Palatinale Gefühlsstörungen nach Septumkorrektur

 

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Zusammenfassung

Gefühlsstörungen am harten Gaumen nach Nasenscheidewandkorrektur sind auf Läsionen des Nervus nasopalatinus am Nasenboden zurückzuführen. In einer prospektiven Studie an 31 Patienten haben wir diese semiquantitativ und subjektiv in ihrem zeitlichen Verlauf untersucht. Hierzu wurde die Schleimhautsensibilitätsschwelle mit Hilfe von Gleichstromimpulsen vor und 1 Woche nach Septumkorrektur bestimmt und diese Ergebnisse durch subjektive Angaben der Patienten ergänzt. Weder nach unilateraler noch nach bilateraler Anlage von Nasenbodentunneln konnte eine signifikante Anhebung der Empfindungsschwelle der palatinalen Schleimhaut gemessen werden. Charakteristische Mißempfindungen hatten 1 Woche postoperativ 32% und 4 Monate postoperativ noch 16% der Patienten. Dauerhafte Sensibilitätsausfälle mit subjektiven Beschwerden sind aufgrund der überlappenden Innervierung der Gaumenschleimhaut nicht zu erwarten. Bei schwierigen Problemen muß daher nicht auf die Anlage von Nasenbodentunneln verzichtet werden.

Summary

A certain percentage of patients complain of numbness or pain in the palatine mucosa, posterior to the incisors, following septal surgery. The symptoms arise from lesions of the nasopalatine nerve near the floor of the nose. In order to demonstrate the sequelae of these lesions, we performed a prospective study on 31 individuals undergoing septoplasty. A maxillary-premaxillary approach to the nasal floor was used on one side in a group of 13 patients and on both sides in a group of 18 patients according to the respective unilateral or bilateral septal pathology. Unilateral or bilateral division of the nasopalatine nerves was anticipated. The threshold of sensitivity to a direct current of up to 500 mA with pulses of 100 msec duration was determined preoperatively. The test was repeated 8 days postoperatively at 5 defined points of the palatine mucosa: posterior to both incisors and both canine teeth and at the incisive papilla. In addition, the patients were questioned about distinct palatine sensations 8 days and 3 to 5 months after septoplasty. Neither group showed any significant elevation of the threshold of sensitivity to a direct current 8 days postoperatively, regardless of whether unilateral or bilateral subperiostal tunnels of the nasal floor had been. However, thirteen patients (32%) described disturbances of sensitivity, most frequently numbness or soreness. The symptoms occured in both groups with equal distribution. After an interval of 3 to 5 months postoperatively, 16% of all operated patients still had some kind of palatine discomfort. The nasal foramen of the incisive canal is located at the fusion of maxilla and premaxilla. The nasopalatine nerve (incisive nerve) is transected in a standard maxillary-premaxillary approach to the septal base. This can also be performed bilaterally without fear of relevant sequelae as shown by the results of our prospective study. Branches of the greater palatine nerve provide additional sensory supply to the anterior palatine mucosa.