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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана
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Functional Reconstructive Nasal
Surgery
2nd Edition
Egbert H. Huizing, MD, PhD
Professor Emeritus and Former Chairman
Department of Otorhinolaryngology
University Medical Center Utrecht
The Netherlands
John A.M. de Groot, MD, PhD
Formerly Assistant Professor
Department of Otorhinolaryngology
University Medical Center Utrecht
The Netherlands
869 illustrations
Thieme
Stuttgart • New York • Delhi • Rio de Janeiro
Library of Congress Cataloging-in-Publication Data is available from the publisher.
© 2015 by Georg Thieme Verlag KG
Thieme Publishers Stuttgart
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Cover design: Thieme Publishing Group
Typesetting by Thomson Digital, India
Printed in Germany at Aprinta Druck, Wemding 5 4 3 2 1
ISBN 978-3-13-129412-8
Also available as an e-book:
eISBN 978-3-13-164122-9
Important note: Medicine is an ever-changing science undergoing continual development. Research
and clinical experience are continually expanding our knowledge, in particular our knowledge of
proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers
may rest assured that the authors, editors, and publishers have made every effort to ensure that such
references are in accordance with the state of knowledge at the time of production of the book.
Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of
the publishers in respect to any dosage instructions and forms of applications stated in the book.
Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug
and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules
mentioned therein or the contraindications stated by the manufacturers differ from the statements
made in the present book. Such examination is particularly important with drugs that are either rarely
used or have been newly released on the market. Every dosage schedule or every form of application
used is entirely at the user's own risk and responsibility. The authors and publishers request every
user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are
found after publication, errata will be posted at www.thieme.com on the product description page.
Some of the product names, patents, and registered designs referred to in this book are in fact
registered trademarks or proprietary names even though specific reference to this fact is not always
made in the text. Therefore, the appearance of a name without designation as proprietary is not to be
construed as a representation by the publisher that it is in the public domain.
This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or
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electronic data processing and storage.
Contents
Preface
Contributors
1Basics
1.1Surgical Anatomy
1.1.1 Face
1.1.2 External Nose (External Pyramid)
1.1.3 Internal Nose
1.1.4 Vasculature of the Nose
1.1.5 Nerve Supply of the Nose
1.2Histological Features of the Main Nasal Structures and Their Implications
for Nasal Surgery
1.2.1 Septum
1.2.2 Turbinates
1.2.3 Bony Pyramid
1.2.4 Cartilaginous Pyramid
1.2.5 Lobule
1.2.6 Lobular Cartilages
1.3Nasal Development and Growth
1.3.1 The Phases
1.3.2 Developmental Phase
1.3.3 Growth Phase
1.3.4 Disturbance of Development and Growth—Consequences for Nasal Pathology and
Surgery
1.4Surgical Physiology
1.4.1 Olfaction
1.4.2 Respiration
1.4.3 Air Conditioning (Heating and Humidification)
1.4.4 Defense
1.4.5 Speech
1.4.6 Facial Beauty and Facial Expression
2Pathology and Diagnosis
2.1Nasal Syndromes
2.1.1 Deviated Pyramid Syndromes
2.1.2 Hump Nose (Dorsal Nasal Deformity)
2.1.3 Prominent-Narrow Pyramid Syndrome (Tension Nose)
2.1.4 Low-Wide Pyramid Syndrome (Saddle Nose)
2.1.5 Ski-Slope Nose
2.1.6 Open Roof Syndrome
2.1.7 Lobular Inspiratory Insufficiency Syndrome (“Alar Collapse”)
2.1.8 Middle Meatus Obstructive Syndrome
2.1.9 Wide Nasal Cavity Syndrome (“Empty Nose” Syndrome)
2.1.10 Dry Nose Syndrome
2.1.11 Cleft Lip–and Cleft Palate–Nose
2.1.12 Congenital Nasal Hypoplasia (Nasomaxillary Dysplasia, Binder Syndrome)
2.1.13 Facial Syndromes
2.1.14 Nasal Neuralgias
2.2Nasal Symptoms—The Most Common Deformities, Abnormalities, and
Anatomical Variations
2.2.1 Pathology and Variations of Nasal Dimensions
2.2.2 Humps
2.2.3 Saddling and Sagging
2.2.4 Bony and Cartilaginous Pyramid
2.2.5 Lobule
2.2.6 Valve Area
2.2.7 Septum
2.2.8 Turbinates
2.3Diagnosis and Documentation
2.3.1 Making the Diagnosis
2.3.2 Examination
2.3.3 Examination of the Internal Nose
2.3.4 Analysis of Nose, Face, and Dentition
2.3.5 Imaging
2.3.6 Photographic Diagnosis and Documentation
2.4Function Tests
2.4.1 Breathing Tests
2.4.2 Olfactometry
2.4.3 Measuring Air-Conditioning Capacity
2.4.4 Measuring Nasal Defense
2.4.5 Allergy and Hyperreactivity Testing
3Surgery—General
3.1Concepts of Functional Reconstructive Nasal Surgery
3.1.1 Surgery for Function and Form
3.1.2 Concepts
3.1.3 Basic Principles
3.2Endonasal versus External Approach
3.2.1 Historical Development
3.2.2 Advantages and Disadvantages of the Two Different Approaches
3.2.3 Which Approach to Use When?
3.2.4 Sequence of the Surgical Steps
3.3Preoperative and Postoperative Care
3.3.1 Preoperative Care
3.3.2 Postoperative Care
3.4Anesthesia and the Bloodless Surgical Field
3.4.1 Local or General Anesthesia?
3.4.2 Local Anesthesia
3.4.3 General Anesthesia
3.4.4 The Bloodless Surgical Field
3.5Antibiotics and Corticosteroids in Nasal Surgery
3.5.1 Antibiotics
3.5.2 Corticosteroids
4Incisions and Approaches
4.1General
4.1.1 Terminology
4.1.2 External versus Internal Incisions
4.1.3 Basic Principles
4.2Main Incisions
4.2.1 Caudal Septal Incision (Hemitransfixion)
4.2.2 Intercartilaginous Incision
4.2.3 Vestibular Incision
4.2.4 Infracartilaginous Incision
4.2.5 Transcolumellar Inverted V Incision
4.3Special Incisions—External
4.3.1 Labiogingival Incision
4.3.2 Sublabial Incision
4.3.3 Paranasal Incision
4.3.4 Lateral Columellar Incision
4.3.5 Rim Incision
4.3.6 Alar-facial Incision (Long-Arm-U Incision; Alatomy)
4.3.7 V Incision of the Columellar Base
4.3.8 Dorsal Incisions—Horizontal Dorsal and Dorsal Reversed V Incision
4.4Special Incisions—Endonasal
4.4.1 Transfixion
4.4.2 Transcartilaginous Incision
4.4.3 Incisions in the Turbinate Mucosa
4.4.4 Incisions in the Septal Mucosa
4.5Stab Incisions
4.5.1 Vestibular Stab Incision
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