Zusammenfassung
In Anbetracht ihrer stetigen Zunahme ist der Hals-Nasen-Ohren-Arzt mehr und mehr in die Frühdiagnostik und Therapie von Hauttumoren des Gesichts eingebunden. Prominente sonnenexponierte Zonen wie Nase, Stirn, Wange und Ohrmuschel sind am häufigsten betroffen, aktinische Keratose und Basalzellkarzinom die häufigsten Diagnosen. Chirurgische Tumorentfernung und Defektdeckung orientieren sich an der Histologie sowie den anatomischen Besonderheiten und respektieren v. a. Dicke und Verschieblichkeit der benachbarten Haut. Generell werden kleine bis mittelgroße Defekte in Regionen gut verschlieblicher Haut mittels einfacher Naht oder Dehnungsplastik verschlossen. Größere Defekte oder Problemzonen betreffende Tumoren erfordern spezielle Techniken der Defektdeckung unter Zuhilfenahme verschiedener gestielter Lappenplastiken oder freier Transplantate. Die Entfernung ausgedehnter Tumoren macht mitunter rekonstruktive Eingriffe an N. facialis, Ductus parotideus und Ductus lacrimalis erforderlich. Gleiches gilt für die Gerüststrukturen von Augenlid, Nase und Ohrmuschel.
Abstract
As the incidence of facial skin tumors is rising, otorhinolaryngologists are becoming more and more involved in the field of facial plastic surgery. The most common tumor locations on the head are the sun-exposed areas such as the nose, forehead, cheek, and auricle. The most common histologic findings are actinic keratosis and basal cell carcinoma. In planning tumor resection and defect repair, many factors, including histology, size, and localization of the tumor as well as conditions of the adjacent skin, must be considered. The key to defect repair after tumor resection is to choose the most appropriate technique from a range of possibilities. Because of skin laxity, most small and midsize facial defects can be closed directly or with high-tension sutures under skin expansion. More extensive defects and those located in critical areas require pedicled flaps or free grafts transferring skin from adjacent or distant areas. In patients with recurrent or deeply infiltrative tumors, reconstructive procedures of the facial nerve, parotid duct, and lacrimal duct might be needed. This is also true for reconstruction of the anatomic framework of the eyelids, the nose, and the pinna.
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Heppt, W. Chirurgie von Hauttumoren des Gesichts. HNO 57, 324–335 (2009). https://doi.org/10.1007/s00106-009-1893-4
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DOI: https://doi.org/10.1007/s00106-009-1893-4