HNO
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The role of ENT surgery in the management of anterior skull base defects has become increasingly important in recent years. Transnasal endoscopic surgical techniques and intraoperative navigation enable a minimally invasive approach in a large proportion of patients, thus helping to avoid morbidity typically associated with neurosurgical subfrontal approaches. Whereas traffic accidents and sport injuries are the main causes of anterior skull base trauma in the civilian setting, penetrating injuries caused by gunshots and improvised explosive devices (IEDs) play an increasing role in the military arena and terroristic attacks. ⋯ Major injuries, involving the midface or neurocranium, require an interdisciplinary approach including maxillofacial surgeons and neurosurgeons. A centre for head and neck medicine and surgery is an ideal setting for such interdisciplinary teams to provide appropriate care for patients with complex skull base trauma in cooperation with ophthalmologists and interventional neuoradiologists. The present article describes concepts for the treatment of anterior skull base trauma established at the head, neck and skull base center at the Ulm military hospital in Germany.
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Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. ⋯ For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.
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Although diseases of the paranasal sinuses have a relatively homogeneous clinical presentation, their causes can vary considerably. Radiological imaging only became relevant in paranasal sinus diagnostics following the introduction of cross-sectional imaging. ⋯ Particularly in acute inflammatory diseases as well as traumatic lesions, imaging is essential in preoperative planning and postoperative control. The article gives a detailed description of options in radiologic imaging of the paranasal sinuses.
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After endotracheal intubation patients most frequently report pharyngolaryngeal complaints. Subsequent impairment of vocal performance might lead to general impairment of communication and job-related performance. ⋯ Knowledge of the pathophysiological aspects and causative factors associated with laryngopharyngeal morbidity are essential cornerstones of quality assurance in perioperative respiratory tract management. This review describes the effects of endotracheal intubation and application of larynx masks in relation to laryngeal morbidity.
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Practice Guideline
[Guidelines for the management of sore throat from the German Society of General Practice and Family Medicine].
The aim of this guideline is to propose a diagnostic and therapeutic approach to manage sore throat in ambulatory care. ⋯ Sore throat is mostly a short, self-limiting infection. Accurate etiologic diagnosis is generally not possible. Routine antibiotic treatment of sore throat for the prevention of complications is currently not indicated. The effect of antibiotics on symptoms and duration of disease is, at best, moderate. It is more pronounced in patients with typical clinical symptoms and signs of pharyngitis caused by group A streptococci (GAS) and slightly more pronounced again in cases of additional positive throat swab for GAS. An algorithm for decision-making is proposed. Rapid testing for streptococcal antigen or a culture for GAS is only recommended if the result is likely to influence therapeutic decision-making. Patients with more severe illness and signs of GAS pharyngitis can be given antibiotic therapy for symptomatic relief.