鼻腔形態と副鼻腔炎鼻副鼻腔粘膜病態の可逆性の検討

鼻腔形態整腹の意義について

抄録

Persistent disturbance of the physiological respiratory function of the nasal cavity is a major factor in the pathogenesis of chronic sinusitis, the causes for this in particular being adenoids in early childhood or deviation of the nasal septum which makes itself distinct around the age of 10.
About 1, 000 patients with chronic sinusitis who came to our university hospital over a three-year period (1973-1975) were radiologically examined (12 tomograms at intervals of 5 mm along the antero-posterior diameter and plane x-rays from three different angles were taken for each patient) in order to carry out a diagnosis of lesions in the paranasal cavity and also obtain measurements of the nasal cavity.
For morphological assessment of the nasal cavity, it was divided into its soft and hard parts consisting of soft tissue and bones and cartilages, respectively, and each of these parts was measured at three different sites along the antero-posterior diameter of the nasal cavity. In addition, color photographs of the nasal cavity were taken and the airflow through it checked (by anterior and combined methods) to investigate the relationship between the variation with time of the airflow through the cavity and its structure, and also between lesions in the paranasal sinus and its structure.
The following conclusions were reached:
1. Adenoids apparently give rise to sinusitis in infants by exerting a simple but unfavorable effect on the width of the nasal cavity and hence the airflow through it.
2. There is a tendency in children aged 5 to 10 for nasal cavity lesions to predominantly occur on the convex side of septal deviation (narrower side of the nasal cavity).
3. It is presumed that septal deviation in adults is a major factor in subnormality of the nasal cavity structure, followed by deviation of the bony structure and then by chronic transformation of soft tissue.
4. In cases of septal deviation of a moderate or lesser degree, swelling or hypertrophy of the interior turbinate is seen more frequently on the concave side rather than the convex side of the nasal cavity, with a tendency at the same time for paranasal lesions to predominantly occur on the concave side.
5. Severe septal deviation with curvature of the upper septum is associated with narrowing of the nasal cavity on its convex side, i.e., stenosis or obliteration of the middle nasal meatus as well as a predominance of paranasal lesions on the convex side.
Finally, there also were some cases in which pathological mucosa of the. paranasal cavity returned to a normal condition in about three months after reconstruction of the nasal cavity (with paranasal mucosa conserved).