Nasenmuschelchirurgie und „Empty Nose” Syndrom

M. O. Scheithauer

doi:10.1055/s-0029-1246126

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2010; 89: S79-S102
DOI: 10.1055/s-0029-1246126

Funktionelle Rhinochirurgie

Nasenmuschelchirurgie und „Empty Nose” Syndrom

Surgery of the Turbinates and “Empty Nose” SyndromeM. O. Scheithauer¹

¹HNO-Klinik und Poliklinik des Universitätsklinikums Ulm. (Ärztlicher Direktor: Professor Dr. med. G. Rettinger)

Abstract

Zusammenfassung

Die Indikation zur chirurgischen Reduktion der unteren und/oder mittleren Nasenmuscheln ist nach erfolgloser Therapie mit topischen Kortikoiden, Antihistaminika oder systemischer Immuntherapie gegeben. Das angestrebte Ziel ist eine an die individuellen anatomischen Verhältnisse angepasste Volumenreduktion des Nasenmuschelkörpers unter größtmöglicher Schonung der Schleimhaut. Die postoperative Erhaltung des Funktionsorgans Nasenmuschel ist für die Klimatisierung, die Aerodynamik und die Reinigung der Atemluft von entscheidender Bedeutung, da eine unbehinderte Nasenatmung Lebensqualität bedeutet. Die zahlreichen in der Literatur vorgestellten Operationstechniken zur Nasenmuschelreduktion weisen darauf hin, dass eine ideale Standardtechnik bis heute nicht entwickelt wurde. Sowohl die genannte Vielzahl der chirurgischen Techniken als auch die unbefriedigende Studienlage erschweren die objektive Bewertung der Verfahren. Der Mangel an prospektiven, randomisierten, vergleichenden Studien mit hoher Fallzahl und funktionsdiagnostisch geprüften Langzeitergebnissen begründet die Schwierigkeit, evidenzbasierte Operationsmethoden zu empfehlen. Dennoch ist anhand der gegenwärtigen Studienlage die anteriore Turbinoplastik als das Verfahren der Wahl zur chirurgischen Reduktion der Nasenmuscheln anzusehen und zu bewerten. Eine Missachtung des Funktionserhalts der Nasenmuscheln kann zu einer sekundär atrophen Rhinitis führen, aus der sich ein „empty nose” Syndrom entwickeln kann. Veränderungen der intranasalen Luftströmung können zu erheblichen Störungen der Atemluftklimatisierung führen und über eine Senkung des Atemwegswiderstandes auch pulmonale Probleme bedingen. Die im Rahmen einer aktuellen klinischen Studie über das Klimatisierungsverhalten und die Luftströmung in vivo bei „empty nose” Patienten gewonnen Erfahrungen werden präsentiert.

Abstract

Surgery of the Turbinates and “Empty Nose” Syndrome

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The wanted goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings and simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose they take care of climatisation, moistening and cleaning of the inhaled air. Thus a free nasal breathing means a decent quality of life as well. Regarding the multitude of different surgical techniques we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover there is a lack of prospective and comparable long-term studies which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation and therefore it is the method of choice today. Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The “empty nose” syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interferes with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in “empty nose” patients are presented.

Schlüsselwörter

Untere Nasenmuschel - mittlere Nasenmuschel - operative Nasenmuschelreduktion - Laserchirurgie - Nasenmuschelchirurgie im Kindesalter - „empty nose” Syndrom

Key words

Inferior turbinate - middle turbinate - turbinate surgery - laser surgery - pediatric surgery of turbinates - “empty nose” syndrome

Full Text

References

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Korrespondenzadresse

Dr. med. Marc Oliver Scheithauer

HNO-Klinik und Poliklinik

Universitätsklinik Ulm

Frauensteige 12

89075 Ulm

Email: marc.scheithauer@uniklinik-ulm.de