Indikation zu operativen Eingriffen im Bereich des Nasenrachenraumes und der mittleren Schädelbasis

Summary

The size of pathological finding and the histopathologic substrate in the nasopharynx and the mid-portion of the skull-base is decisive for all operative procedures in this region. Pathological changes due to trauma are exeptions.

Furthermore, the operative indication is dependent on age and health condition of the patient. The risks as well as the necessity of the operation must be carefully considered.

Besides routine diagnosis which includes endoscopy and biopsy, tomograms, angiograms and other supporting examinations are necessary.

For the treatment of malignancies of the nasopharynx and the middle of the base of skull the high voltage irradiation of the primary tumor and regional lymphnodes is the therapy of first choice. It can also be used in combination with cytostatic drugs or in the form of synchronization. The indication for operative procedure is given only in few cases.

Today, operative approach is only indicated for benign pathological changes — some few other cases excepted. The removal of small benign tumors (cysts, fibromas, choanal polypes), the inferior conchotomy or hyperplastic tubal elevations can be performed directly looking through a nasopharyngeal endoscope. The same is true for the removal of cicatricial stenosis or mucosal scars. With deformations (choanal atesia) the transpalatinal way of approach is preferred to others. This method is also convenient for large tumors of the nasopharynx, the choanas and the middle of the base of the skull. With plastic reconstruction a good functional result can be obtained. This is shown with own examples.