Restorative procedures in disturbed function of the upper airways - nasal breathing.

GMS current topics in otorhinolaryngology, head and neck surgery Pub Date : 2005-01-01 Epub Date: 2005-10-17
Gunter Mlynski
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Abstract

These days, functional rhinosurgery is almost always taken to mean the improvement of nasal airflow. However, air should not only pass through the nose without obstruction. It needs to be warmed, moistened and filtered. This requires sufficient air/mucous membrane contact by spreading airflow over the entire turbinate region, as well as regulation of nasal airway resistance and the degree of turbulence within the nasal cycle. These factors are not considered enough in the concept of functional rhinosurgery.There cannot be a rigid concept for functional/aesthetic rhinosurgery, the surgical procedure must be adapted to the individual anatomy and pathology. In spite of this, it must be clear (based on evidence) which surgical steps can solve a functional problem of the nose in the long term. This paper cannot explain evidence-based treatment strategies to restore nasal respiratory function because in all branches of rhinosurgery, there are no prospective studies available with a sufficiently high sample size and long-term results objectivized by functional diagnosis. Studies available on septal surgery show better results for SP after Cottle than for SMR after Killian. However, the success rate of a 70 to 80% improvement in nasal breathing is not satisfactory. The incidence of postoperative, dry nasal mucosa is also too high. The task of rhinology is to stress the functional side of rhinosurgery more. This includes preoperative analysis of the causes of disturbed respiratory function using the functional diagnosis methods available, the use of evidence-based surgical techniques and postoperative, objectivized quality control. More research needs to be done on the physiology and pathophysiology of nasal airflow as well as on the effect of rhinosurgery on airflow. Numerical flow simulation can contribute greatly to this because the effects of shape changes on the flow can be visualized. Methods need to be developed which can be used for routine, diagnostic recording of warming, moistening and filtering of the respiratory air.

Abstract Image

Abstract Image

上呼吸道功能紊乱的修复程序--鼻腔呼吸。
如今,功能性鼻手术几乎总是被认为是指改善鼻腔气流。然而,空气不仅要畅通无阻地通过鼻腔,还需要加温、湿润和过滤。它还需要被加热、湿润和过滤。这需要通过将气流扩散到整个鼻甲区域来实现空气与粘膜的充分接触,以及调节鼻腔气道阻力和鼻腔循环内的湍流程度。功能性/美学鼻整形术不可能有一个僵化的概念,手术过程必须适应个体的解剖和病理情况。尽管如此,必须明确(基于证据)哪些手术步骤可以长期解决鼻功能问题。本文无法解释以证据为基础的恢复鼻呼吸功能的治疗策略,因为在鼻外科的所有分支中,还没有样本量足够大且长期结果以功能诊断为客观依据的前瞻性研究。现有的鼻中隔手术研究表明,Cottle 术后的 SP 效果优于 Killian 术后的 SMR。然而,鼻呼吸改善率达到 70% 至 80% 的成功率并不令人满意。术后鼻粘膜干燥的发生率也过高。鼻科的任务是更加强调鼻外科手术的功能性。这包括术前利用现有的功能诊断方法分析呼吸功能紊乱的原因,使用循证外科技术,以及术后客观化的质量控制。需要对鼻气流的生理学和病理生理学以及鼻外科手术对气流的影响进行更多的研究。由于可以直观地看到形状变化对气流的影响,因此数字气流模拟可以在这方面做出巨大贡献。需要开发可用于常规诊断性记录呼吸空气升温、湿润和过滤的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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