Baumann I
Universitäts-HNO-Klinik, Im Neuenheimer Feld 400, 69120 Heidelberg.
Laryngorhinootologie. 2010 Jun;89(6):373-84. doi: 10.1055/s-0030-1252057. Epub 2010 Jun 10.
Septoplasty is one of the most frequently performed otorhinolaryngological procedures which might be very challenging for the surgeon. An accurate preoperative diagnosis of pathologies of the septum in the context of the nasal cavity is essential for the success of surgery. Intraoperative visualization through microscope or endoscope is very helpful for the surgeon and for the training of the residents. The modern technique of septoplasty with the phases of approach, mobilization, resection/repositioning and reconstruction/fixation is presented. Furthermore, the extracorporeal septoplasty in extreme deviations of the septum and alternative techniques for use in cases with limited pathologies as well as aspects of septoplasty in children are discussed. As particularly pathologies of the caudal septum are responsible for failures of septal surgery, some special problems of this region such as the vertical fracture of the caudal septum, the lack of caudal septum or anterior convexities of the cartilaginous septum are argued. Finally, advices for the management of intra-and postoperative complications are given.
鼻中隔成形术是最常开展的耳鼻喉科手术之一,对外科医生来说可能极具挑战性。在鼻腔环境中准确术前诊断鼻中隔病变对于手术成功至关重要。通过显微镜或内窥镜进行术中可视化操作对外科医生及住院医师培训非常有帮助。本文介绍了鼻中隔成形术的现代技术,包括入路、松动、切除/复位以及重建/固定阶段。此外,还讨论了鼻中隔极度偏曲时的体外鼻中隔成形术、病变有限情况下的替代技术以及儿童鼻中隔成形术的相关方面。由于鼻中隔尾端病变尤其会导致鼻中隔手术失败,本文探讨了该区域的一些特殊问题,如鼻中隔尾端垂直骨折、鼻中隔尾端缺失或软骨性鼻中隔前凸等。最后,给出了术中及术后并发症处理的建议。