蝶形骨洞炎の手術とその適応症

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タイトル別名
  • SPHENOIDECTOMY AND ITS INDICATION
  • 蝶形骨洞炎の手術とその適応性
  • チョウケイコツドウエン ノ シュジュツ ト ソノ テキオウセイ

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As the reliable findings to determine the indication for sphenoidectomy the author has noticed the endoscopic examination of the spheno.ethmoidal recess, into which the sphenoid sinus opens.The author has developed an endoscopic apparatus for this purpose. With this apparatus we can study pathological condition in the sphenoid sinus. However, to determine whether the radical operation should be performed or not, first we have to open the sinus. In the cases, in wliieh sphenoiditis is suspected, usually ethmoiditis is also present. Therefore, following to the ethmoidectomy, we open the sphenoid sinus. We use tomography to study the relation of the sphenoid sinus to the ethmoid sinus. With this approach, the location of the sphenoid sinus is easily determined and a small trial opening is made.<br>The author prefers the maxillary approach, and the endonasal approach is avoided as much as possible. For the adaquate exposure of the sinus in the endonasal approach, usually the middle concha is broken. Although it is repaired after the operation, it offen causes postoperative chronic obstruction of the middle nasal meatus. This causes diffiiculty during the immediate postoperative period by obstructing the drainage from the ethmoid sinus.<br>A short description of the procedure is as follows: The sphenoid sinus is exposed through the maxillary sinus. Then, using special bone forceps designed for this purpose, the anterior wall of the sphenoid sinus is excised.<br>Thus a wide opening is made between the posterior nasal cavity, the posterior ethmoid sinus and the sphenoid sinus. This allows good drainage from these sinuses.<br>The author suggests that the removal of the mucous membrane must be done only when the membrane is remarkably swollen. Histologic examination of the mucous membrane of the sphenoid sinuses from these patients, revealed characteristic changes mainly chronic fibrous reaction indicating the process of healing and for these cases, radical operation is not indicated.

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