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Laryngorhinootologie 2005; 84: 101-124
DOI: 10.1055/s-2005-861133
Gestörte Funktion der oberen Atemwege
© Georg Thieme Verlag KG Stuttgart · New York

Gestörte Funktion der oberen Atemwege
Wiederherstellende Verfahren bei gestörter Funktion der oberen Atemwege. Nasale Atmung

G.  Mlynski1
  • 1Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Ernst-Moritz-Arndt-Universität Greifswald (Direktor: Prof. Dr. med. W. Hosemann)
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Publication History

Publication Date:
22 April 2005 (online)

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Zusammenfassung

Unter funktioneller Rhinochirurgie wird heute fast ausschließlich die Verbesserung der Luftdurchgängigkeit der Nase verstanden. Die Luft soll die Nase aber nicht nur unbehindert passieren, sondern sie muss angewärmt, angefeuchtet und gesäubert werden. Die Voraussetzungen dafür, ein suffizienter Luft-Schleimhautkontakt durch eine Ausbreitung des Luftstromes über die gesamte Muschelregion sowie die Regulierung des nasalen Atemwiderstandes und des Turbulenzgrades innerhalb des Nasenzyklus, werden zu wenig in das Konzept der funktionellen Rhinochirurgie einbezogen.

Für die funktionell-ästhetische Rhinochirurgie kann es kein starres Konzept geben, sondern das chirurgische Vorgehen muss sich nach der individuell unterschiedlichen Anatomie und Pathologie richten. Trotzdem muss evidenzbasiert klar sein, mit welchen chirurgischen Schritten sich ein funktionelles Problem der Nase auf lange Zeit sicher lösen lässt. In diesem Referat können keine evidenzbasierten Behandlungsstrategien für die Wiederherstellung der respiratorischen Funktion der Nase dargelegt werden, da auf allen Teilgebieten der Rhinochirurgie prospektive Studien mit ausreichend hoher Patientenzahl und funktionsdiagnostisch objektivierten Langzeitergebnissen fehlen.

Die vorhandenen Studien zur Septumchirurgie zeigen bessere Ergebnisse bei der SP nach Cottle im Vergleich zur SMR nach Killian. Die Erfolgsrate bezüglich Verbesserung der Nasenatmung ist mit durchschnittlich 70 bis 80 % jedoch nicht zufrieden stellend. Auch die Häufigkeit der postoperativ auftretenden trockenen Nasenschleimhaut ist zu hoch.

Es ist die Aufgabe der Rhinologie, die funktionelle Seite der Rhinochirurgie stärker zu betonen. Das umfasst die präoperative Analyse der Ursachen einer gestörten respiratorischen Funktion unter Nutzung der zur Verfügung stehenden funktionsdiagnostischen Methoden, die Verwendung evidenzbasierter Operationstechniken sowie eine postoperative, objektivierte Qualitätskontrolle. Die Physiologie und Pathophysiologie der nasalen Luftströmung und der Einfluss von rhinochirurgischen Maßnahmen auf die Atemströmung müssen weiter erforscht werden. Dabei kann die numerische Strömungssimulation einen wesentlichen Beitrag leisten, da die Auswirkungen von Formänderungen auf die Strömung visualisiert werden können. Die Entwicklung von Methoden zur routinemäßigen diagnostischen Erfassung des Anwärmens, Anfeuchtens und Säuberns der Atemluft ist erforderlich.

Schlüsselwörter

Funktionell-ästhetische Rhinochirurgie - respiratorische Funktion der Nase - Atemströmung - rhinologische Funktionsdiagnostik

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Prof. Dr. med. Gunter Mlynski

Klinik und Poliklinik für Hals-Nasen-Ohrenkrankheiten · Kopf- und Halschirurgie der Ernst-Moritz-Arndt-Universität

Walther-Rathenau-Straße 43-45 · 17487 Greifswald

Email: mlynski@uni-greifswald.de

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