涙道のレ線学的研究知見補遺
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概要
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The lacrimal passage shows a tendency to be affected by the diseases of the nasal cavity and paranasal sinuses which adjoin it. A roentgenographic study of the lacrimal passage made by the author in several kinds of diseases of the nose has clarified some aspects of the diseases of the nose, and has produced results which would be of great diagnostic value in the treatment of the diseases by surgery. Roentgenographic images of the lacrimal canaliculi, lacrimal sac and nasolacrimal duct of 94 patients with diseases of the nose which do not have any destructive influences on, or tend to infiltrate, the lacrimal passage (50 patients with chronic paranasal sinusitis, 21 patients who had had their paranasal sinuses operated on, and 23 patients with atrophic rhinitis), along with those of 20 normal persons, were subjected to an analytical study. The images of lacrimal canaliculi of the patients showed no deviation from the normal image; the images of the lacrimal sace of the patients, which showed no marked deviation from the normal image in the outline indicating the nature of the mucous surface, were found to show no significant changes in form as compared with the normal image. The roentgenographic images of the lacrimal sacs of the patients were measured, and the sacs 3 mm wide or less than that in posteroanterior view and 5.5 mm wide or less than that in lateral view were classified as normal, and the sacs having widths larger than these standards were classified as dilated. It was shown that the lacrimal sacs of the patients did not show any tendency to dilatation. The roentgenographic images of the nasolacrimal ducts of the patients were measured at the upper, middle and lower parts, and the ducts 0.8 mm wide or less than that in posteroanterior view and 1.2 mm wide or less than that in lateral view were classified as strictured. It was revealed that a considerably large number of patients had strictured nasolacrimal ducts. Then, roentgenographic images of the nasolacrimal ducts were classified into the following 5 types according to the differences in width between the three parts of a duct (a duct of which the differences in width were less than 0.9 mm was assumed as having an overall equal width.): 1. Type. I, ducts of an equal overall width, 2. Type II, ducts of which the lower part is wider than the other parts, 3. Type III, ducts of which the middle is narrower than the other parts, 4. Type. IV, ducts of which the middle is wider than the other parts, 5. Type V, ducts of which the lower part is narrower than the other parts. It was shown that the majority of normal persons had the nasolacrimal ducts of type I , II or III, while many of the patients were found to have the nasolacrimal ducts of type IV or V. It was revealed that abnormal outline of the duct, the tendency of the shade of a duct becoming lighter in the patients when visualized by means of contrast medium (moljodol), and abnormal distribution of the duct were observations which suggested that there might be inflammation in the lacrimal pessage, though none of these observations could in itself be a factor definitely indicating the presence of inflammatory changes in the lacrimal passage. The complete removal of the anterior ethmoid cells by means of Kitamura's paranasal method has attained favorable results in several cases in which the spread of inflammation of the paranasal sinuses, especially of the anterior ethmoid cells, to the lacrimal passage had been confirmed. For the purpose of clarifying the degree and manner of the process of the invasion of diseases to the lacrimal passage, the author next made a roentgenographic study of 40 patients with diseases of the nose which have destructive influence on, or tend to infiltrate, the lacrimal passage (20 patients with malignant tumors, 7 patients with postoperative cyst of accessary sinus, 6 patients with mucocele, etc.). It was shown in patients with malignant tumors that there were no other characteristic changes in the lacrimal sac than marked dilatation, that the nasolacrimal ducts were marked by defects and abnormal distribution, and that this observation, along with the observation that the images of the ducts were lighter in shade would afford an important clue to the extent of development of a tumor. It would be possible to determine whether the circumstances responsible for the abnormal image of a nasolacrimal duct is benign or malignant, if, in passing judgment, the differences between the image of a duct rendered abnormal owing to the development of a malignant tumor and the image of a duct pushed aside by some benign causes is taken into consideration.
- 千葉大学の論文