両側外転神経麻痺を来したアレルギー性真菌性鼻副鼻腔炎の1例  [in Japanese] A Case of Bilateral Abducens Nerve Palsy Caused by Allergic Fungus Rhinosinusitis  [in Japanese]

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Author(s)

    • 井伊 里恵子 Ii Rieko
    • 筑波大学耳鼻咽喉科・頭頸部外科 Department of Otolaryngology Head and Neck Surgery, University of Tsukuba
    • 田中 秀峰 Tanaka Shuho
    • 筑波大学耳鼻咽喉科・頭頸部外科 Department of Otolaryngology Head and Neck Surgery, University of Tsukuba
    • 原 晃 Hara Akira
    • 筑波大学耳鼻咽喉科・頭頸部外科 Department of Otolaryngology Head and Neck Surgery, University of Tsukuba

Abstract

<p>骨破壊を伴う鼻副鼻腔疾患の鑑別としては,浸潤性副鼻腔真菌症,アレルギー性真菌性鼻副鼻腔炎(AFRS:Allergic fungal rhinosinusitis),鼻副鼻腔悪性腫瘍などが挙げられる。</p><p>今回我々は,斜台部骨欠損を認め,両側外転神経麻痺を来したAFRSの1症例を経験した。症例は4年前より慢性副鼻腔炎に対して内服加療歴のある29歳女性。運転中に複視を自覚し,眼科で両側外転神経麻痺を指摘された。CTでは左上顎洞篩骨洞蝶形骨洞,右蝶形骨洞に軟部陰影を認め,斜台後壁の骨は広範に欠損していた。内視鏡下鼻副鼻腔手術を施行し,術後2日目に複視の自覚は改善した。蝶形骨洞後壁から斜台の骨欠損が広範であったため,斜台後方を走行する両側の外転神経が,橋前面から海綿静脈洞内に入るところで障害を受け,両側外転神経麻痺の症状が生じたと考えられた。</p>

<p>Invasive fungal rhinosinusitis, allergic fungal rhinosinusitis (AFRS), and malignant tumor should be considered for a bone defect found on a sinonasal CT scan.</p><p>We report a case of bilateral abducens nerve palsy caused by AFRS with a bone defect at the clivus.</p><p>The case was a 29-year-old woman with a history of sinusitis for four years. She visited the Department of Ophthalmology due to a sensation of double vision when she was driving a car. Ophthalmological examination showed bilateral abducens nerve palsy. CT showed soft tissue density in the left paranasal sinuses and right sphenoid sinus, and bone defect at the clivus. Two-days after ESS, double vision was improved.</p><p>The wide bone defect caused by the sphenoid lesion at the posterior wall of the sphenoid sinus and clivus might affect the bilateral abducens nerves in front of the pons or at the Dorello's canal.</p>

Journal

  • Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology)

    Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology) 57(4), 631-636, 2018

    Japan Rhinologic Society

Codes

  • NII Article ID (NAID)
    130007535894
  • Text Lang
    JPN
  • ISSN
    0910-9153
  • Data Source
    J-STAGE 
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