I.Relation between epithelial function of maxillary sinus and thickness of mucous membrane.
Fifty per cent Molojodol wa s injected into the maxillary sinus and X-ray films from the occipito-frontal direction were taken in prone (face down) and normal (standing) positions.Thus, in 245 cases on 475 sides, comparative were studies made as tothe relation between the M. shadow type which expressed the epithelial function of the sinus mucous membrane and the thickness of the mucous membrane. In most cases the intensity of lesion judged from these roentgenograms paralleled the epithelial fuaction. However, a lowered epithelical function was found in some patients with slight thickness of the sinus mucous membrane and a relatively good epithelial function in some with marked thickness of the mucous membrane. The discrepancy between the lesion in the tunica propria of the sinus mucous membrane and the epithelium function was supposed to be due to the difference of improvement and worsening, above all reversibility, between them. Therefore, in chronic maxillary sinusitis, the examination of the thickness of the sinus mucous membrane combined with the roentgenological functional examination assured a higher diagnostic value.
II. Chronic maxillary sinusitis observed seasonly and yearly by roentgenological functional examination.
A follow-up roentgenological functional examination was made on fifty-two patients with chronic maxillary sinusitis of varying intensity for more than three years and the improvement and worsening were studied in relation to season, age episodes of cold, malformation of the septum nasi and others. In four cases (7.7%) unilateral paranasal sinusitis was always observed throughout the observation period. The epithelial function of mucous membrane did not always change bilaterally in parallel. The great difference which was observed at one time was supposed to be due to the abnormal structure in the nasal cavity and the anatomical pathological abnormalities near the meatus of the sinus. In aditions, from the change in the M. shadow type, a labile state of mucous membrane was assumed. It was also confirmed that, by slight inflammation during repeated attects of cold, the epithelial function was lowered and the symptoms were worsened. From the above stated results, among the various factors which developed and fixed chronic paranasal sinusitis, three, repeated slight inflammation, abnormal structure in the nasal cavity and predisposition of the sinus mucous membrane, presumably played an important part.
III. Effects of plastic operation of nasal cavity on chronic maxillary sinusitis which was studied by roentgenological functional examination.
A follow-up roentgenological functional examination was made on 20 patients, on whom plastic operation of nasal cavity and fenestration of maxillary sinus combined with pernasal opening of ethmoid cellulae had been made, to study the healing process of the mucous membrane of the maxillary sinus for the periods ranging between one month and four years. In most cases the state of the sinus mucous membrane was worsened for a while after the operation. However, it soon recovered and the healing process proceeded. Though this process was different in each case, in those with marked lesions of the sinus mucous membrane, the marphological recovery of the mucous membrane was not observed pathohistologically even after the recovery of the epithelial function and healing was achieved in the form of the production of con-nective tissue.
This operation is indicated for the patients with abnormal structures in the nasalcavity and with the focus of paranasal sinusitis in the ethmoid cellulae. Even if it is applied to those with paranasal sinusitis of considerably severity, sufficient cure can expected with suitable after-treatment. Therefore, this trertment has an indication wider than that which has been hitherto accepted.
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