Nasentamponaden und Stents

Zusammenfassung

Nasentamponaden sind unverzichtbares Rüstzeug des HNO-Arztes, weswegen der aktuelle Stand zu Einsatz, Nutzen und Risiken von Nasentamponaden und Stents wiedergegeben wird. In der endonasalen Chirurgie sollten nach individuellem Abwägen der Notwendigkeit nur noch solche konventionellen Nasentamponaden eingesetzt werden, die eine glatte Oberfläche besitzen und damit Schleimhautschädigungen, potenzielle Verschlechterung der Wundheilung und Einschränkung des Patientenkomforts minimieren. Die endonasale funktionelle endoskopische NNH-Chirurgie impliziert moderne Verfahren der Nasentamponaden, die sich vom alten Formkörper, der Druck ausübt und Raum einnimmt, lösen (müssen). Die sog. hämostatischen/resorbierbaren Materialien sind ein erster, allerdings noch nicht ausreichender Schritt in diese Richtung, da sie zu vermehrten Synechien führen und teilweise Fremdkörperreaktionen aufgrund Inkorporation in die Schleimhaut auslösen. Das Zukleben der Nase ist eine einfache und sehr effektive Methode zur Schaffung eines feuchten Milieus zur Optimierung der endonasalen Wundheilung und Therapie einer trockenen Nase. Ein Stenting der Stirnhöhle wird nur dann empfohlen, wenn es operativ nicht gelingt, eine ausreichend weite, physiologische geformte und in weiten Teilen mit Schleimhaut bedeckte Stirnhöhlendrainage zu realisieren.

Abstract

Despite nasal packing is not necessary after functional endoscopic sinus surgery according to modern surgical techniques, nasal packing is a necessary tool in ENT. Therefore the state of the art regarding indications, benefit and risk of nasal packing and stents are given. In endonasal surgery only those conventional nasal packing materials should be used – if necessary – which have a smooth surface and minimize mucosal damage, potential worsening of wound healing and negative impact on patient comfort. Modern FESS implicates modern types of nasal packing, which leave the old concept of performing pressure and occupying space. So called hemostatic/resorbable materials are a first step in this direction. But they are critical, because these materials cause increased synechiae and sometimes foreign body reactions because of incorporation into the mucosa. Occlusion of the nose via simple taping of the nasal entrance is a simple and very effective method to create a moist environment to optimize endonasal wound healing or management of a dry nose. Stenting of the frontal sinus is only recommended if it is not possible to realize a sufficiently wide, physiologically formed and in large areas with mucosa covered frontal sinus outflow tract.

Schlüsselwörter

Nasentamponade - Zukleben der Nase - Okklusionsbehandlung - Wundheilung - Chitosan - Stirnhöhlenstent - hämostatische Tamponaden - Nutzen-Risiko-Analyse - Synechien - Review

Key words

nasal packing - nasal occlusion - wound healing - moist wound healing - Chitosane - frontal sinus stent - hemostatic packing - wound healing after FESS - benefit – risk – analysis

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