Rhinochirurgie bei Systemerkrankungen

Zusammenfassung

Systemerkrankungen stellen eine heterogene Gruppe von Erkrankungen dar, die sich primär oder sekundär an der Nase und den Nasennebenhöhlen manifestieren können. Obwohl die Therapie von Systemerkrankungen primär systemisch ist, können in Einzelfällen zusätzlich rhinochirurgische Maßnahmen indiziert sein. Diese beinhalten die Therapie von Komplikationen der Nasennebenhöhlen einschließlich der Orbita und der Tränenwege sowie die Korrektur von (Sattel-)Nasendeformitäten und Septumperforationen. Bei begrenzter Datenlage belegen die bisher publizierten Erfahrungen ein erfolgreiches Einheilen von autogenen Knorpel- bzw. Knochentransplantaten bei Nasendeformitäten infolge von Tuberkulose, Lepra, M. Wegener, Sarkoidose und der rezidivierenden Polychondritis. Die hierbei gewonnenen Erfahrungen sprechen dafür, dass bewährte Techniken der Septorhinoplastik auch bei Systemerkrankungen zum Einsatz kommen können. Eine essentielle Voraussetzung ist jedoch, dass rhinochirurgische Maßnahmen im Zustand der Remission bzw. Vollremission erfolgen. Bei der Korrektur von Nasendeformitäten infolge von Systemerkrankungen stellt die Implantation von autogenen Knorpel- bzw. Knochentransplantaten häufig einen wesentlichen Bestandteil des rhinochirurgischen Vorgehens dar. In ähnlicherweise werden diese Transplantatmaterialien auch zum Verschluss von Septumperforationen genutzt, sodass die Erfahrungen, die bei der Korrektur von Nasendeformitäten infolge von Systemerkrankungen gewonnen wurden, zum Teil auch für das Vorgehen bei Septumperforationen herangezogen werden können. Die Nasennebenhöhlenchirurgie kann abgesehen von der Behandlung von Komplikationen in Einzelfällen auch zur Symptomreduktion und Verbesserung der Lebensqualität bei erfolgloser systemischer Therapie beitragen.

Abstract

Nasal Surgery in Patients with Systemic Disorders

Systemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and sinuses as limited disease or secondarily as part of the systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of systemic disorders is primary systemic, additional nasal surgery may become necessary. Surgical procedures include sinus surgery for the treatment of complications of the orbit and the lacrimal duct, septorhinoplasty due to saddle nose deformity and closure of septal perforation. Since many systemic disorders represent very rare diseases, recommendations are based on the analysis of single case reports and studies with a limited number of patients. Even though data is still limited, experiences published so far have shown that autogenous cartilage or bone transplants can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, wegener's granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support our observation that well-established techniques of septorhinoplasty can be used in systemic disorders as well. However, reaching a state of remission is an essential condition before considering any rhinosurgery in these patients. Under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. These observations in part may also be useful for the treatment of nasal septal perforations since implantation of cartilage- or bone grafts represents an essential step in the closure of septal perforations. Apart from the treatment of orbital complications, sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.

Schlüsselwörter

Systemerkrankung - Septorhinoplastik - Septumperforation - Sattelnase - Sinusitis

Key words

systemic disorder - septorhinoplasty - nasal septal perforation - saddle nose - sinusitis

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