Коррекция носовой перегородки у детей с хирургической патологией околоносовых пазух (обзор литературы)
Коррекция носовой перегородки у детей с хирургической патологией околоносовых пазух (обзор литературы)
Алексеенко С.И., Карпищенко С.А., Мельник Б.О. Коррекция носовой перегородки у детей с хирургической патологией околоносовых пазух (обзор литературы). Consilium Medicum. 2021; 23 (3): 226–230.
DOI: 10.26442/20751753.2021.3.200701
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Alekseenko SI, Karpishchenko SA, Melnik BO. Correction of the nasal septum in children with surgical pathology of the paranasal sinuses (literature review). Consilium Medicum. 2021; 23 (3): 226–230.
DOI: 10.26442/20751753.2021.3.200701
Коррекция носовой перегородки у детей с хирургической патологией околоносовых пазух (обзор литературы)
Алексеенко С.И., Карпищенко С.А., Мельник Б.О. Коррекция носовой перегородки у детей с хирургической патологией околоносовых пазух (обзор литературы). Consilium Medicum. 2021; 23 (3): 226–230.
DOI: 10.26442/20751753.2021.3.200701
________________________________________________
Alekseenko SI, Karpishchenko SA, Melnik BO. Correction of the nasal septum in children with surgical pathology of the paranasal sinuses (literature review). Consilium Medicum. 2021; 23 (3): 226–230.
DOI: 10.26442/20751753.2021.3.200701
Заболевания носа и околоносовых пазух (ОНП) лидируют среди патологий верхних дыхательных путей. Заболеваемость хроническим синуситом у детей составляет от 16 до 34%. У 74% детей в возрасте 14 лет выявляется девиация носовой перегородки. Проведен ряд исследований, доказывающих эффективность одномоментного проведения септопластики и функциональной операции под эндоскопическим контролем (functional endoscopic sinus surgery) – FESS-операции у взрослых пациентов. В то же время данных об эффективности и безопасности проведения одномоментной септум-операции и FESS в детском возрасте недостаточно. Результатом таких вмешательств является улучшение носового дыхания и предоставление широкого хирургического доступа к оперируемой пазухе в рамках единого временного этапа. К преимуществам также можно отнести снижение анестезиологической нагрузки на ребенка и количества госпитализаций. Проведение операций на структурах носа и ОНП под эндоскопическим контролем позволяет уменьшить травматизацию слизистой оболочки и опорных тканей, улучшает обзор и видимость операционного поля для хирурга и носит малоинвазивный характер. Одномоментное хирургическое лечение ОНП и искривления носовой перегородки с применением методов функциональной эндоскопической риносинусохирургии у детей является перспективным и безопасным методом лечения по данным литературных источников. Такое оперативное вмешательство требует от хирурга владения всеми практическими навыками, оснащения ЛOP-стационара необходимым инструментарием педиатрического диаметра, правильного определения объема и разработки алгоритма проведения хирургического вмешательства, а также тщательного ведения ребенка в предоперационном и послеоперационном периодах.
Ключевые слова: искривление перегородки носа, функциональная операция под эндоскопическим контролем, септопластика, эндоскопическая септопластика, дети
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Diseases of a nose and paranasal sinuses are in the lead among pathology of upper respiratory tract. The incidence of chronic sinusitis in children ranges from 16 to 34%. Deviation of a nasal septum is detected in 74% of children at the age of 14 years. There are researches proving efficiency of one-stage performing septoplasty and FESS operations at adult patients. At the same time, data on efficiency and safety of carrying out one-stage septum-operation and FESS at children’s age aren’t enough. Improvement of nasal breathing and providing broad access to the surgical area is a result of such interventions. It is also possible to refer decrease anesthesiology load of the child and readmission number. Carrying out low-invasive operations on structures of nose and paranasal sinuses under endoscopic control allows to reduce traumatization of a mucous membrane and improves visibility of the surgery field for the operator. Simultaneous surgical treatment of paranasal sinuses and a nasal septum deviation using methods of FESS in children is a perspective and safe method of treatment. Such surgery demands good practical skills, up-to-date equipment, correct algorithm of performing surgical intervention and also thorough observation of the patient in preoperative and postoperative periods.
Keywords: nasal septum deviation, FESS, septoplasty, endoscopic septoplasty, children
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1. Lopatin AS. Rekonstruktivnaya khirurgiya deformatsii peregorodki nosa. Rossiiskaya rinologiya (prilozhenie). 1994; 1: 3–31 (in Russian)
2. Aaronson NL, Vining EM. Correction of the deviated septum: From ancient Egypt to the endoscopic era. Int Forum Allergy Rhinol. 2014; 4 (11): 931–6. DOI: 10.1002/alr.21371
3. Fettman N, Sanford T, Sindwani R. Surgical management of the deviated septum: Techniques in septoplasty. Otolaryngol Clin North Am. 2009; 42: 241–52. DOI: 10.1016/j.otc.2009.01.005
4. Meloni F, Bozzo C, De Filippis C. The evolution of the techniques used to correct nasal septum function. Acta Otorhinolaryngol Ital. 1996; 16: 180–8.
5. Most SP, Rudy SF. Septoplasty: Basic and advanced techniques. Facial Plast Surg Clin North Am. 2017; 25: 161–9. DOI: 10.1016/j.fsc.2016.12.002
6. Hinderer KH. History of septoplasty. In: Fundamentals of Anatomy and Surgery of the Nose. Aesculapius Publishing Co., 1971; p. 1.
7. Fettman N, Sanford T, Sindwani R. Surgical management of the deviated septum: Techniques in septoplasty. Otolaryngol Clin North Am. 2009; 42: 241–52. DOI: 10.1016/j.otc.2009.01.005
8. Pastorek NJ, Becker DG. Treating the caudal septal deflection. Arch Facial Plast Surg. 2000; 2: 217–20. DOI: 10.1001/archfaci.2.3.217
9. Lee JW, Baker SR. Correction of caudal septal deviation and deformity using nasal septal bone grafts. JAMA Facial Plast Surg. 2013; 15 (2): 96–100. DOI:
10.1001/2013.jamafacial.73
10. Fomon S, Syracuse VR, Bolotow N, Pullen M. Plastic repair of the deflected nasal septum. Arch Otolaryngol. 1946; 44: 141–56.
11. Lawson W, Westreich R. Correction of caudal deflections of the nasal septum with a modified Goldman septoplasty technique: How we do it. Ear Nose Throat J. 2007; 86: 617–20.
12. Cottle MH, Loring RM. Surgery of the nasal septum; new operative procedures and indications. Ann Otol Rhinol Laryngol. 1948; 57: 705–13.
13. Cottle MH, Loring RM, Fischer GG, Gaynon IE. The maxilla-premaxilla approach to extensive nasal septum surgery. AMA Arch Otolaryngol. 1958; 68: 301–13.
14. Gubisch W. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg. 2005; 7 (4): 218–26. DOI: 10.1001/archfaci.7.4.218
15. Trigilia JM, Cannoni M, Peech A. Septorhinoplasty in children: Benefits of the external approach. J Otolaryngol. 1990; 19 (4): 274–8.
16. Vetter U, Pirsig W, Helbing G, et al. Patterns of growth in human septal cartilage: a review of new approaches. Int J Pediatr Otorhinlaryngol. 1984; 7 (1): 63–74.
17. Van der Heijden P, Korsten-Мeijer AG, van der Laan BF, et al. Nasal growth and maturation age in adolescents. Arch Otolaryngol Head Neck Surg. 2008; 134 (12): 1288–93. DOI: 10.1001/archoto.2008.501
18. Bejar I, Farkas LG, Messner AH, Crysdale WS. Nasal growth after externalseptoplasty in children. Arch Otolaryngol Head Neck Surg. 1996; 122: 816–21. DOI: 10.1001/archotol.1996.01890200008002
19. Christophel JJ, Gross CW. Pediatric septoplasty. Otolaryngol Clin North Am. 2009; 42 (9): 287–94.
20. Kulkarni SV, Kulkarni VP, Burse K, et al. Endoscopic septoplasty: A retrosptctive analysis of 415 cases. Indian J Otolaryngol Head Neck Surg. 2015; 67 (3): 248–54. DOI: 10.1007/s12070-015-0880-1
21. Bothra R, Mathur NN. Comparative evaluation of conventional versus endoscopic septoplasty for limited septal deviation and spur. J Laryngol Otol. 2009; 123 (7): 737–41.
DOI: 10.1017/s0022215108004192
22. Yunusov AS, Daikhes NA, Rybalkin SV. Pediatric Reconstructive Rhinosurgery. Moscow: Triada Ltd, 2016 (in Russian)
23. Rusetskii IuIu, Spiranskaia OA, Makhambetova EA, Sergeeva NV. Endoscopic septoplasty and prospects for its use in children (literature review). Russian Rhinology. 2019; 27 (3): 134–40 (in Russian) DOI: 10.17116/rosrino201927031134
24. Calvo-Henríquez C, Neves JC, Arancibia-Tagle D, et al. Does pediatric septoplasty compromise midfacial growth? A systematic review. Eur Arch Otorhinolaryngol. 2020; 277 (6): 1565–74. DOI: 10.1007/s00405-020-05919-725
25. Gulati SP, Wadhera R, Ahuja N, et al. Comparative evaluation of endoscopic with conventional septoplasty. Indian J Otolaryngol Head Neck Surg. 2009; 61 (1): 27–9. DOI: 10.1007/s12070-009-0029-1
26. Giles WС, Gross CW, Abram AC, et al. Endoscopic septoplasty. Laryngoscope. 1994; 104 (12): 1507–9. DOI: 10.1288/00005537-199412000-00015
27. Hwang PH, Mclaughlin RB, Lanza DC, Kenedy DW. Endoscopic septoplasty: indications, technique, and results. Otolaryngol Head Neck Surg. 1999; 120 (5): 678–82. DOI: 10.1053/hn.1999.v120.a93047
28. Nawaiseh S, Al-Khtoum N. Endoscopic septoplasty: retrospective analysis of 60 cases. J Pak Med Assoc. 2010; 60 (10): 796–8.
29. Karpishchenko SA, Aleksandrov AN, Shakhnazarov AE, et al. Funktsional'noe sostoyanie polosti nosa posle ehndoskopicheskoi septoplastiki. Rossiiskaya otorinolaringologiya. 2020; 3 (106): 16–21 (in Russian) DOI: 10.18692/1810-4800-2020-3-16-21
30. Anderson K, Ritchie K, Chorney JM, et al. The impact of septoplasty on health-related quality of life in paediatric patients. Clin Otolaryngol. 2016; 41 (2): 144–8. DOI: 10.1111/coa.12485
31. Shukla RH, Nemade SV, Shinde KJ. Comparison of visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) score in evaluation of post septoplasty patients. World J Otorhinolaryngol Head Neck Surg. 2020; 6 (1): 53–8. DOI: 10.1016/j.wjorl.2019.06.002
32. Baliasinskaia GL, Edgem SR. Opyt lecheniia ostrykh rinosinusitov u detei topicheskimi preparatami. Effektivnaia farmakoterapiia. 2011; 33: 98–103 (in Russian)].
33. Пискунов С.З. Клиническая ринология. М.: Миклош, 2002 [Piskunov SZ. Clinical Rhinology. Moscow: Miklosh, 2002 (in Russian)
34. Subarić M, Mladina R. Nasal septum deformities in children and adolescents: a cross sectional study of children from Zagreb, Croatia. Int J Pediatr Otorhinolaryngol. 2002; 63 (1): 41–8. DOI: 10.1016/s0165-5876(01)00646-2
35. Bothwell MR, Piccirillo JF, Lusk RP, Ridenour BD. Long-term outcome of facial growth after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2002; 126 (6): 628–34. DOI: 10.1067/mhn.2002.125607
36. Fetta M, Tsilis NS, Segas JV, et al Functional endoscopic sinus surgery improves the quality of life in children suffering from chronic rhinosinusitis with nasal polyps. Int J Pediatr Otorhinolaryngol. 2017; 100: 145–8. DOI: 10.1016/j.ijporl.2017.06.007
37. Chang CC, Tai CJ, Ng TY, et al. Can FESS combined with submucosal resection (SMR)/septoplasty reduce revision rate? Otolaryngol Head Neck Surg. 2014; 151 (4): 700–5. DOI: 10.1177/0194599814543778
38. Bayiz U, Dursun E, Islam A, et al. Is septoplasty alone adequate for the treatment of chronic rhinosinusitis with septal deviation? Am J Rhinol. 2005; 19: 612–6.
39. Alekseenko SI. The effectiveness and safety of FESS in chronic rhinosinusitis in children. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2019; 25 (4): 4–14 (in Russian) DOI: 10.33848/foliorl23103825-2019-25-4-4-14
40. Alekseenko S, Karpishchenko S. Comparison of the efficiency and safety of endonasal and open rhinosurgery in children. Laryngoscope. 2020; 130 (4): 1056–63. DOI: 10.1002/lary.28145
41. Alekseenko S, Karpishchenko S, Stancheva O, et al. The effectiveness of endoscopic sinus surgery in case of isolated sphenoid sinusitis in children. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2019; 25 (1): 4–14 (in Russian)
42. Rudmik L, Mace J, Ferguson BJ, Smith TL. Concurrent Septoplasty During Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Does It Confound Outcomes Assessment? Laryngoscope. 2011; 121: 2679–83. DOI: 10.1002/lary.22361
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1 ФГБУ «Санкт-Петербургский научно-исследовательский институт уха, горла, носа и речи» Минздрава России, Санкт-Петербург, Россия;
2 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия;
3 СПб ГБУЗ «Детский городской многопрофильный клинический центр высоких медицинских технологий им. К.А. Раухфуса», Санкт-Петербург, Россия;
4 ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России
*baurzhan.melnik@yandex.ru
________________________________________________
Svetlana I. Alekseenko1–3, Sergey A. Karpishchenko4, Baurzhan O. Melnik*3,4
1 Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg, Russia;
2 Mechnikov North-Western State Medical University, Saint Petersburg, Russia;
3 Rauhfus Saint Petersburg Children’s Municipal Multi-specialty Clinical Center of High Medical Technology, Saint Petersburg, Russia;
4 Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
*baurzhan.melnik@yandex.ru