Nasenatmungsbehinderung nach Septumplastik: Deviation der Lamina perpendicularis bei Schiefnase

Zusammenfassung

Hintergrund:

Die funktionelle Septorhinoplastik (SRP) dient der Verbesserung der Nasenatmung bei symptomatischer Deformität der inneren und äußeren Nase. In einigen Fällen wird jedoch trotz knöcherner Schiefnase lediglich eine Septumplastik (SPL) durchgeführt. Als Grund für Septorhinoplastik-Revision (rSRP) wurde in unserer Klinik bei zahlreichen Patienten mit persistierender Nasenatmungsbehinderung nach SPL eine knöcherne Schiefnase in Verbindung mit einer kontralateralen hohen Deviation der Lamina perpendicularis, ipsilateralen Luxation des knorpeligen Septums und Nasenklappenstenose identifiziert.

Material und Methoden:

Alle Patienten, die von 2005 bis 2011 eine Septorhinoplastik-Revision (rSRP) erhielten wurden retrospektiv untersucht.

Ergebnisse:

398 Patienten erhielten eine rSRP, bei 57 Patienten (14%) wurde eine knöcherne Schiefnase bei Z. n. SPL diagnostiziert. In allen Fällen zeigte sich eine Deviation der knöchernen Nasenpyramide mit Deviation der Lamina perpendicularis, welche im Rahmen einer rSRP korrigiert wurde. Die Nasenatmung konnte in allen Fällen verbessert werden. Dies konnte durch einen Anstieg des endonasalen Volumens und der inspiratorischen Luftströmung in der akustischen Rhinometrie bzw. aktiven anterioren Rhinomanometrie bestätigt werden.

Schlussfolgerung:

Die Deviation der Lamina perpendicularis bei knöcherner Schiefnase ist eine wichtige Ursache für persistierende Nasenatmungsbehinderung nach SPL. Eine sorgfältige präoperative Analyse der Nase, des knorpeligen und knöchernen Septums und der Nasenklappen ist notwendig, um die korrekte rhinochirurgische Indikation zur SRP oder SPL zu stellen.

Abstract

Persistent Nasal Obstuction Following Septoplasty: Deviated Nasal Pyramid and Perpendicular Plate

Background:

Functional septorhinoplasty (SRP) is a surgical procedure for improvement of symptomatic deformity of the inner and outer nose. Due to inadequate preoperative analysis and consequently insufficient surgical indication, septoplasty (SPL) alone may be performed. A frequent cause for revision septorhinoplasty (rSRP) in our institution was found to be due to a deviated bony pyramid in compound with a contralateral high deviation of the perpendicular plate, ipsilateral reluxation of the cartilaginous septum and a resulting nasal valve stenosis.

Materials and Methods:

The medical records of all patients undergoing revision septorhinoplasty in our institution from 2005–2011 were evaluated retrospectively.

Results:

398 patients underwent rSRP, in 57 patients (14%) a deviated bony nose after septoplasty was diagnosed. In all cases a deviated bony nose and contralateral deviation of the perpendicular plate was found and corrected by rSRP. The nasal breathing was improved in all cases. This was also shown in an increase of endonasal volume and nasal air flow in acoustic rhinometry and active anterior rhinomanometry.

Conclusion:

A deviated nasal pyramid and perpendicular plate was found to be a common cause for persistent nasal obstruction after septoplasty. A careful preoperative analysis of the nose, the pathology of the bony and cartilaginous septum and the nasal valves is mandatory in order to recognize anatomical details and set up the right indication for rhinosurgical interventions.

Schlüsselwörter

Septorhinoplastik Revision - Septumdeviation - Septumplastik - Lamina perpendicularis - Nasenatmungsbehinderung - Schiefnase

Key words

revision septorhinoplasty - septal deviation - septorhinoplasty - perpendicular plate - deviated nose - decreased nasal breathing

• Literatur

• 1 Bagal AA, Adamson PA. Revision rhinoplasty. Facial Plast Surg 2002; 18 (04) 233-244
• 2 Becker DG, Becker SS. Treatment of nasal obstruction from nasal valve collapse with alar batten grafts. J Long Term Eff Med Implants 2003; 13 (03) 259-269
• 3 Becker DG, Bloom J. Five techniques that i cannot live without in revision rhinoplasty. Facial Plast Surg 2008; 24 (03) 358-364
• 4 Becker SS, Dobratz EJ, Stowell N, Barker D, Park SS. Revision septoplasty: review of sources of persistent nasal obstruction. Am J Rhinol 2008; 22 (04) 440-444
• 5 Buyukertan M, Keklikoglu N, Kokten G. A morphometric consideration of nasal septal deviations by people with paranasal complaints; a computed tomography study. Rhinology 2003; 41 (01) 21-24
• 6 Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 1996; 98 (01) 38-54 discussion 5–8
• 7 de Monredon O, Dumon T, Stoll D. Anatomy of nasal obstruction. The recognition of the role of septum. Its application to the surgical treatment of nasal obstruction. Rev Laryngol Otol Rhinol (Bord) 1998; 119 (01) 29-34
• 8 Dinis PB, Haider H. Septoplasty: long-term evaluation of results. Am J Otolaryngol 2002; 23 (02) 85-90
• 9 Konstantinidis I, Triaridis S, Triaridis A, Karagiannidis K, Kontzoglou G. Long term results following nasal septal surgery. Focus on patients’ satisfaction. Auris Nasus Larynx 2005; 32 (04) 369-374
• 10 Parkes ML, Kanodia R, Machida BK. Revision rhinoplasty. An analysis of aesthetic deformities. Arch Otolaryngol Head Neck Surg 1992; 118 (07) 695-701
• 11 Szucs E, Clement PA. Acoustic rhinometry and rhinomanometry in the evaluation of nasal patency of patients with nasal septal deviation. Am J Rhinol 1998; 12 (05) 345-352
• 12 Tao Z, Zhang J, Wu Y. Clinical analysis of 28 patients with unsuccessful septoplasty. Lin Chuang Er Bi Yan Hou Ke Za Zhi 1999; 13 (11) 503-504
• 13 Vuyk HD, Watts SJ, Vindayak B. Revision rhinoplasty: review of deformities, aetiology and treatment strategies. Clin Otolaryngol Allied Sci 2000; 25 (06) 476-481
• 14 Xiao HJ, Kong WJ, Wang GP, Yang CZ, Le JX. Revision of submucous resection of nasal septum. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2006; 41 (03) 184-186
• 15 You X, Gao Q, Liu Z, Cui Y. The value of nasal endoscopy in the resection of upper and posterior nasal septum deviation. Lin Chuang Er Bi Yan Hou Ke Za Zhi 1999; 13 (09) 392-393
• 16 Galetti G, Dallari S, Galetti R. Turbinoplasty: personal technique and long-term results. ORL J Otorhinolaryngol Relat Spec 1991; 53 (02) 111-115
• 17 Grymer LF, Illum P, Hilberg O. Bilateral inferior turbinoplasty in chronic nasal obstruction. Rhinology 1996; 34 (01) 50-53
• 18 Katz S, Schmelzer B, Cammaert T, Della Faille D, Leirens J. Our technique of partial inferior turbinoplasty: long-term results evaluated by rhinomanometry. Acta Otorhinolaryngol Belg 1996; 50 (01) 13-18
• 19 Mabry RL. Inferior turbinoplasty: patient selection, technique, and long-term consequences. Otolaryngol Head Neck Surg 1988; 98 (01) 60-66
• 20 Scheithauer MO. Surgery of the turbinates and “empty nose” syndrome. Laryngorhinootologie May 2010; 89 (Suppl 1): S79-S102 [Epub 2010 Mar 29. Review. German]
• 21 Clement PAR, Gordts F. Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 2005; 43: 169-179
• 22 Cuddihy PJ, Eccles R. The use of nasal spirometry as an objective measure of nasal septal deviation and the effectiveness of septal surgery. Clin Otolaryngol Allied Sci 2003; Aug 28 (04) 325-330