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Laryngorhinootologie 2016; 95(02): 132-145
DOI: 10.1055/s-0041-110455
Facharztwissen-HNO
© Georg Thieme Verlag KG Stuttgart · New York

Chirurgie im Rachen – Adenotomie, Tonsillektomie, Tonsillotomie und Eingriffe bei obstruktivem Schlafapnoe-Syndrom

Surgery in the Pharynx: Adenoidectomy, Tonsillectomy, Tonsillotomy and Surgery for Obstructive Sleep Apnea
K. Geißler
,
O. Guntinas-Lichius
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Publikationsverlauf

Publikationsdatum:
09. Februar 2016 (online)

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Zusammenfassung

Operative Eingriffe im Rachen gehören zu den häufigsten HNO-Eingriffen. Adenotomie und Tonsillektomie zählen zu den häufigsten operativen Eingriffen überhaupt und sind einige der ersten Eingriffe, die Ärzte während der Facharztausbildung unter fachärztlicher Aufsicht vornehmen. Daher ist eine Beschäftigung mit den häufigsten HNO-Operationen im Rachen, den verschiedenen Techniken, Komplikationen und Erfolgsaussichten bereits früh in der Facharztausbildung unerlässlich. Zur Adenotomie hat es gerade in den letzten Jahren eine Reihe von hervorragenden klinischen Studien und Metaanalysen gegeben, die der Adenotomie einen festen Stellenwert in der pädiatrischen HNO-Heilkunde zuweisen. Insbesondere durch die laserchirurgische Technik hat die Tonsillotomie in den letzten Jahren eine Renaissance erfahren. Das Indikationsspektrum weitet sich immer noch aus, und es gibt viele Indikationsbereiche, in denen es insbesondere durch klinische Studien zu untersuchen gilt, inwieweit eine Tonsillotomie einer Tonsillektomie bei geringerer perioperativer Morbidität im Hinblick auf das Outcome gleichwertig sein kann. Es gibt eine Vielzahl von operativen Verfahren im Rachen zur Behandlung von Patienten mit obstruktivem Schlafapnoe-Syndrom, die sich bewährt haben als Alternativen zur konservativen Therapie und bei Therapieversagern unter Atemhilfstherapie. Da die Obstruktion bei dieser schlafbezogenen Atemstörung meist nicht auf eine Lokalisation begrenzt ist, ist häufig eine individuelle Kombination mehrerer HNO-Eingriffe gefragt, um den Patienten effektiv behandeln zu können. Der vorliegende Fortbildungs-Beitrag gibt eine Übersicht über die wichtigsten operativen Verfahren im Rachen für den angehenden HNO-Facharzt.

Abstract

Surgery in the pharynx belongs to the most frequent otorhinolaryngological procedures. Adenoidectomy and tonsillectomy are amongst the most frequent surgeries at all and belong to the first procedures which are performed by otorhinolaryngology residents during their specialist training. Therefore, it is essential to study early during the specialist training the most frequent pharyngeal procedures, surgical techniques, complications and outcome. A series of excellent clinical trials and meta-analyses have been published in the recent year demonstrating that adenoidectomy is an important therapy element in pediatric otorhinolaryngology. In particular due to the developments in the field of laser surgery, tonsillotomy could experience a revival in the recent years. The indication spectrum is still widening. There are many fields where clinical trials are needed to proof if tonsillotomy is as effective as tonsillectomy but with the advantage of lower morbidity. There are manifold pharyngeal surgical procedures to treat patients with obstructive sleep apnea. These surgical techniques have proved valuable especially as alternative to conservative therapy and in case of treatment failure under airway pressure therapy. As the obstruction during this type of sleep-related respiratory disorder is often not located at one anatomical site, an individual combination of several pharyngeal and other surgeries are needed for an effective treatment of the patient. The present article gives an overview of the most important pharyngeal surgeries for future otorhinolaryngologists under specialist training.

 

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