Download PDF
Laryngorhinootologie 2007; 86: 1-14
DOI: 10.1055/s-2007-966303
Funktionelle und ästhetische Chirurgie der Nase

© Georg Thieme Verlag KG Stuttgart · New York

Chirurgie des Nasenseptums und der Nasenmuscheln

C.  Matthias1
  • 1Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum Großhadern und Innenstadt, Ludwigs-Maximilians-Universität München (Direktor: Prof. Dr. med. A. Berghaus)
Further Information

Publication History

Publication Date:
13 April 2007 (online)

Also available at
    Permissions and Reprints

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
    Google Scholar
  • 2 Eccles R. Nasal Airflow in Health and Disease.  Acta Otolaryngol. 2000;  120 580-595
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 8 Mlynski G. Wiederherstellende Verfahren bei gestörter Funktion der oberen Atemwege. Nasale Atmung.  Laryngo-Rhino-Otol. 2005;  84 101-117
    PubMedGoogle Scholar
  • 9 Maran A GD, Lund V J. Nasal Anatomy. In: Maran AGD, Lund VJ (Hrsg.) Clinical Rhinology. Stuttgart; Thieme 1990: 5
    Google Scholar
  • 10 McKinney P, Johnson P, Walloch J. Anatomy of the Nasal Hump.  Plast Reconstr Surg. 1986;  77 404-407
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 12 Converse J M. The Cartilaginous Structures of the Nose.  Ann Otol Rhinol Laryngol. 1955;  64 220
    CrossrefPubMedGoogle Scholar
  • 13 O’Neal R M, Beil R J, Schlesinger J. Surgical Anatomy of the Nose.  Clin Plast Surg. 1996;  23 (2) 195-222
    PubMedGoogle Scholar
  • 14 Dingman R O, Natvig P. Surgical Anatomy in Aesthetic and Corrective Rhinoplasty.   Plast Surg Clin. 1977;  4 111-114
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 16 Haight J SJ, Cole P. Site and Function of the Nasal Valve.  Laryngoscope. 1983;  93 49-55
    PubMedGoogle Scholar
  • 17 Bridger G P. Physiology of the Nasal Valve.  Arch Otolaryngol. 1970;  92 543-553
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 21 Ganzer U, Arnold W. Leitlinien: Septumplastik. www.hno.org . 
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 23 Cottle J M. The Maxilla-Premaxillary Approach to Extensive Nasal Septum Surgery.  Arch Otolaryngol Head Neck Surg. 1958;  68 301-306
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 27 Carroll T, Ladner K, Meyers A D. Alternative Surgical Dissection Techniques.  Otolaryngol. Clin North Am. 2005;  38 (2) 397-411
    CrossrefPubMedGoogle Scholar
  • 28 Fjermedal O, Saunte C, Pedersen S. Septoplasty and/or Submucous Resection? 5 Years Nasal Septum Operation.  J Laryngol Otol. 1988;  102 796-798
    CrossrefPubMedGoogle Scholar
  • 29 Gubisch W. The Extracorporeal Septumplasty: Technique to Correct Difficult Nasal Deformities.  Plast Reconstr Surg. 1995;  95 (4) 672-681
    CrossrefPubMedGoogle Scholar
  • 30 Gubisch W. 20 Jahre mit der extrakorporalen Septumkorrektur.  Laryngo-Rhino-Otol. 2002;  81 22-30
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Hellmich S. Septumplastik.  Laryngo-Rhino-Otol.. 1997;  76 663-666
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 33 Kastenbauer E R. Eingriffe an der Nasenscheidewand.  Laryngo-Rhino-Otol. 1997;  76 A93-A103
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 35 Marschall H AH, Johnston M N, Jones N S. Principles of Septal Correction.  J Laryngol Otol. 2004;  118 129-134
    PubMedGoogle Scholar
  • 36 Masing H, Hellmich S. Erfahrungen mit konserviertem Knorpel bei Wiederaufbau der Nase.   Z Laryngol Rhinol. 1968;  47 904-914
    PubMedGoogle Scholar
  • 37 Mayer B, Henkes H. Mini-Septumplastik - für Funktion und Form.  Larnygo-Rhino-Otol. 1990;  69 303-307
    PubMedGoogle Scholar
  • 38 Newman M H. Surgery of the Nasal Septum.  Clin Plast Surg. 1996;  23 (2) 271-279
    PubMedGoogle Scholar
  • 39 Peacock MR. Mucous Resection of the Nasal Septum.  J Laryngol Otol. 1981;  95 341-356
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 41 Toriumi D M, Becker D G. Septoplasty. In: Toriumi DM, Becker DG (Hrsg.) Rhinoplasty: Dissection Manual. Philadelphia; Lippincott 1999: 31
    Google Scholar
  • 42 Schultz-Coulon H J. Anmerkungen zur Septumplastik.  HNO. 2006;  54 59-70
    CrossrefPubMedGoogle Scholar
  • 43 Stockstead V P, Vase P. Perforations of the Nasal Septum Following Operative Procedures.  Rhinology. 1978;  16 123-138
    PubMedGoogle Scholar
  • 44 Lawson W, Kessler S, Biller J F. Unusual and Fatal Complications of Rhinoplasty.  Arch Otolaryngol. 1983;  109 164-169
    PubMedGoogle Scholar
  • 45 Miller T. Immediate Postoperative Complications of Septoplasties and Septorhinoplasties.  Trans Pac Coast Ophthalmol Soc. 1976;  57 201-205
    PubMedGoogle Scholar
  • 46 Schwab J A, Pirsig W. Complications of Septal Surgery.   Facial Plast Surg. 1997;  13 (1) 3-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 48 Raynor E M. Powered endoscopic septoplasty for septal deviations and isolated spurs.   Arch Facial Plast Surg. 2005;  7 (6) 410-412
    CrossrefPubMedGoogle Scholar
  • 49 Rettinger G. Autogene und allogene Knorpeltransplantate in der Kopf- und Halschirurgie.  Eur Arch Oto-Rhino-Laryngol Suppl. 1992;  1 127-162
    PubMedGoogle Scholar
  • 50 Holt G R, Garner E T, McLarey D. Postoperative Sequelae and Complications of Rhinoplasty.  Otolaryngol. Clin North Am. 1987;  20 853-876
    PubMedGoogle Scholar
  • 51 Boccieri A, Pascali M. Septal Crossbar Graft for the Correction of the Crooked Nose.  Plast Reconstr Surg. 2003;  111 (2) 629-638
    CrossrefPubMedGoogle Scholar
  • 52 Foda H MT. The Role of Septal Surgery in Management of the Deviated Nose.  Plast Reconstr Surg. 2005;  115 (2) 406-415
    CrossrefPubMedGoogle Scholar
  • 53 Tzadik A, Gilbert S E, Sade J. Complications of Submucous Resections of the Nasal Septum.  Arch Otorhinlaryngol. 1988;  245 74-76
    PubMedGoogle Scholar
  • 54 Pirsig W, Schäfer J. The Importance of Antibiotic Treatment in Functional and Aesthetic Rhinosurgery.  Rhinology Suppl. 1998;  4 3-11
    PubMedGoogle Scholar
  • 55 Weimert TA, Yoder M G. Antibiotics and Nasal Surgery.  Laryngoscope. 1980;  90 667-672
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 57 Huizing E H. The Management of Septal Abscesses.  Facial Plast Surg. 1986;  3 (4) 243-252
    PubMedGoogle Scholar
  • 58 Bewarder S, Pirsig W. Long-Term Results of Submucous Septal Resection.  Laryngol Rhinol. 1978;  57 922-931
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 60 Shone G R, Clegg R T. Nasal Adhesions.  J Laryngol Otol. 198;  101 555-557
    PubMedGoogle Scholar
  • 61 White A, Murray J A. Intransal Adhesion Formation Following Surgery for Chronic Nasal Obstruction.  Clin Otolaryngol. 1988;  13 139-143
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 64 Pfaar O, Hüttenbrink K B, Hummel T. Assessment of Olfactory Function after Septoplasty: A Longitudinal Study.  Rhinology. 2004;  43 195-199
    PubMedGoogle Scholar
  • 65 Stevens C N, Stevens M G. Quantitative Effects of Nasal Surgery on Olfaction.  Am J Otolaryngol. 1985;  6 264-267
    CrossrefPubMedGoogle Scholar
  • 66 Kimmelmann C P. The Risk of Olfaction from Nasal Surgery.  Laryngoscope. 1994;  104 981-988
    PubMedGoogle Scholar
  • 67 Rowe-Jones J. Nasal Surgery: Evidence of Efficacy. Septal and Turbinate Surgery.  Rhinology. 2004;  42 (4) 248-250
    PubMedGoogle Scholar
  • 68 Schultz-Coulon H J. Experiences with the bridge-flap technique for the repair of large nasal septal perforations.  Rhinology. 1994;  32 25-33
    PubMedGoogle Scholar
  • 69 Schultz-Coulon H J. Three layer repair of nasoseptal defects.  Otolaryngol Head Neck Surg. 2005;  132 (2) 213-217
    CrossrefPubMedGoogle Scholar
  • 70 Kridel R WH. Septal perforation repair.  Otolaryngol Clin North Am. 1999;  32 (4) 695-724
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 72 Fairbanks D N. Closure of nasal septal perforations.  Arch Otolaryngol. 1980;  106 (8) 509-513
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 78 Federspil P A, Schneider M. Der individuell angepasste Nasenscheidewandobturator.  Laryngo-Rhino-Otol. 2006;  85 323-325
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 80 Berghaus A, Jovanovic S. Technique and indications of extended sublabial rhinotomy („midfacial degloving”).  Rhinology. 1991;  29 (2) 105-110
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 83 Argenta L C, Friedman RJ, Dingman RO, Duus E C. The versatility of pericranial flaps.  Plast Reconstr Surg. 1985;  76 (5) 695-702
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 87 Hoffmann P, Rudert H. CO2- und Nd-YAG-Laser: Vergleich zweier Verfahren zur Nasenmuschelreduktion.  Arch Otorhinolaryngol Suppl. 1992;  2 116-117
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 90 Jovanovic S, Dokic D. Nd:YAG-Laserchirurgie in der Behandlung der allergischen Rhinitis.  Laryngo-Rhino-Otol. 1995;  74 419-422
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 93 Lippert B M, Werner J A. Behandlung der hyperplastischen unteren Nasenmuscheln.  HNO. 2000;  48 (4) 267-274
    CrossrefPubMedGoogle Scholar
  • 94 Lippert B M, Werner J A. Long-Term Results after Laser Turbinektomy.  Laser Surg Med. 1998;  22 126-134
    CrossrefPubMedGoogle Scholar
  • 95 Talmon Y, Samet A, Gilbey P. Total inferior Turbinectomy: Operative Results and Technique.  Ann Otol Rhinol Laryngol. 2000;  109 1117-1119
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar

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