Rudes M, Schwan F, Klass F, Gassner H G
The Finesse Center for Facial Plastic Surgery/ENT, Froehliche-Tuerkenstraße 8, 93047, Regensburg, Germany.
Department of Otorhinolaryngology and Head and Neck Surgery, University of Regensburg, Regensburg, Germany.
HNO. 2018 Feb;66(2):111-117. doi: 10.1007/s00106-017-0450-9.
Turbinate surgery is an important adjunct to functional and cosmetic rhinoplasty. Many studies have analyzed the effects of various mucosal-sparing techniques, such as radiofrequency, laser, shaver, and others. These techniques, however, result in the destruction of the submucosal tissue of the turbinate. The goal of this study was to determine whether excellent functional outcome could be achieved with techniques sparing both the mucosa and submucosa from destruction when addressing the turbinates in rhinoplasty surgery.
A prospective single-surgeon clinical study analyzing submucous resection of turbinate bone without destruction of the submucosa or mucosa in patients undergoing functional-esthetic rhinoplasty was performed. In all, 122 patients (47 men, 75 women, average age: 32.1 years, range: 16-69 years) were eligible for the study. The functional outcome was measured prospectively using the Nasal Obstruction Symptom Evaluation (NOSE) score. Occurrence of complications was documented.
Of over 1000 surgical patients, 307 candidates fulfilled multiple selection criteria and were entered in a rhinoplasty database. The surveys sufficient for the present study were completed by 122 of 307 patients (39.7%), of whom 91 patients reported improvement, 14 patients reported no subjective change, and 12 patients reported minimal worsening of nasal breathing. Overall, postoperative function was excellent (preoperative vs. postoperative NOSE score 47.5 vs. 20.1, p < 0.001). A large proportion of patients reporting worsening of symptoms (50%) were diagnosed with decongestant nasal spray abuse. Specific complications such as bleeding, foul drainage, dryness, and crusting were not reported.
All function-bearing structures of the inferior nasal turbinates, mucosa, and submucosa can be fully preserved without impairment of functional outcome during rhinoplasty. The technique of selective submucous bone resection is as an excellent alternative for patients undergoing rhinoplasty for concomitant treatment or prevention of nasal obstruction.
鼻甲手术是功能性和美容性鼻整形术的重要辅助手段。许多研究分析了各种保留黏膜技术的效果，如射频、激光、刨削器等。然而，这些技术会导致鼻甲黏膜下组织的破坏。本研究的目的是确定在鼻整形手术中处理鼻甲时，采用能使黏膜和黏膜下组织均免于破坏的技术是否能实现良好的功能效果。
进行了一项前瞻性单术者临床研究，分析在接受功能性美容性鼻整形术的患者中不破坏黏膜或黏膜下组织的鼻甲骨质黏膜下切除术。共有122例患者（47例男性，75例女性，平均年龄：32.1岁，范围：16 - 69岁）符合该研究条件。前瞻性地使用鼻阻塞症状评估（NOSE）评分来衡量功能效果。记录并发症的发生情况。
在超过1000例手术患者中，307名候选者符合多项选择标准并被纳入鼻整形数据库。307例患者中的122例（39.7%）完成了本研究所需的调查，其中91例患者报告症状改善，14例患者报告无主观变化，12例患者报告鼻呼吸稍有恶化。总体而言，术后功能良好（术前与术后NOSE评分分别为47.5和20.1，p < 0.001）。报告症状恶化的患者中很大一部分（50%）被诊断为滥用减充血剂鼻喷雾剂。未报告出血、异味引流、干燥和结痂等特定并发症。
在鼻整形术中，下鼻甲所有具有功能的结构，包括黏膜和黏膜下组织，均可完全保留而不影响功能效果。选择性黏膜下骨质切除术是接受鼻整形术以同时治疗或预防鼻阻塞患者的一种极佳选择。
