Aktueller Stand der endonasalen Nasennebenhöhlenchirurgie

Zusammenfassung

Die endonasale endoskopische Chirurgie der Nasennebenhöhlen ist als Standardverfahren in der operativen Therapie der meisten Erkrankungen der Nasennebenhöhlen etabliert. Unter geeigneten Rahmenbedingungen ist sie sicher und erfolgreich. Dies betrifft die technische Ausstattung, anatomisch orientierte Operationstechnik, geeignete Patientenauswahl und das individuell adaptierte Ausmaß des Eingriffs.

Die Bandbreite endonasaler Nasennebenhöhlenoperationen hat sich in den letzten 20 Jahren erheblich vergrößert und reicht von der partiellen Uncinektomie bis zur Pansinusoperation mit erweiterter Drainage von Stirnhöhle (Typ III nach Draf), Kieferhöhle (Grad 3–4, mediale Maxillektomie, prälakrimaler Zugang) und Keilbeinhöhle. Hinzu kommen Operationen außerhalb oder jenseits der eigentlichen Sinus paranasales. Die Entwicklung von Operationstechniken der eigentlichen Nasenebenhöhlen und darüber hinaus ist keineswegs abgeschlossen.

In der vorliegenden Arbeit wird ein Überblick über den aktuellen Stand zu folgenden Aspekten entsprechend der Literatur gegeben: Prinzipien und Grundlagen, Operationstechniken, Operationsindikationen, Ergebnisse, Nachbehandlung, Nasentamponaden und Stents, technische Hilfsmittel.

Abstract

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases.

Appropriate frame conditions provided, the respective procedures are safe and successful.

These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery.

The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinusoperation with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus.

In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving.

This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.

Schlüsselwörter

Endoskopische Nasennebenhöhlenchirurgie - FESS - Nachbehandlung nach Nasennebenhöhlenchirurgie - Nasentamponade - Ergebnisse der Nasennebenhöhlenchirurgie

Key words

endoscopic sinus surgery - FESS - postoperative care after sinus surgery - nasal packing - outcome after sinus surgery

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