上顎洞炎根本手術における中鼻道開大についての臨床的及び実験的研究 (服部浩教授開講10周年記念論文集)
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A new operative procedure for the radical treatment of maxillary sinusitis was first tried in the Department of Otolaryngology, Kobe University School of Medicine in May 1967, in which the maxillary sinus ostium was enlarged and the middle meatus opened, instead of establishing a counter opening in the inferior meatus. Since then, 5 patients were similarly treated in the Department. Furthermore, 108 cases in which the same operative procedure was applied, were experienced during 7 years in the Department of Otolaryngology, Osaka Dental University.One hundred and thirteen patients were similarly treated in the last 9 years. The present report describes the clinical significance of the procedure, and discusses it based on an experimental nasal-maxillary model.1) Operative procedure: In the radical operation of maxillary sinusitis, after complete removal of the mucous membrane of the maxillary sinus, (a) the bone wall of the inferior meatus, (b) the bone of the inferior concha of the hiatus sinus maxillaris, i. e. Crista conchae, (c) the membranous part of the hiatus sinus maxillaris, and (d) mucus membrane of the middle meatus side of the inferior concha, are removed in that order. At the completion of the operation, it is confirmed that the free edge of the middle concha and the nasal septum can be seen from the maxillary sinus side.Namely, the hiatus sinus maxillaris is anatomically opened.2) The post-operative regeneration tissue in the sinus develops from the lateral inferior side, and is eventually replaced by connective tissue in 3 months to 3 years. The regenerated maxillary sinus can be roentogenographically seen as an excavation connected with the middle meatus.3) According to questionnaires, our patients are progressing favofably.4) In an experimental model with an enlarged sinus ostium, ventilation within the maxillary sinus is well done on expiration.5) No later complication such as postoperative maxillary cyst is noted.
- 耳鼻咽喉科臨床学会の論文
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