Mlynski Gunter
Hospital and Outpatient Department for ENT, Head and Neck Surgery of the Ernst-Moritz-Arndt University, Greifswald, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2005;4:Doc07. Epub 2005 Oct 17.
These days, functional rhinosurgery is almost always taken to mean the improvement of nasal airflow. However, air should not only pass through the nose without obstruction. It needs to be warmed, moistened and filtered. This requires sufficient air/mucous membrane contact by spreading airflow over the entire turbinate region, as well as regulation of nasal airway resistance and the degree of turbulence within the nasal cycle. These factors are not considered enough in the concept of functional rhinosurgery.There cannot be a rigid concept for functional/aesthetic rhinosurgery, the surgical procedure must be adapted to the individual anatomy and pathology. In spite of this, it must be clear (based on evidence) which surgical steps can solve a functional problem of the nose in the long term. This paper cannot explain evidence-based treatment strategies to restore nasal respiratory function because in all branches of rhinosurgery, there are no prospective studies available with a sufficiently high sample size and long-term results objectivized by functional diagnosis. Studies available on septal surgery show better results for SP after Cottle than for SMR after Killian. However, the success rate of a 70 to 80% improvement in nasal breathing is not satisfactory. The incidence of postoperative, dry nasal mucosa is also too high. The task of rhinology is to stress the functional side of rhinosurgery more. This includes preoperative analysis of the causes of disturbed respiratory function using the functional diagnosis methods available, the use of evidence-based surgical techniques and postoperative, objectivized quality control. More research needs to be done on the physiology and pathophysiology of nasal airflow as well as on the effect of rhinosurgery on airflow. Numerical flow simulation can contribute greatly to this because the effects of shape changes on the flow can be visualized. Methods need to be developed which can be used for routine, diagnostic recording of warming, moistening and filtering of the respiratory air.
如今，功能性鼻外科手术几乎总是被认为意味着改善鼻气流。然而，空气不仅应无障碍地通过鼻腔。它还需要被加热、加湿和过滤。这需要通过将气流分散在整个鼻甲区域来实现足够的空气/黏膜接触，以及调节鼻气道阻力和鼻周期内的湍流程度。在功能性鼻外科手术的概念中，这些因素没有得到足够的重视。功能性/美容性鼻外科手术不能有一个刻板的概念，手术操作必须适应个体的解剖结构和病理情况。尽管如此，必须明确（基于证据）哪些手术步骤能够长期解决鼻子的功能性问题。本文无法解释恢复鼻呼吸功能的循证治疗策略，因为在鼻外科的所有分支中，都没有足够大样本量且通过功能诊断客观化长期结果的前瞻性研究。关于鼻中隔手术的现有研究表明，Cottle法行鼻中隔成形术（SP）的效果优于Killian法行鼻中隔黏膜下切除术（SMR）。然而，鼻呼吸改善70%至80%的成功率并不令人满意。术后鼻黏膜干燥的发生率也过高。鼻科学的任务是更加强调鼻外科手术的功能性方面。这包括使用现有的功能诊断方法对呼吸功能障碍的原因进行术前分析，采用循证手术技术以及术后进行客观化的质量控制。需要对鼻气流的生理学和病理生理学以及鼻外科手术对气流的影响进行更多研究。数值流模拟在这方面可以做出很大贡献，因为可以可视化形状变化对气流的影响。需要开发可用于常规诊断记录呼吸空气加热、加湿和过滤情况的方法。
