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„Radikale“ vs. „funktionelle“ Chirurgie der Nasennebenhöhlen – ein Widerspruch?

“Radical” versus “functional” surgery of the paranasal sinuses—A contradiction?

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Zusammenfassung

Hintergrund und Ziel der Arbeit

Die Begriffe „funktionelle“ und „radikale“ Nasennebenhöhlenchirurgie gelten häufig als Beschreibung von Operationen, die sich ausschließen und eher unvereinbar gegenüberstehen. In dieser Übersichtsarbeit sollen die Grundlagen der hinter den Begriffen stehenden Eingriffe und die sich hieraus ergebenden aktuellen Therapiekonzepte herausgearbeitet werden.

Material und Methoden

Selektive Literaturrecherche in der Literaturdatenbank Pubmed, Themen bezogenen Textbüchern bzw. in hieraus sich ergebender Sekundärliteratur zur funktionellen und radikalen Nasennebenhöhlenchirurgie. Gleichartig wurde die aktuelle Literatur zu den klinisch relevanten Indikationen zur Nasennebenhöhlenchirurgie durchgesehen und bewertet.

Ergebnisse und Diskussion

Moderne pathophysiologische Erkenntnisse, eine anatomisch und pathophysiologisch begründete endoskopische Vorgehensweise und die Nutzung aktueller technischer Möglichkeiten haben dazu geführt, dass funktionelle und sogenannte radikale bzw. erweiterte Nasennebenhöhlenchirurgie sich ergänzen und teilweise sogar überlappen.

Dies macht die präoperative Diagnostik und Definition der zugrundeliegenden Erkrankung umso wichtiger, da sich hieraus das operative Konzept ergibt, in welchem Ausmaß und in welchem Detail operiert werden soll: ausschließliche Schaffung einer freien Drainage, ergänzende Schaffung eines Zuganges zur Anwendung topischer Therapien oder die vollständige (radikale) Entfernung eines krankhaften Prozesses.

Abstract

Background and objective

The terms “functional” and “radical” paranasal sinus surgery were often considered to be different operations which were mutually exclusive. This overview aims to look at the basics of these terms and surgical procedures and to work out the resulting surgical concepts for clinically relevant indications.

Material and methods

Selective literature analysis using the data base PubMed, corresponding textbooks and resulting secondary literature regarding functional and radical or extended paranasal sinus surgery. Similarly, the current literature regarding clinically relevant indications for sinus surgery were analyzed.

Results and conclusion

Modern pathophysiological knowledge, anatomically and pathophysiologically substantiated endoscopic surgical procedures and the usage of up to date technical possibilities have resulted in concepts which combine functional and so-called radical or extended surgery of the paranasal sinuses that complement each other and sometimes even overlap.

The preoperative diagnosis and definition of underlying diseases are decisive and should be as precise as possible, as the extent and surgical details mainly depend on them: a sole creation of free drainage pathways, an additional creation of anatomical access for subsequent topical treatment or a complete (radical) removal of a pathological process.

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Authors and Affiliations

  1. Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland

    Rainer K. Weber

  2. Sinus Academy, Karlsruhe, Deutschland

    Rainer K. Weber

  3. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland

    Tanja Hildenbrand

  4. Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland

    Thomas Kühnel

  5. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland

    Thomas K. Hoffmann & Fabian Sommer

  6. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Christian Betz

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  1. Rainer K. Weber
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  2. Tanja Hildenbrand
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  3. Thomas Kühnel
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  4. Thomas K. Hoffmann
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  5. Christian Betz
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  6. Fabian Sommer
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Correspondence to Rainer K. Weber.

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Interessenkonflikt

R.K. Weber, T. Hildenbrand, T. Kühnel, T.K. Hoffmann, C. Betz und F. Sommer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Weber, R.K., Hildenbrand, T., Kühnel, T. et al. „Radikale“ vs. „funktionelle“ Chirurgie der Nasennebenhöhlen – ein Widerspruch?. HNO 72, 102–112 (2024). https://doi.org/10.1007/s00106-023-01378-8

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  • DOI: https://doi.org/10.1007/s00106-023-01378-8

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