Sommer F, Hoffmann T, Lindemann J, Hahn J, Theodoraki M-N
Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
HNO. 2020 Aug;68(8):573-580. doi: 10.1007/s00106-020-00870-9.
Until the 1990s, radical sinus surgery was considered a standard procedure for maxillary sinus diseases, but it is no longer favored due to the high morbidity. Today, functional endoscopic sinus surgery (FESS) is considered the gold standard in sinus surgery. Modifications of surgical approaches also allow access to regions of the maxillary sinus that were previously difficult to reach. Depending on anatomy and pathology, different methods for widening the maxillary ostium can be selected. In type I sinusotomy, the natural ostium is widened dorsally by a maximum of 1 cm. Sinusotomy type II involves widening the natural ostium up to a maximum diameter of 2 cm. In sinusotomy type III, the natural ostium is widened dorsally to the posterior wall of the maxillary sinus and caudally to the base of the inferior turbinate. Beside the prelacrimal approach, more invasive approaches are the medial maxillectomy, in which the dorsal part of the inferior turbinate and the adjacent medial wall of the maxillary sinus is resected, as well as its modifications "mega antrostomy" and "extended maxillary antrostomy." Correct selection of the size of the maxillary sinus window is prerequisite for successful treatment and long-term postoperative success. Isolated purulent maxillary sinusitis can usually be treated by a type I sinusotomy. Sinusotomy type II addresses nasal polyps with involvement of the mucosa of the ostium, recurrent stenosis after previous surgery, chronic maxillary sinusitis due to cystic fibrosis, and purulent maxillary sinusitis with involvement of other adjacent sinuses. Sinusotomy type III is required for choanal polyps with attachment to the floor of the maxillary sinus, for extensive polyposis and fungal sinusitis, and for inverted papilloma. Particularly for (recurrent) disease and extensive interventions in the maxillary sinus, medial maxillectomy or a modification thereof may be required.
直到20世纪90年代，根治性鼻窦手术一直被认为是上颌窦疾病的标准术式，但由于其高发病率，如今已不再受青睐。如今，功能性鼻内镜鼻窦手术（FESS）被视为鼻窦手术的金标准。手术入路的改良也使得能够进入以前难以到达的上颌窦区域。根据解剖结构和病理情况，可以选择不同的扩大上颌窦开口的方法。在I型鼻窦切开术中，自然开口最多可在背侧扩大1厘米。II型鼻窦切开术是将自然开口扩大至最大直径2厘米。在III型鼻窦切开术中，自然开口在背侧扩大至上颌窦后壁，在尾侧扩大至下鼻甲基部。除泪前入路外，更具侵入性的入路是上颌骨内侧切除术，即切除下鼻甲的背侧部分和上颌窦相邻的内侧壁，以及其改良术式“大鼻窦造口术”和“扩大上颌窦造口术”。正确选择上颌窦开窗的大小是治疗成功和术后长期成功的先决条件。孤立性化脓性上颌窦炎通常可通过I型鼻窦切开术治疗。II型鼻窦切开术适用于累及开口黏膜的鼻息肉、既往手术后复发性狭窄、囊性纤维化引起的慢性上颌窦炎以及累及其他相邻鼻窦的化脓性上颌窦炎。III型鼻窦切开术适用于附着于上颌窦底部的后鼻孔息肉、广泛息肉病和真菌性鼻窦炎，以及内翻性乳头状瘤。特别是对于（复发性）疾病以及上颌窦的广泛干预，可能需要进行上颌骨内侧切除术或其改良术式。
