Skip to main content
SpringerLink
Log in

Endoskopie bei der Versorgung von Fehlbildungspatienten

Unter besonderer Berücksichtigung von Patienten mit Lippen-Kiefer-Gaumen-Segel-Spalten

Endoscopy in the treatment of patients with malformations

With special reference to patients with cleft lip and palate

  • Leitthema
  • Published:
Der MKG-Chirurg Aims and scope

Zusammenfassung

Ziel der Arbeit

Endoskopische Diagnostik und Therapiemaßnahmen haben einen festen Stellenwert bei der Behandlung von Fehlbildungen im Fachbereich der MKG-Chirurgie. Sowohl bei der Versorgung von kindlichen Patienten mit Lippen-Kiefer-Gaumen-Segel(LKGS)-Spalten als auch bei Risikopatienten mit syndromalen Erkrankungen ermöglicht die minimalinvasive Endoskopie eine sichere und wenig invasive Diagnostik. Auch die interdisziplinären Therapieergebnisse können mithilfe der Endoskopie verbessert werden.

Material und Methoden

Dargestellt werden typische Indikationen, standardisierte Techniken, interdisziplinäre Therapieansätze sowie Risiken der Endoskopie bei Neugeborenen, Kleinkindern und Heranwachsenden mit Fehlbildungen im Gesichtsbereich. Als zusätzlicher interdisziplinärer Ausblick werden minimalinvasive endoskopische Therapieverfahren der abführenden Tränenwege beschrieben, die sowohl bei Fehlbildungen im Gesichtsbereich als auch bei posttraumatischen Folgezuständen Anwendung finden können.

Ergebnisse

Bei der Planung endoskopischer Therapieverfahren müssen patienten- und altersspezifische Faktoren Berücksichtigung finden. Die endoskopische Behandlung von Patienten mit Fehlbildungen im MKG-Bereich sollte durch erfahrene Untersucher erfolgen oder begleitet werden.

Schlussfolgerung

Besonders bei Patienten mit LKGS-Spalten und syndromalen Erkrankungen des Kiefer-Gesicht-Bereichs sind die endoskopische Diagnostik und Therapie für die Prävention von spezifischen Komplikationen ebenso wie für den interdisziplinären Behandlungserfolg von sehr hohem Wert.

Abstract

Background

Nasopharyngeal endoscopy is a valuable tool in the diagnostics and treatment of patients with malformations in the oral and maxillofacial region. Nasopharyngeal endoscopy is particularly important for the interdisciplinary therapy of hypoxia, velopharyngeal insufficiency (VPI) and speech outcome in pediatric patients with cleft lip and palate (CLP) and Robin sequence.

Objectives

The indications, standardized techniques and specific risks of nasopharyngeal endoscopy are described and age-related recommendations for patients with malformations of the oral and maxillofacial region are given, e.g. for patients with CLP, Robin sequence and CHARGE syndrome. Velopharyngeal closure and VPI are discussed. In addition, minimally invasive therapeutic procedures for dacryoendoscopy are described.

Results

When performing nasopharyngeal endoscopy in patients with malformations of the oral and maxillofacial region, patient-specific as well as age-dependent criteria have to be considered. Endoscopic examination of patients with malformations of the oral and maxillofacial region should be carried out or accompanied by experienced personnel. The results of therapy have to be assessed and discussed in an interdisciplinary board.

Conclusion

Endoscopic diagnostics and treatment will increase the successful outcome of interdisciplinary treatment with special respect to VPI, breathing and speech, especially in patients with CLP, Robin sequence and syndromal oral and maxillofacial malformations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Berry S, Roblin G, Williams A, Watkins A, Whittet HB (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115(3):538–540

    Article  CAS  PubMed  Google Scholar 

  2. Blake KD, Prasad C (2006) CHARGE-Syndrom- A review. Orphanet J Rare Dis 1:34

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bravo G, Ysunza A, Arrieta J, Pamplona MC (2005) Videonasopharyngoscopy is useful for identifying children with Pierre Robin sequence and severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 69(1):27–33

    Article  PubMed  Google Scholar 

  4. Buchenau W, Urschitz MS, Sautermeister J, Bacher M, Herberts T, Arand J, Poets CF (2007) A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence. J Pediatr 151(2):145–149

    Article  PubMed  Google Scholar 

  5. Chadha NK, Lam GO, Ludemann JP, Kozak FK (2013) Intranasal topical local anesthetic and decongestant for flexible nasendoscopy in children: a randomized, double-blind, placebo-controlled trial. JAMA Otolaryngol Head Neck Surg 139(12):1301–1305

    Article  PubMed  Google Scholar 

  6. Chou MS, Chung HK, Tsou YA, Chen JJ, Tsai MH, Jan CI (2014) Endoscopic management of pediatric sinonasal schwannoma: case report. B-ENT 10:299–302

    CAS  PubMed  Google Scholar 

  7. Croft CB, Shprintzen RJ, Rakoff SJ (1981) Patterns of velopharyngeal valving in normal and cleft palate subjects. A multi-view videofluoroscopic and nasendoscopic study. Laryngoscope 91(2):265–271

    Article  CAS  PubMed  Google Scholar 

  8. De Sousa TV, Marques IL, Carneiro AF, Bettiol H, Freitas JA (2003) Nasopharyngoscopy in Robin sequence: clinical and predictive value. Cleft Palate Craniofac J 40(6):618–623

    Article  PubMed  Google Scholar 

  9. Dharmawardana N, Ruthenbeck G, Woods C, Elmiyeh B, Diment L, Ooi EH, Reynolds K, Carney AS (2015) Validation of virtual reality based simulations for endoscopic sinus surgery. Clin Otolaryngol. [Epub ahead of print]

  10. Durmaz A, Tosun F, Yldrm N, Sahan M, Kvrakdal C, Gerek M (2008) Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg 19(3):1270–1274

    Article  PubMed  Google Scholar 

  11. Emmerich KH, Ungerechts R, Meyer-Rüsenberg HW (2009) Mikroendoskopische Tränenwegschirurgie. Ophthalmologe 106(5):194–204

    Article  PubMed  Google Scholar 

  12. Gilleard O, Sommerlad B, Sell D, Ghanem A, Birch M (2013) Nasendoscopy: an analysis of measurement uncertainties. Cleft Palate Craniofac J 50(2):351–357

    Article  PubMed  Google Scholar 

  13. Grevers G, Leunig A, Klemens A, Hagedorn H (2002) Computerassistierte Chirurgie der Nasennebenhöhlen – Technologie und klinische Erfahrungen mit dem Vector-Vision-Compact-System an 102 Patienten. Laryngorhinootologie 81(4):476–483

    Article  CAS  PubMed  Google Scholar 

  14. Havstam C, Lohmander A, Persson C, Dotevall H, Lith A, Lilja J (2005) Evaluation of VPI-assessment with videofluoroscopy and nasoendoscopy. Br J Plast Surg 58(7):922–931

    Article  PubMed  Google Scholar 

  15. Hay I, Oates J, Giannini A, Berkowitz R, Rotenberg B (2009) Pain perception of children undergoing nasendoscopy for investigation of voice and resonance disorders. J Voice 23(3):380–388

    Article  PubMed  Google Scholar 

  16. Heichel J, Bredehorn-Mayr T, Struck H-G (2015) Tränenwegendoskopie im Kindesalter. Klin Monatsbl Augenheilkd 232:881–885

    Article  CAS  PubMed  Google Scholar 

  17. Heman-Ackah SE, Sidman J, Lui M (2009) Conscious sedation in pediatric speech endoscopy. Int J Pediatr Otorhinolaryngol 73(12):1686–1690

    Article  PubMed  Google Scholar 

  18. Horsch U, Scheele A (2009) Das CHARGE-Syndrom. Ein Fachbuch für Mediziner, Pädagogen, Therapeuten, Eltern und Betroffene. Median, Heidelberg

    Google Scholar 

  19. Kinsella JB, Calhoun KH, Bradfield JJ, Hokanson JA, Bailey BJ (1995) Complications of endoscopic sinus surgery in a residency training program. Laryngoscope 105(3):1029–32

    Article  CAS  PubMed  Google Scholar 

  20. Korkmaz H, Korkmaz M, Karakahya RH, Serhatl M (2013) Endoscopic intranasal surgery for congenital nasolacrimal duct obstruction – a new approach. Int J Pediatr Otorhinolaryngol 77(4):918–921

    Article  PubMed  Google Scholar 

  21. Krings JG, Kallogjeri D, Wineland A, Nepple KG, Piccirillo JF, Getz AE (2014) Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 124(2):838–845

    Article  PubMed Central  PubMed  Google Scholar 

  22. Kummer AW (2014) Speech evaluation in Cleft Palate. In: Sitzman TJ, Marcus JR (Hrsg) Cleft lip and palate: current surgical management. Elsevier, Philadelphia, S 241–251

    Google Scholar 

  23. Kummer AW, Clark SL, Redle EE, Thomsen LL, Billmire DA (2012) Current practice in assessing and reporting speech outcomes of cleft palate and velopharyngeal surgery: a survey of cleft palate/craniofacial professionals. Cleft Palate Craniofacial J 49(2):146–152

    Article  Google Scholar 

  24. Lam DJ, Starr JR, Perkins JA, Lewis CW, Eblen LE, Dunlap J, Sie KC (2006) A comparison of nasendoscopy and multiview videofluoroscopy in assessing velopharyngeal insufficiency. Otolaryngol Head Neck Surg 134(3):394–402

    Article  PubMed  Google Scholar 

  25. Masters IB, Eastburn MM, Francis PW, Wootton R, Zimmerman PV, Ware RS, Chang AB (2005) Quantification of the magnification and distortion effects of a pediatric flexible video-bronchoscope. Respir Res 10:6–16

    Google Scholar 

  26. Mehendale FV, Sommerlad BC (2004) Surgical significance of abnormal internal carotid arteries in velocardiofacial syndrome in 43 consecutive Hynes pharyngoplasties. Cleft Palate Craniofac J 41(4):368–374

    Article  PubMed  Google Scholar 

  27. Mehendale FV, Birch MJ, Birkett L, Sell D, Sommerlad BC (2004) Surgical management of velopharyngeal incompetence in velocardiofacial syndrome. Cleft Palate Craniofac J 41(2):124–135

    Article  PubMed  Google Scholar 

  28. Meyer-Rüsenberg HW, Emmerich KH (2010) Moderne Tränenwegschirurgie aus ophtalmologischer Sicht. Dtsch Arztbl Int 107:254–258

    Google Scholar 

  29. Nankivell PC, Pothier DD (2008) Nasal and instrument preparation prior to rigid and flexible nasendoscopy: a systematic review. J Laryngol Otol 122(10):1024–1028

    Article  CAS  PubMed  Google Scholar 

  30. Nayak DR, Balakrishnan R, Hazarika P (1998) Prevention and management of synechia in pediatric endoscopic sinus surgery using dental wax plates. Int J Pediatr Otorhinolaryngol 46(4):171–178

    Article  CAS  PubMed  Google Scholar 

  31. Pagon RA, Graham JM Jr, Zonana J, Young SL (1981) Coloboma, congenital heart disease, and choanal atresia with multiple anomalies: CHARGE association. J Pediat 99(2):223–227

    Article  CAS  PubMed  Google Scholar 

  32. Pigott RW, Bensen JF, White FD (1969) Nasendoscopy in the diagnosis of velopharyngeal incompetence. Plast Reconstr Surg 43(2):141–147

    Article  CAS  PubMed  Google Scholar 

  33. Poets CF, Bacher M (2011) Treatment of upper airway obstruction and feeding problems in Robin-like phenotype. J Pediatr 159(6):887–892

    Article  PubMed  Google Scholar 

  34. Pothier DD, Raghava N, Monteiro P, Awad Z (2006) A randomized controlled trial: is water better than a standard lubricant in nasendoscopy? Clin Otolaryngol 31(2):134–137

    Article  CAS  PubMed  Google Scholar 

  35. Probst R, Grevers G, Iro H (2000) Hals-Nasen-Ohren-Heilkunde, 28. Aufl. Georg Thieme Verlag, Stuttgart

    Google Scholar 

  36. Ram B, Barras CW, White PS, MacEwen CJ, Young JD (2000) The technique of nasendoscopy in the evaluation of nasolacrimal duct obstruction in children. Rhinology 38(2):83–86

    CAS  PubMed  Google Scholar 

  37. Ramamurthy L, Wyatt RA, Whitby D, Martin D, Davenport P (1997) The evaluation of velopharyngeal function using flexible nasendoscopy. J Laryngol Otol 111(8):739–737

    Article  CAS  PubMed  Google Scholar 

  38. Rene C, Rose GE, Lenthall R, Moseley I (2001) Major orbital complications of endoscopic sinus surgery. Br J Ophthalmol 85(4):598–603

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Rombaux P, de Toeuf C, Hamoir M, Eloy P, Bertrand B, Veykemans F (2003) Transnasal repair of unilateral choanal atresia. Rhinology 41(3):31–36

    PubMed  Google Scholar 

  40. Schilling C, Will K, Lochner P (2008) Die endonasale endoskopische Dacryo-Zysto-Rhinostomie: Erfahrungen über 18 Jahre. Klin Monatsbl Augenheilkd 4:225

    Google Scholar 

  41. Seccia V, Dallan I, Massimetti G, Segnini G, Navari E, Fortunato S, Bajraktari A, Lenzi R, Muscatello L, Sellari-Franceschini S (2014) Patient-related and ENT-related predictive factors based on the pain experienced during flexible nasendoscopy. Laryngoscope 124(7):1648–1652

    Article  PubMed  Google Scholar 

  42. Sharp HR, Crutchfield L, Rowe-Jones JM, Mitchell DB (2001) Major complications and consent prior to endoscopic sinus surgery. Clin Otolaryngol Allied Sci 26(2):33–38

    Article  CAS  PubMed  Google Scholar 

  43. Stammberger H, Hawke M (1997) Practical endoscopy of the nose, sinuses and anterior skull base. Martin Dunitz, London

    Google Scholar 

  44. Streitmann MJ, Otto RA, Sakai CS (1994): Anatomic considerations in complications of endoscopic and intranasal sinus surgery. Ann Otol Rhinol Laryngol 103(2):105–109

    Article  CAS  PubMed  Google Scholar 

  45. Strutz J, Mann W (2010) Praxis der HNO-Heilkunde, Kopf-Halschirurgie. 2. Aufl. Georg Thieme Verlag, Stuttgart

    Google Scholar 

  46. Ungkanont K, Friedman EM, Sulek M (1998) A retrospective analysis of airway endoscopy in patients less than 1-month old. Laryngoscope 108(11):1724–1728

    Article  CAS  PubMed  Google Scholar 

  47. Vleming M, Middelweerd RJ, de Vries N (1992) Complications of endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 118(6):617–623

    Article  CAS  PubMed  Google Scholar 

  48. Weber R, Draf W, Keerl R, Schick B, Saha A (1997) Endonasal microendoscopic pansinusoperation in chronic sinusitis. II. Results and complications. Am J Otolaryngol 18(3):247–253

    Article  CAS  PubMed  Google Scholar 

  49. Weber R, Draf W, Kratzsch B, Hosemann W, Schaefer SD (2001) Modern concepts of frontal sinus surgery. Laryngoscope 111(1):137–146

    Article  CAS  PubMed  Google Scholar 

  50. Welkoborsky HJ, Graß S, Deichmüller C, Bertram O, Hinni ML (2015) Orbital complications in children: differential diagnosis of a challenging disease. Eur Arch Otorhinolaryngol 272(5):1157–1163

    Article  PubMed  Google Scholar 

  51. West JM (1910) A window resection oft he nasal duct in case of stenosis. Trans Am Opthalmol Soc 12(2):659

    Google Scholar 

  52. Wilke M (2008) Diagnostischer Nutzen der Dakryoendoskopie im Vergleich zur Dakryozystographie und Tränenwegspülung. Med. Dissertation, Ludwig-Maximilians-Universität München. https://edoc.ub.uni-muenchen.de/9470/1/Wilke_michaela.pdf

  53. Zhang S, Liu Y, Tan Y, Zhang J, Xiao J (2009) Complication and prevention of transnasal endoscopic adenoidectomy in children. Zhong Nan Da Xue Xue Bao Yi Xue Ban 34:834–836

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland

    J.-H. Lenz, A. Dieckmann & B. Frerich

  2. Poliklinik für Kieferorthopädie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland

    B. Koos

Authors
  1. J.-H. Lenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Koos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Dieckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Frerich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.-H. Lenz.

Ethics declarations

Interessenkonflikt

J.-H. Lenz gibt an, dass kein Interessenkonflikt besteht.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Fall von nichtmündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

Additional information

Redaktion

W.M.H. Kaduk, Greifswald

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lenz, JH., Koos, B., Dieckmann, A. et al. Endoskopie bei der Versorgung von Fehlbildungspatienten. MKG-Chirurg 8, 232–238 (2015). https://doi.org/10.1007/s12285-015-0030-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12285-015-0030-5

Schlüsselwörter

Keywords

Search

Navigation