Subscribe to RSS
DOI: 10.1055/s-2007-966303
© Georg Thieme Verlag KG Stuttgart · New York
Chirurgie des Nasenseptums und der Nasenmuscheln
Publication History
Publication Date:
13 April 2007 (online)
![](https://www.thieme-connect.de/media/lro/2007S1/lookinside/thumbnails/10.1055-s-2007-966303-1.jpg)
Zusammenfassung
Im folgenden Referat wird die Nasenseptum- und Nasenmuschelchirurgie dargestellt. Nach einem Überblick über die anatomischen und physiologischen Grundlagen werden Indikationen zur Septumplastik herausgestellt, sowie das heutige operative Standardverfahren nach Cottle mit seinen Variationen skizziert. Im weiteren Verlauf wird auf spezielle Operationstechniken eingegangen, mit denen besondere Probleme im Bereich der Septumchirurgie gelöst oder erwünschte Effekte an der äußeren Nase erzielt werden können. Eine Darstellung der möglichen Komplikationen sowie die Langzeitergebnisse folgen. Hier sei aber darauf hingewiesen, dass die derzeitige Studienlage von rhinochirurgischen Eingriffen gerade im Hinblick auf höhere Evidenz-Level noch immer recht unbefriedigend ist. In einem weiteren Kapitel werden Techniken zum Septumperforationsverschluss vorgestellt und ihre Indikation im Vergleich zu der mittlerweile als Standardverfahren geltenden Brückenlappentechnik diskutiert. Der zweite Teil widmet sich der Nasenmuschelchirurgie. Nach einer erneuten Darstellung der anatomischen und physiologischen Grundlagen werden Indikationen zur Nasenmuschelchirurgie insbesondere vor dem Hintergrund verschiedener Operationstechniken diskutiert. Es folgt die Beschreibung der einzelnen Techniken sowie deren Nachsorge, Komplikationen und Langzeitergebnisse.
Schlüsselwörter
Nasenatmungsbehinderung - Septumchirurgie - Septumperforationsverschluss - Nasenmuschelchirurgie
Literatur
- 1 Cole P. The Respiratory Role of the Upper Airways. A Selective Clinical and Pathological Review. Saint Louis, Mittelohr; Mosby Year Book 1993: 164-165
- 2 Eccles R. Nasal Airflow in Health and Disease. Acta Otolaryngol. 2000; 120 580-595
- 3 Hanf G, Schierhorn K, Brunnée T, Matthias C, Kunkel G. Neuromodulation von Mastzellen in humaner Nasenschleimhaut. Histaminfreisetzung durch Neuropeptide in vitro. Allergologie. 1997; 20 121-127
- 4 Kamani T, Yilmaz T, Surucus Turan E, Brent K A. Scanning Electron Microscopy of Ciliae and Saccharine Test for Ciliary Function in Septal Deviations. Laryngoscope. 2006; 116 586-590
-
5 Mabry R L.
Chronic Nasal Obstruction. In: Gates G (Hrsg.) Current Therapy in Otorhinolarnygology, Head and Neck Surgery. Toronto; BC Decker 1987: 274-286 - 6 Matthias C, de Souza P, Merker H J. Morphological Investigations on the Epithelium and Subepithelial Connective Tissue of the Human Paranasal Sinus Mucosa. J Rhinol. 1997; 4 (2) 129-138
- 7 Wiesmiller K, Keck T, Rettinger G, Leiacker R, Dzida R, Lindemann I. Nasal Air Conditioning in Patients before and after Septoplasty with Bilateral Turbinoplasty. Laryngoscope. 2006; 116 (6) 890-894
- 8 Mlynski G. Wiederherstellende Verfahren bei gestörter Funktion der oberen Atemwege. Nasale Atmung. Laryngo-Rhino-Otol. 2005; 84 101-117
-
9 Maran A GD, Lund V J.
Nasal Anatomy. In: Maran AGD, Lund VJ (Hrsg.) Clinical Rhinology. Stuttgart; Thieme 1990: 5 - 10 McKinney P, Johnson P, Walloch J. Anatomy of the Nasal Hump. Plast Reconstr Surg. 1986; 77 404-407
- 11 Straatsma B R, Straatsma C R. The Anatomical Relationship of the Lateral Nasal Cartilage to the Nasal Bone and the Cartilaginous Nasal Septum. Plast. Reconstr Surg. 1951; 8 443-445
- 12 Converse J M. The Cartilaginous Structures of the Nose. Ann Otol Rhinol Laryngol. 1955; 64 220
- 13 O’Neal R M, Beil R J, Schlesinger J. Surgical Anatomy of the Nose. Clin Plast Surg. 1996; 23 (2) 195-222
- 14 Dingman R O, Natvig P. Surgical Anatomy in Aesthetic and Corrective Rhinoplasty. Plast Surg Clin. 1977; 4 111-114
-
15 Cauna N.
Blood and Nerve Supply of the Nasal Lining. In: Proctor DF, Andersen I (Hrsg.) The Nose, Upper Airways Physiology and the Athmospheric Environment. Amsterdam; Elsevier 1982: 45-69 - 16 Haight J SJ, Cole P. Site and Function of the Nasal Valve. Laryngoscope. 1983; 93 49-55
- 17 Bridger G P. Physiology of the Nasal Valve. Arch Otolaryngol. 1970; 92 543-553
- 18 Matthias C, de Suuza P, Merker H J. Electron Microscopic and Immunomorphological Investigations of the Mucosa of the Human Paranasal Sinuses. Eur. Arch Otorhinolaryngol. 1997; 254 230-235
- 19 Schierhorn K, Zang M, Matthias C, Kunkel G. Influence of Ozone and Nitrogen Dioxide upon Histamine and Interleukin Formation in a Human Nasal Mucosa System. Am J Respir Cell Mol Biol. 1999; 20 (5) 1013-1019
- 20 Yigit O, Akgul G, Alkan S, Uslu B. Dadas B. Changes Occurring in the Nasal Mucociliary Transport in Patients with One-Sided Septum Deviation. Rhinology. 2005; 43 257-260
- 21 Ganzer U, Arnold W. Leitlinien: Septumplastik. www.hno.org .
- 22 van Dishoek H AE, Leiden M D. The Part of the Valve and the Turbinates in Total Nasal Resistance. Int Rhinol. 1965; 3 19-26
- 23 Cottle J M. The Maxilla-Premaxillary Approach to Extensive Nasal Septum Surgery. Arch Otolaryngol Head Neck Surg. 1958; 68 301-306
- 24 Berger G, Gass S, Ophir T D. The Histopathology of the Hypertrophic Inferior Turbinate. Arch Otolarnygol Head Neck Surg. 2006; 132 (6) 588-594
- 25 Guyuron B, Uzzo C D, Scull H. A practical classification of septonasal deviation and an effective guide to septal surgery. Plast Reconstruct Surg. 1999; 104 (7) 2202-2212
- 26 Sciuto S, Bernadesci D. Exzision and Replacement of Nasal Septum in Aesthetic and Functional Nose Surgery: Setting Criteria and Establishing Indications. Rhinology. 1999; 37 74-79
- 27 Carroll T, Ladner K, Meyers A D. Alternative Surgical Dissection Techniques. Otolaryngol. Clin North Am. 2005; 38 (2) 397-411
- 28 Fjermedal O, Saunte C, Pedersen S. Septoplasty and/or Submucous Resection? 5 Years Nasal Septum Operation. J Laryngol Otol. 1988; 102 796-798
- 29 Gubisch W. The Extracorporeal Septumplasty: Technique to Correct Difficult Nasal Deformities. Plast Reconstr Surg. 1995; 95 (4) 672-681
- 30 Gubisch W. 20 Jahre mit der extrakorporalen Septumkorrektur. Laryngo-Rhino-Otol. 2002; 81 22-30
- 31 Hellmich S. Septumplastik. Laryngo-Rhino-Otol.. 1997; 76 663-666
- 32 Hwang P H, McLaughlin R B, Lanza D C, Kennedy D. Endoscopic Septoplasty: Indications, Technique, and Results. Otolaryngol. Head Neck Surg. 1999; 120 (5) 678-682
- 33 Kastenbauer E R. Eingriffe an der Nasenscheidewand. Laryngo-Rhino-Otol. 1997; 76 A93-A103
-
34 King H C, Mabry R L.
Surgical Approaches to Correcting Nasal Obstruction. In: King HC, Mabry RL (Hrsg.) A Practical Guide to the Management of Nasal and Sinus Disorders. Stuttgart; Thieme 1993: 94-106 - 35 Marschall H AH, Johnston M N, Jones N S. Principles of Septal Correction. J Laryngol Otol. 2004; 118 129-134
- 36 Masing H, Hellmich S. Erfahrungen mit konserviertem Knorpel bei Wiederaufbau der Nase. Z Laryngol Rhinol. 1968; 47 904-914
- 37 Mayer B, Henkes H. Mini-Septumplastik - für Funktion und Form. Larnygo-Rhino-Otol. 1990; 69 303-307
- 38 Newman M H. Surgery of the Nasal Septum. Clin Plast Surg. 1996; 23 (2) 271-279
- 39 Peacock MR. Mucous Resection of the Nasal Septum. J Laryngol Otol. 1981; 95 341-356
- 40 Pirsig W, Kern E B, Ferser T. Reconstruction of Anterior Nasal Septum: Back-to-Back Autogenous Ear Cartilage Graft. Laryngoscope. 2004; 114 627-638
-
41 Toriumi D M, Becker D G.
Septoplasty. In: Toriumi DM, Becker DG (Hrsg.) Rhinoplasty: Dissection Manual. Philadelphia; Lippincott 1999: 31 - 42 Schultz-Coulon H J. Anmerkungen zur Septumplastik. HNO. 2006; 54 59-70
- 43 Stockstead V P, Vase P. Perforations of the Nasal Septum Following Operative Procedures. Rhinology. 1978; 16 123-138
- 44 Lawson W, Kessler S, Biller J F. Unusual and Fatal Complications of Rhinoplasty. Arch Otolaryngol. 1983; 109 164-169
- 45 Miller T. Immediate Postoperative Complications of Septoplasties and Septorhinoplasties. Trans Pac Coast Ophthalmol Soc. 1976; 57 201-205
- 46 Schwab J A, Pirsig W. Complications of Septal Surgery. Facial Plast Surg. 1997; 13 (1) 3-14
- 47 Boenisch M, Tamas H, Nolst-Trenité G J. Influence of Polydioxanone Foil on growing Septal Cartilage after Surgery in an Animal Model: New Aspects of Cartilage Healing and Regeneration. Arch Facial Plast Surg.. 2003; 5 (4) 316-319
- 48 Raynor E M. Powered endoscopic septoplasty for septal deviations and isolated spurs. Arch Facial Plast Surg. 2005; 7 (6) 410-412
- 49 Rettinger G. Autogene und allogene Knorpeltransplantate in der Kopf- und Halschirurgie. Eur Arch Oto-Rhino-Laryngol Suppl. 1992; 1 127-162
- 50 Holt G R, Garner E T, McLarey D. Postoperative Sequelae and Complications of Rhinoplasty. Otolaryngol. Clin North Am. 1987; 20 853-876
- 51 Boccieri A, Pascali M. Septal Crossbar Graft for the Correction of the Crooked Nose. Plast Reconstr Surg. 2003; 111 (2) 629-638
- 52 Foda H MT. The Role of Septal Surgery in Management of the Deviated Nose. Plast Reconstr Surg. 2005; 115 (2) 406-415
- 53 Tzadik A, Gilbert S E, Sade J. Complications of Submucous Resections of the Nasal Septum. Arch Otorhinlaryngol. 1988; 245 74-76
- 54 Pirsig W, Schäfer J. The Importance of Antibiotic Treatment in Functional and Aesthetic Rhinosurgery. Rhinology Suppl. 1998; 4 3-11
- 55 Weimert TA, Yoder M G. Antibiotics and Nasal Surgery. Laryngoscope. 1980; 90 667-672
- 56 Eschelmann L T, Schleunig A J, Brummett R E. Prophylactic Antibiotics and Otolaryngologic Surgery. A Double Blind Study. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75 387-394
- 57 Huizing E H. The Management of Septal Abscesses. Facial Plast Surg. 1986; 3 (4) 243-252
- 58 Bewarder S, Pirsig W. Long-Term Results of Submucous Septal Resection. Laryngol Rhinol. 1978; 57 922-931
- 59 Campbell J B, Watson M G, Shenoi P M. The Role of Intranasal Splints in the Prevention of Postoperative Adhesions. J Laryngol Otol. 1987; 101 1140-1143
- 60 Shone G R, Clegg R T. Nasal Adhesions. J Laryngol Otol. 198; 101 555-557
- 61 White A, Murray J A. Intransal Adhesion Formation Following Surgery for Chronic Nasal Obstruction. Clin Otolaryngol. 1988; 13 139-143
- 62 Konstantinidis I, Triaridis S, Triaridis A, Karagianidis K, Kontzoglou G. Long-Term Results Following Nasal Septum Surgery: Focus on Patients’ Satisfaction. Auris Nasus Larynx. 2005; 32 369-374
- 63 Stewart M G, Smith T L, Weaver E M, Witsell DL, Yueah B, Hannley M T, Johnson J T. Outcomes after Nasal Septoplasty: Results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) Study. Otolaryngol Head Neck Surg. 2004; 130 283-290
- 64 Pfaar O, Hüttenbrink K B, Hummel T. Assessment of Olfactory Function after Septoplasty: A Longitudinal Study. Rhinology. 2004; 43 195-199
- 65 Stevens C N, Stevens M G. Quantitative Effects of Nasal Surgery on Olfaction. Am J Otolaryngol. 1985; 6 264-267
- 66 Kimmelmann C P. The Risk of Olfaction from Nasal Surgery. Laryngoscope. 1994; 104 981-988
- 67 Rowe-Jones J. Nasal Surgery: Evidence of Efficacy. Septal and Turbinate Surgery. Rhinology. 2004; 42 (4) 248-250
- 68 Schultz-Coulon H J. Experiences with the bridge-flap technique for the repair of large nasal septal perforations. Rhinology. 1994; 32 25-33
- 69 Schultz-Coulon H J. Three layer repair of nasoseptal defects. Otolaryngol Head Neck Surg. 2005; 132 (2) 213-217
- 70 Kridel R WH. Septal perforation repair. Otolaryngol Clin North Am. 1999; 32 (4) 695-724
- 71 Woolford T J, Jones N S. Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft. J Laryngol Otol. 2001; 115 22-25
- 72 Fairbanks D N. Closure of nasal septal perforations. Arch Otolaryngol. 1980; 106 (8) 509-513
- 73 Newton J R, White P S, Lee M SW. Nasal septal perforation repair using open septoplasty and unilateral bipedicled flaps. J Laryngol Otol. 2003; 117 52-55
- 74 Stoor P, Grenman R. Bioactive glass and turbinate flaps in the repair of nasal septal perforations. Ann Otol Rhinol Laryngol. 2004; 113 655-661
- 75 Meyer R, Berghaus A. Closure of perforations of the septum including a single session method for large defects. Head Neck Surg. 1983; 8 390-400
-
76 Kastenbauer E R, Masing H.
Chirurgie der inneren Nase, Versorgung von Nasenverletzungen. In: Naumann HH (Hrsg.) Kopf- und Halschirurgie, Band 1, Teil 1. Stuttgart, New York; Georg Thieme Verlag 1985: 403-408 - 77 Osma Ü, Cüreoglu S, Akbulut N. The results of septal botton insertion in the management of nasal septal perforation. J Laryngol Otol. 1999; 113 823-824
- 78 Federspil P A, Schneider M. Der individuell angepasste Nasenscheidewandobturator. Laryngo-Rhino-Otol. 2006; 85 323-325
- 79 Romo 3rd T, Foster C A, Korovin G S. Repair of nasal septal perforation utilizing the midface degloving technique. Arch Otolaryngol. 1988; 114 739-742
- 80 Berghaus A, Jovanovic S. Technique and indications of extended sublabial rhinotomy („midfacial degloving”). Rhinology. 1991; 29 (2) 105-110
- 81 Paloma V, Samper A, Cervera-Pas F. Surgical technique for reconstruction of the nasal septum: the pericranial flap. Head Neck. 2000; 22 (1) 90-94
- 82 Fukuta K, Avery C, Jachson Y T. Long term complications of the galea-frontalis myofascial flap in craniofacial surgery. Eur J Plast Surg. 1993; 16 174-176
- 83 Argenta L C, Friedman RJ, Dingman RO, Duus E C. The versatility of pericranial flaps. Plast Reconstr Surg. 1985; 76 (5) 695-702
- 84 Cook P R, Begegni A, Cullen Bryant W, Davis W E. Effect of Partial Middle Turbinectomy on Nasal Airflow and Resistance. Otolaryngol Head Neck Surg. 1995; 113 (4) 413-419
- 85 Chang C W, Ries W R. Surgical Treatment of the Inferior Turbinate: New Techniques. Current Opin Otolaryngol Head Neck Surg. 2004; 12 (1) 53-57
- 86 Cavaliere M, Mottola G, Imma M. Comparison of the Effectiveness and Safety of Radiofrequency Turbinoplasty and Traditional Surgical Technique in Treatment of Inferior Turbinate Hypertrophy. Otolaryngol Head Neck Surg. 2005; 133 (6) 972-978
- 87 Hoffmann P, Rudert H. CO2- und Nd-YAG-Laser: Vergleich zweier Verfahren zur Nasenmuschelreduktion. Arch Otorhinolaryngol Suppl. 1992; 2 116-117
- 88 Hopf J UG, Hopf M, Koffroth-Becker C. Minimal invasive Chirurgie obstruktiver Erkrankungen der Nase mit dem Diodenlaser. Laser Med. 1999; 14 (4) 106-115
- 89 Janda P, Sroka R, Baumgartner R, Grevers G, Leunig A. Laser Treatment of Hyperplastic Inferior Nasal Turbinates: A Review. Lasers Surg Med. 2001; 28 (5) 404-413
- 90 Jovanovic S, Dokic D. Nd:YAG-Laserchirurgie in der Behandlung der allergischen Rhinitis. Laryngo-Rhino-Otol. 1995; 74 419-422
- 91 Kezirian J, Powell N B, Riley R W, Hester I E. Incidence of Complications of Radiofrequency Treatment of the Upper Airway. Laryngoscope. 2005; 115 (7) 1298-1304
- 92 Krespi Y P, Slatkine M. Nd:YAG-Fiber Delivery System for Submucosal Interstitial Coagulation of Nasal Turbinates. Laser Surg Med. 1994; 15 217-248
- 93 Lippert B M, Werner J A. Behandlung der hyperplastischen unteren Nasenmuscheln. HNO. 2000; 48 (4) 267-274
- 94 Lippert B M, Werner J A. Long-Term Results after Laser Turbinektomy. Laser Surg Med. 1998; 22 126-134
- 95 Talmon Y, Samet A, Gilbey P. Total inferior Turbinectomy: Operative Results and Technique. Ann Otol Rhinol Laryngol. 2000; 109 1117-1119
- 96 Porter M W, Hales N W, Nease C I, Krempel G A. Long-Term Results of Inferior Turbinate Hypertrophy with Radiofrequency Treatment. A New Standard of Care?. Laryngoscope. 2006; 116 (4) 554-557
- 97 De la Chaux R, Dreher A, Clemens C, Rasp G, Leunig A. Respiratory Sleep Disorders: Benefit from Laser-Surgery. MMW. 2004; 146 (47) 49-50
-
98 Oswal V, Hopf J UG, Hopf M, Scherer H.
Endonasal Laser Applications. In: Oswal V, Remacle M (Hrsg.) Principles and Practice of Lasers in Otorhinolaryngology and Head and Neck Surgery. The Hague, Holland; Kugler 2002: 163 -
99 Oswal V, Hopf J UG, Hopf M, Scherer H.
Endonasal Laser Applications. In: Oswal V, Remacle M (Hrsg.) Principles and Practice of Lasers in Otorhinolaryngology and Head and Neck Surgery. The Hague, Holland; Kugler 2002: 221
Prof. Dr. med. Christoph Matthias
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde
Klinikum Großhadern
Marchioninistraße 15
81377 München
Email: Christoph.Matthias@med.uni-muenchen.de