of 13 type Ia injuries, 5 developed apical periodontitis and dilatation of the periodontal space. Therefore one root canal treatment and three apicoectomies were performed. One tooth had to be extracted. Three further type Ia injuries and two type Ib injuries showed root resorptions inducing two root canal treatments. One of six type Ib injuries required root canal treatment because of apical periodontitis. One of four type II injuries caused root resorption not requiring therapy. No relevant, pathological finding could be identified after type III injury. CONCLUSIONS: The type of dental root trauma caused by miniplate osteosynthesis determines therapy, complication rate, and survival of the injured tooth.     

Dentoalveolar trauma. Analysis of 4763 patients with 6237 injuries in 10 years]

PURPOSE: The purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation based on the analysis of a large amount of dentoalveolar injuries over a 10-year period. PATIENTS AND METHODS: Between 1991 and 2000, 4763 of 9543 patients suffering from oral and maxillofacial injuries, sustained dentoalveolar trauma. Records of 6237 different dental injury patterns were reviewed according to the five main injury mechanisms: age, sex, type of injury, cause of accident, and frequency of dentoalveolar trauma. They were statistically analyzed using frequency distribution, chi-square test, t-test, Mann-Whitney U test, Kolmogorov-Smirnov test, and logistic regression analysis. RESULTS: Household and play (2117), sports (1533), traffic accidents (438), acts of violence (426), and work-related accidents (201) were noted. A total of 4763 patients had 2988 subluxations, 2356 showed crown fractures, 444 had avulsions, 176 root fractures, 154 intrusions, and 119 patients suffered from concussions. This number of patients accounts for the prevalence of 49.9% for dentoalveolar trauma among all facial injuries. CONCLUSION: Only the analysis of a large number of injuries reveals the risk of suffering from dentoalveolar trauma. Due to this fact, preventive methods can be recommended and demanded more effectively.     

人类免疫缺陷病毒感染及艾滋病在耳鼻咽喉头颈外科的临床表现

目的 提高对人类免疫缺陷病毒感染者及艾滋病患者在耳鼻咽喉头颈外科临床表现的认识,以便能及时诊治并做好必要的防护.方法 分析55例坦桑尼亚首诊于耳鼻咽喉头颈外科的HIV感染者及艾滋病患者的临床表现及其预后.55例患者中男23例,女32例;年龄3～67岁,中位年龄31岁.结果 55例患者中腮腺肿胀17例次(30.9%);鼻腔、口腔、咽部卡波西肉瘤19例次(34.5%);慢性化脓性中耳炎12例次(21.8%);颈部肿块11例次(20.0%);咽部肿物7例次(12.7%);口腔及咽部黏膜糜烂溃疡6例次(10.9%);口腔白色念珠菌感染2例次(3.6%).HIV感染者或艾滋病患者经治疗后耳鼻咽喉科感染状况可缓解,但易反复发作,且逐渐加重.结论 HIV感染者及艾滋病患者可首诊于耳鼻咽喉头颈外科.对耳鼻咽喉科感染等治疗缓解后反复发作者,应除外是否合并HIV感染或是否为艾滋病患者.

Abstract：

Objective To improve the recognition of clinical manifestation of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in otorhinolaryngology head and neck surgery, and to emphasize the early diagnosis, correct treatment and effective protection. Methods Fifty-five patients with HIV infection and AIDS encountered in the department of otorhinolaryngology head and neck surgery in Tanzania were included in this study. There were 23 males and 32 femals with age ranged from 3 -67 years, medium 31 year. The clinical manifestation and prognosis of the patients were analyzed and summed up. Results Parotid glands swelling was the most commonly seen clinical manifestation in the 55 cases. Among the cases reported here, 17 (30.9%) showed parotid glands swelling, 19(34. 5% ) had Kaposi's sarcoma in nasal cavity or oral cavity or pharynx,12(21.8% ) were accompanied with chronic suppurative otitis media, 11 (20.0%) had masses in the neck,7 ( 12.7% ) had masses in the pharynx, 6 ( 10.9% ) were seen to have ulcer in oral and pharyngeal mucosa,2(3.6% ) showed infection due to candidaalbicans. The infection in most cases could be controlled and symptoms relieved, but recurrence could occur over time and got worse gradually. Conclusions Many patients with HIV infection and AIDS first see a doctor in otorhinolaryngology head and neck surgery.Patients who had the above clinical manifestations in repeated poor results should be observed carefully,early diagnosis and treatment are important to prevent transmission, prolong life and maximize the quality of life of the patients.     

The incidence of sports-related facial trauma in children

We conducted a survey of physician members of the American Academy of Facial Plastic and Reconstructive Surgery to determine the incidence and nature of facial traumas seen in their practices. We solicited information on the anatomic location of each injury, the severity of the trauma, and whether the injury occurred during a sports activity. According to the responses, 21% of facial fractures and 29% of nasal fractures were experienced by patients aged 17 years and younger who were participating in sports. We believe that many such injuries can be prevented with greater use of protective equipment.     

Management of complication from temporal bone fractures

The objective of the study is to review clinical findings and outcomes in patients with temporal bone fractures, and to show an incidence and management of complications. It is the retrospective clinical study and the study took place at tertiary referral center. Fifty-two patients with temporal bone fractures. Data were collected from patients’ charts and clinical review. Patients were classified into five groups according to the CT scan. The primary endpoint of study was to show management of possible complication from temporal bone fractures and to analyze association with intracranial injuries. The second endpoint was to show incompleteness of traditionally classification of fracture type. Of the 52 patients with 54 fractures, 27 (50%) had longitudinal fractures, 4 (7.4%) had transverse fractures, 17 (31.5%) had temporal squama-mastoid fractures, 4 (7.4%) had mixed fractures and 2 (3.7%) had isolated meatal fracture. Fifty-eight percent of patients had at least one intracranial pathologic finding, of which 11% had two or more. Persistent conductive hearing loss was noted in 8 of 16 affected patients. The facial paralysis occurred in seven patients. One patient had benign paroxysmal positional vertigo developed 3 weeks after injury. In conclusion, rarely temporal bone fractures are isolated injures. The squama-mastoid fracture in most cases associated with intracranial injuries. Coordination between the neurosurgeon and otologist is essential in the care of such patients. Further large studies will be done to give a more complete classification of temporal bone fractures which will include all fracture patterns and predict clinical outcome.     

Traumatologie des Ohrs und der lateralen Sch?delbasis

In addition to injuries to the pinna otologic traumatology comprises in particular injuries of the tympanic membrane and ossicular chain, temporal bone fractures together with accompanying impairment of the labyrinth and facial nerve as well as acoustic trauma and barotrauma. Depending on the mechanism of injury and typical symptoms, such as hemorrhagic otorrhoea, hearing loss, vertigo, tinnitus, facial nerve palsy, otoliquorrhea or pseudorhinoliquorrhea, further investigations should be planned. The present article provides an overview of the necessary further diagnostic measures as well as the therapeutic options currently available for all forms of injury mentioned here.