下鼻甲介後端付近の鼻出血について
特に動脈に対する形態学及び組織学的研究
1988 年 31 巻 Supplement6 号 p. 659-673
詳細
1988 年 31 巻 Supplement6 号 p. 659-673
Epistaxis is encountered rather frequently in daily practices. Bleeding from Kiesselbach's area has long been the title of many studies. However, many points remain unelucidated concerning bleeding from the posterior area of the nasal cavity.
In the present study epistaxis from infraturbinal posterior end was investigated variously by clinical statistical analysis and roentgonography using contrast medium. Moreover, the infraturbinal posterior end was studied using vascular mold preparation and skull of the carcass, and running of arteries in this area was investigated histologically.
Following results were obtained:
1. It was postulated that the arteries which are responsible for epistaxis around the infraturbinal posterior end are the sphenopalatine artery and the descending palatine artery (in particular the major palatine artery).
2. In the lateral posterior nasal branch of the sphenoplatine artery, there was a site where the blood vessel considerably approaches the mucosa similar to the Kiesselbach's area. After departing from the spheno-platine foramen the lateral posterior nasal branch showed vascular structure different from that before it leaves that foramen. There was a site where the thickness of the tunica media became not constant and the adventitia was in direct contact with the internal elastic plate. In addition, about 10 mm posterior to the infratubinal posterior end, there was a site where adipose tissue of the surrounding area is scanty and the border between the adventitia and the surrounding connective tissue is not obvious. It was assumed that blood vessel is broken relatively easily through external force to the blood vessel and intravascular pressure.
3. The bone defect of the internal wall of the major palatine artery was found in as high as about 28% of cases. In this area, arteries are considerably approximating to the submucosa. Therefore, it is postulated that blood vessels of this area are relatively easily broken by external force to the blood vessel and intravascular pressure.
