Weber R K
Leiter der Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, HNO-Klinik, Städtisches Klinikum Karlsruhe.
Laryngorhinootologie. 2009 May;88 Suppl 1:S139-55. doi: 10.1055/s-0028-1119504. Epub 2009 Apr 7.
Despite nasal packing is not necessary after functional endoscopic sinus surgery according to modern surgical techniques, nasal packing is a necessary tool in ENT. Therefore the state of the art regarding indications, benefit and risk of nasal packing and stents are given. In endonasal surgery only those conventional nasal packing materials should be used--if necessary--which have a smooth surface and minimize mucosal damage, potential worsening of wound healing and negative impact on patient comfort. Modern FESS implicates modern types of nasal packing, which leave the old concept of performing pressure and occupying space. So called hemostatic/resorbable materials are a first step in this direction. But they are critical, because these materials cause increased synechiae and sometimes foreign body reactions because of incorporation into the mucosa. Occlusion of the nose via simple taping of the nasal entrance is a simple and very effective method to create a moist environment to optimize endonasal wound healing or management of a dry nose. Stenting of the frontal sinus is only recommended if it is not possible to realize a sufficiently wide, physiologically formed and in large areas with mucosa covered frontal sinus outflow tract.
尽管根据现代手术技术,功能性鼻内镜鼻窦手术后无需鼻腔填塞,但鼻腔填塞仍是耳鼻喉科的一种必要手段。因此,本文给出了鼻腔填塞和支架的适应症、益处及风险的最新情况。在内鼻手术中,如有必要,应仅使用那些表面光滑、能将黏膜损伤、伤口愈合潜在恶化及对患者舒适度的负面影响降至最低的传统鼻腔填塞材料。现代功能性鼻内镜鼻窦手术意味着采用新型鼻腔填塞材料,摒弃了以往施加压力和占据空间的观念。所谓的止血/可吸收材料是朝着这个方向迈出的第一步。但它们存在问题,因为这些材料会因融入黏膜而导致粘连增加,有时还会引发异物反应。通过简单粘贴鼻口来堵塞鼻腔是一种简单且非常有效的方法,可营造湿润环境,以优化内鼻伤口愈合或处理鼻干问题。仅在无法实现足够宽、生理形态良好且大面积有黏膜覆盖的额窦流出道时,才建议对额窦进行支架置入。