Zur chirurgischen Therapie des invertierten Papilloms (Epithelioms) der Nase und Nasennebenhöhlen
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Surgical therapy of inverted papilloma of the nose and paranasal sinus
The inverted papilloma is preferably located in the middle nasal concha and the middle nasal meatus. Dealing with the histological benign tumor, however malignant because of his tendancy to increase in direction of the stroma, it leads terminating from here to invasion in the neighbouring nasal conchas, the orbit wall and the cranial fossa. Aim of the surgical therapy is a total removal and the shaping of a controlable cavity. If merely the middle nasal concha and the middle nasal meatus is invaded, we resect pernasal permaxillary the middle maxillary sinus wall, just as the ethmoid cell system with resection of the middle nasal concha. If the ethmoid cell system is invaded the removal is to be done with a paranasal cutt in addition, besides this an optical controle is to be done (the frontal sinus punction of Kümmel-Beck, controle by Hopkins Optic), in positive conditions we do the frontal sinus operation in the usual way. The sphenoidal sinus should be diclosed largely — because otherwise the postoperative optical controle is impossible. Tumorinvasion in the orbit soft tissue is an indication for exenteratio orbitae. Is one side of the septum invaded the resection of the mucous membrane and of the perichondrium of this side is to be done, only if the cartilage is not yet worn out. Is the cartilage invaded and/or the septum perforated the septum in this region is to be removed totally.