An extranasal transethmoidal approach has been applied for optic canal decompression surgery in patients suffering from indirect traumatic optic neuropathy. However, this approach does not always offer a wide operative field to surgically manage the entire course of the optic canal, because the medial wall of the orbit bulges medially.
In the last two years, we have performed optic canal decompression surgery in four patients who suffered from indirect traumatic optic neuropathy. Three of these patients underwent optic nerve decompression by an endonasal approach under endoscopic control and one patient by a transcranial approach. Two of the three patients who were operated on by the endoscopic endonasal approach showed a remarkable improvement in their visual acuity after surgery. The other lost his vision six days after surgery, because it was not possible to remove a relatively large bone fragment of the skull base which had compressed the optic nerve from above. One patient who underwent optic nerve decompression transcranially markedly recovered his vision.
Compared to the external transethmoidal approach, endoscopic endonasal and transcranial approaches can provide a wide operative field for the decompression of the optic nerve. In addition, an endonasal approach under endoscopic control is less traumatic than an extranasal transethmoidal approach. A transcranial approach is also useful for the patients with severe skull base bone fracture.

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Pleomorphic adenoma usually occurs in the salivary gland, and is rarely seen in the nasal cavity. Pleomorphic adenoma which originates from the lateral nasal wall less common than from the nasal septum.
A 33-year-old man complained of nasal transformation. He had a large, hard, white, smooth tumor that originated from lateral nasal wall in his nasal cavity. The tumor was removed by the intranasal approach and Denker's operation. His tumor was diagnosed as pleomorphic adenoma. There has been no recurrence for three years.

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今回我々は, 鼻中隔癌症例を経験したので報告する。我々が調べ得た範囲内では鼻中隔原発の悪性腫瘍の報告は本邦文献において109例であった。しかし, 原発性鼻中隔腺癌は, わずか10例しか認められず (9.2%), 比較的まれな症例であった。
症例は55歳の女性で, 主訴は鼻出血であった。鼻中隔後端に有茎性の楕円形で小指頭大の腫瘤を認め, 全麻下懸垂頭位にて絞断器を用いて鼻中隔後端粘膜より切除した。病理組織検査で, 外側が正常な線毛上皮と重層扁平上皮に覆われた, 高分化腺癌と診断した。現在術後13ヵ月で再発は認めない。

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Eosinophils are characteristic of the IgE- mediated allergic reaction and may be classified as EG1-positive cells or EG2-positive cells.
Author measured the number of EG1- and EG2-positive cells in the nasal mucosa of the perennial allergic rhinitis patients using an immunohistochemical procedure. Thirty-six patients with HD mite (D. f, D. p) nasal allergy without treatment (Group II), twenty patients treated with topical steroid spray (Group III), and twenty normal controls (Group I) were studied by staining with monoclonal antibodys EG1 and EG2 using a LSAB kit. The number and the ratio of EG1- and EG2- positive cells were correlated with nasal symptoms and severity. In addition the relationship between EG2- positive cells and the RAST score was examined.
In untreated patients (Group II), the number of EG1- and EG2-positive cells and the ratio of EG2/EG1-positive cells were significantly higher than in patients treated with topical steroid spray (Group III) (p<0.05). A significant correlation between the number of EG2-positive cells and severity of symptoms as noticed seen in patients who did not receive treatment (Group II) (p<0.05).
In conclusion, we have demonstrated a role for EG2-positive cells (which contain the secreted form of ECP) in the pathophysiology of perennial allergic rhinitis, and the use of topical steroid spray can modulate the infiltration and activation of eosinophils in the nasal mucosa.

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We were studied the autoradiographic localization of H₁ Receptors (H₁ R) and H₂ receptors (H₂ R) in human nasal mucosa. Autoradiograms indicated that H₁ R exist on the basement membrane directly under the epithelium and vessel smooth muscle, and that H₂ R exist on the lamina propria mucosa directly under the basement membrane and vessel smooth muscle.

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The Smell Identification Test (SIT; 12 odors) was developed as an olfactory test which can be used outside of the United States. This test has been found useful for clinical assessment of olfactory function in Japan. In this study, 81 normal volunteers and 93 patients with complaints of olfactory dysfunction, ranging in age from 20 to 79 years, were given the SIT and a quantified questionnare about their ability to smell (full mark 30). In the normal group, the mean score of the SIT was 9.8; in the patient group it was 5.9. The percentage of correct answers for each item in the normal group was significantly higher than that in the patient group (p<0.05). However, older persons (more than 65 years old) showed the poorest performance in the SIT. There was a relatively high correlation between the SIT scores and the scores of the questionnaire (Spearman; r=0.77).

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During the season of cedar pollen dispersion in 1996, specific IgE and IL-4 levels in serum and nasal mucosa were determined with time in volunteers who have cedar pollen allergy. In comparison with the serum IgE level determined on January 24 as the baseline value, both values determined during and two months after the cedar pollen season decreased significantly. This was further supported by simultaneously changed IL-4 levels, though the rate of change was relatively small. However, the fact that the determination was performed in a year of small amount of dispersed pollen might have influenced the result. Since changes in IgE and IL-4 levels before and after induction for 6 consecutive days during the nondispersion period showed an increasing trend especially in the nasal mucosa. a possibility was suggested that IgE antibody began to be produced on January 24 when a small amount of cedar pollen had already been dispersed. Since IgE levels in the nasal mucosa decreased during the dispersion period and recovered around two months after dispersion, a possible relation of production to consumption was indicated. Though the mucosal IgE and IL-4 levels were determined in a minimal sample of a mucosal abrasion fragment, these values correlated well with serum IgE levels. Thus this method of determination seemed to be of value for future application.

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Three cases of aspergillosis of the paranasal sinuses with the orbit and the skull base invasion are reported. Two patients had diabetes mellitus. Symptoms of continuous headache, fever and anorexia were found in all patients, and sudden blindness, ocular proptosis and paralysis of eye movement were observed in two patients. The characteristic CT finding in invasive aspergillosis was that the destruction of the posterior wall of the maxillary sinus or the medial orbital wall was small compared with the size of the mass invading the pterygopalatine fossa or the orbital spase. All patients underwent the Caldwell-Luc operation and were given postoperative antifungal chemotherapy (amphotericin B, flucytosine and fluconazole). One patient died of a brain hemorrhage soon after surgery and the other two died of subarachnoid hemorrhage and general prostration at 2 and 4 months following surgery. We think that the treatment of the invasive aspergillosis of the paranasal sinuses should be determined from the point of view of whether there was invasion of the skull base or not. An extended radical operation with eye ball extirpation is recommended in case skull base invasion is not found by CT evaluation. Otherwise a small local operation instead of an extended radical operation is recommended to avoid brain hemorrhage following surgery. But it must be noted that the risk of brain hemorrhage still remains even if such a small operation is selected.

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Twenty six maxillary sinuses of 22 patients who suffered from post-operative maxillary cyst (POMC) were studied. Their chief complaints were pain of the cheek or the gum and swelling of the cheek. The average age of the patients was 49.5 years old. All of them had been treated for bilateral chronic sinusitis by the Caldwell-Luc procedure between 16 to 39 years ago. The coronal plane computerized tomographic scans (CT) were taken both before and after surgery in which a counter opening between the cyst and inferior nasal meatus was made by Caldwell-Luc procedure. The maxillary portions of these CT images were categorized into four groups as follows; (1) the whole maxillary portion was replaced with scar tissue, (2) reduced maxillary cavity without any high density area, (3) reduced maxillary cavity with some high density area, (4) reduced maxillary cavity filled with high density area. Twenty maxillary sinuses (76.9%) were evaluated as showing good healing and were classed as groups (1), (2) or (3). Six sinuses needed careful follow-up, and these CT images were group (4).
In general, extensive POMCs which had on occasion destroyed maxillary bone showed good healing after surgery. The authors suggested three reasons for these results, the first reason was that the cells and glands of the inner wall of the cyst were damaged by the pressure of the contents of the cyst. The second was that the tissue around the cyst pressed the cyst which lost its tension after surgery. The third was that it was easy to make a suitable sized counter opening because of pressed thin bony wall of inferior nasal meatus. As a surgical procedure, the establishment or reopening the counter opening of the inferior nasal meatus without removal of the whole cyst is safe and effective.

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