Palma P, Sacilotto C, Sulsenti G
Centro di Chirurgia Funzionale e Correttiva del Naso, Casa di Cura Sant' Ambrogio, Milano.
Acta Otorhinolaryngol Ital. 1996 Jun;16(3):211-24.
Inner nose surgery should be addressed to normalize the geometry of the nasal cavities in order to restore physiologic nasal resistance. As the nasal septum plays a key role in the form and the function of the nose, a successful rhinosurgeon must be able to deal with all septal problems ranging from localized spurs to severely traumatized or surgically damaged nasal septa. Nasal airway obstruction due to septal derangements cannot be successfully solved simply by submucous resections of septal window(s) but does often require a range of corrective maneuvers on the anatomic sub-units constituting the septum. Septal surgery is systematically performed by the Authors using the maxilla-premaxilla approach (MPA) which allows access to and manipulation of the entire nasal septum including the caudal and anterior septal margins, columella, upper lateral cartilages, inferior nasal spine as well as floor of the nasal cavities and maxillary crest areas. Correction of the septum combines mobilization and/or removal of any deranged portion of the bony and/or cartilaginous septum, followed by reconstruction of the septum support, preferably using autogenous septal grafts. Reconstruction procedures are designed to reconstitute a stable medial wall and at the same time minimize scar tissue formation. Reconstruction is indispensable to avoid septal flapping occurring when the medial wall consists of muco-periosteal tissue only without firm intermediary support. When reconstructing the medial wall, great care must be taken with the most important portion of the septum, i.e. the dorso-caudal margin and the cartilaginous elements. However, many common nasal problems require procedures to correct the inside of the nose and the external pyramid at the same time. To effectively and efficiently address the challenge posed by the combination of internal and external nasal problems, a thorough understanding of respiratory rhinology as well a familiarity with the many procedures involved in both extensive septal surgery and external nasal pyramid surgery are imperative for the modern-day rhinosurgeon.
鼻内手术应致力于使鼻腔几何结构正常化，以恢复生理性鼻阻力。由于鼻中隔在鼻腔的形态和功能中起关键作用，一名成功的鼻外科医生必须能够处理所有鼻中隔问题，从局部棘突到严重创伤或手术损伤的鼻中隔。鼻中隔紊乱导致的鼻气道阻塞不能仅通过鼻中隔窗的黏膜下切除术成功解决，而通常需要对构成鼻中隔的解剖亚单位进行一系列矫正操作。作者系统性地采用上颌-前上颌入路（MPA）进行鼻中隔手术，该入路可进入并操作整个鼻中隔，包括鼻中隔的尾侧和前侧边缘、鼻小柱、上外侧软骨、鼻下棘以及鼻腔底部和上颌嵴区域。鼻中隔矫正包括动员和/或切除骨和/或软骨性鼻中隔的任何紊乱部分，随后重建鼻中隔支撑，最好使用自体鼻中隔移植物。重建程序旨在重建一个稳定的内侧壁，同时尽量减少瘢痕组织形成。当内侧壁仅由黏膜-骨膜组织构成而没有坚实的中间支撑时，重建对于避免鼻中隔摆动是必不可少的。在内侧壁重建时，必须特别小心处理鼻中隔最重要的部分，即背侧-尾侧边缘和软骨成分。然而，许多常见的鼻腔问题需要同时进行鼻内和鼻外锥体的矫正手术。为了有效且高效地应对鼻内和鼻外问题组合带来的挑战，对于现代鼻外科医生来说，深入理解呼吸鼻科学以及熟悉广泛的鼻中隔手术和鼻外锥体手术所涉及的众多操作是必不可少的。
