Laryngorhinootologie 2010; 89: S46-S71
DOI: 10.1055/s-0029-1246162
Funktionelle Rhinochirurgie

© Georg Thieme Verlag KG Stuttgart · New York

Rhinochirurgie bei Kindern: Entwicklungsphysiologische und chirurgische Aspekte der wachsenden Nase

Rhinosurgery in Children: Developmental and Surgical Aspects of the Growing NoseC. D. A. Verwoerd1 , H. L. Verwoerd-Verhoef1
  • 1Department of Otorhinolaryngology, ErasmusMC, Erasmus University, Rotterdam, The Netherlands
Further Information

Publication History

Publication Date:
29 March 2010 (online)

Zusammenfassung

Die Anatomie des Nasenskeletts bei Neugeborenen und Erwachsenen ist nicht identisch. Das komplette Knorpelgerüst der Neugeborenen-Nase verknöchert schrittweise in der Wachstumsperiode und ist während dieser Zeit anfälliger für Traumen. Eine Verletzung in der frühen Jugend kann große Folgen für die Entwicklung einer Deformität der Nase haben, die während des Wachstums zunimmt und ihren Höhepunkt während und nach Abschluss der pubertären Wachstumsphase erreicht. Um mehr über die zugrunde liegenden Probleme der nasalen Fehlbildungen und ihre Behandlung (Septumplastik) zu verstehen, rückten diese Gesichtspunkte während der letzten 40 Jahre in den Fokus mehrerer tierexperimenteller Studien. Die Auswirkungen von Eingriffen an der Nasenscheidewand waren sehr unterschiedlich, je nachdem, welche Versuchstiere verwendet wurden. Rückblickend zeigte sich jedoch, dass eher die sehr unterschiedlichen Operationstechniken von höherer Bedeutung sein dürften. Die Auswertung einer größeren Studien an jungen Kaninchen beinhaltete Skelett-Ausmessungen mit statistischer Analyse und mikroskopischer Untersuchung der Gewebe. Die Eigenschaften des hyalinen Knorpels der menschlichen Nase schien vergleichbar mit dem der Säugetiere. Knorpel kann leicht frakturieren, obwohl er elastisch ist, wohingegen die Heilungstendenz niedrig ist, auch wenn das Perichondrium geschont wurde. Auch chirurgische Eingriffe – wie bei der Septumplastik – können zu Wachstumsstörungen des Nasenskeletts im Sinne einer Septumdeviation oder eines -sporns führen. Verlust von Knorpel, wie er nach einem Septumabszess auftreten kann, wird trotz gewisser Knorpelregeneration nie vollständig ersetzt. In diesem Artikel werden die vielen experimentellen Studien bewertet und verglichen. Trotz allem fehlt in der Literatur bislang ein wirklicher Konsens über die Auswirkungen rhinochirurgischer Eingriffe auf das Mittelgesichtswachstum bei Kindern. Auf der Grundlage von Beobachtungen an Tieren und wenigen klinischen Studien, meist an einer kleinen Patientenzahl aber mit langem Beobachtungszeitraum, haben die Autoren eine Liste von Richtlinien zusammengestellt, die vor Eingriffen am Mittelgesicht bei Kindern in der Entwicklungsphase in Betracht gezogen werden sollten.

Abstract

Rhinosurgery in Children: Developmental and Surgical Aspects of the Growing Nose

The anatomy of the nasal skeleton in newborns and adults are not alike. The complete cartilaginous framework of the neonatal nose becomes partly and gradually ossified during the years of growth and is more vulnerable to trauma in that period. Injury in the early youth may have large consequences for development of a nasal deformity which will increase during growth and reach its peak during and after the adolescent growth spurt. To understand more of the underlying problems of nasal malformations and their treatment (septoplasty) these items became the focus of multiple animal studies in the last 40 years. The effects of surgery on the nasal septum varied considerably, seemingly depending on which experimental animal was used. In review, however, it appeared that the very different techniques of surgery might be even more influential in this respect. Study of one of the larger series of experiments in young rabbits comprised skeletal measurements with statistical analysis and microscopic observations of the tissues. The behaviour of hyaline cartilage of the human nose appeared to be comparable to that of mammals. Cartilage, although resilient, can be easily fractured whereas its tendency to integrated healing is very low, even when the perichondrium has been saved. Also surgical procedures – like in septoplasty – may result in growth disturbances of the nasal skeleton like deviation or nasal spine. Loss of cartilage, as might occur after a septum abscess, is never completely restored despite some cartilage regeneration. In this article the many experimental studies are reviewed and compared. Still there remains a lack of real consensus in the literature concerning the developmental effects of rhinosurgry in children. Based on their observations in animals and a few clinical studies, mostly with small numbers of patients but with a long follow-up, the authors have compiled a list of guidelines to be considered before starting to perform surgery on the growing midface in children.

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Korrespondenzadresse

Prof. Dr. med. C. D. A. Verwoerd
Dr. med. H. L. Verwoerd-Verhoef

Kroeskarper 36

2661 KL Bergschenhoek

The Netherlands

Email: kroeskarper@hotmail.com

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