The authors report an unusual case of primary frontal sinus cyst. The patient is a 26-year-old man whose chief complaints were a swelling and pain at the left frontal sinus.
At operation, the frontonasal duct was found to be wide open and the main frontal sinus to be intact with normal mucosal lining, but with a cyst at the lateral aspect of the sinus.
The authors speculated the cause of the disease to be that either one of the partitions of the frontal sinus had undergone inflammation with subsequent scar formation isolating a lateral cell or a cell within the depth of the frontal bone had been isolated after inflammatory obstruction of its draining outlet.

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A case of case of carcinoma originating in the frontal sinus was treated by a combination of Co⁶⁰ irradiation, chemotherapy and surgery. The prognosis appeared favorable and the patient returned to his work ten months postoperatively without any sign of recurrence.

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The authors summarized the results of obliterations of the frontal sinus with autogenous bone, homogenous bone, Kiel bone and self-prepared deproteinized heterogenous bone, which had been performed during the past 20 years and discuss the possible causes of failures.
Autogenous bone was used in 50 (62 sides), homogenous bone in 36 (49 sides), Kiel bone in 30 (30 sides) and self-prepared heterogenous bone in 19 cases (26 sides).
Recurrence occurred in 4 cases (4 sides) of autogenous bone, two of which were considered due to technical failure, in 3 cases of homogenous bone, in 4 cases (4 sides) of Kiel bone and none with self-prepared heterogenous bone.
Among the above four materials, the authors consider self-prepared deproteinized heterogenous bone as the most convenient for this technique as it is easy to obtain and less expensive than the others.
Failures in the operation may be attributable to
1. failure in total removal of the mucous membrane in the sinus,
2. inadequate treatment of the fistulas,
3. delay in removal of the obliteration material in the early stage of infection if developed,
4. obstruction of the nasofrontal duct,
5. infection of contralateral sinus in the presence of communicating holes,
6. presence of foreign objects in the sinus.

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原発性洞癌は稀な疾患であり, しかも特有な臨床所見や症状がないため洞疾患との鑑別が問題となる。早期発見に努め根治手術を行ってもなお予後不良である。
今回我々は, 原発性洞癌の1例を報告する。患者は77歳女性で, 右部有痛性腫脹を主訴に当科紹介受診した。鼻副鼻腔X線写真で, 右洞の拡大と混濁を認めたため, 全身麻酔下洞鼻外術を施行した。病理組織検査にて, 扁平上皮癌と判明し, 術後電子線照射を行った。術前診断に際し, MRIが他の洞疾患との鑑別に有用であると思われた。

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今回我々は複視, 左眼瞼下垂, 左眼球突出, 左前額部軽度腫脹を主訴とした巨大な洞嚢胞を経験したので報告した。術前CTにて眼窩上壁の骨欠損とともに眼窩内に陥入する境界明瞭な巨大な嚢胞を認め, ほぼ左部全体から頭頂部の近位まで広がっていた。また洞頭蓋内反の消失もあり, 嚢胞が左葉を広範囲に圧迫し, さらに一部脳室も圧排していたが, 葉の局所徴候 (精神症状, 異常反射, 運動失調) などをきたさなかった。このような巨大な嚢胞に対しても, 我々は内視鏡下鼻内手術を選択することにより, 侵襲が少なく安全に開放することができた。

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副鼻腔嚢胞は,術後性嚢胞を含めると上顎洞嚢胞が最も多く,ついで洞,筋骨洞の順であるといわれる.とくに洞嚢胞は約半数の症例において副鼻腔手術の既往がなく,眼部症状を初発症状とし,鼻症状を欠くため,眼科を受診することが多い.最近,われわれは,眼球突出,複視を主訴とした巨大洞嚢胞を経験したので報告する.症例は69歳,男性.徐々に進行する右の眼球突出と瞼裂低位がみられ,複視,流涙を来すようになり,近医眼科を受診した.術前MRIにて右葉を圧排,右簾骨洞,眼窩に進展した巨大洞嚢胞が確認され,手術目的にて当科紹介となった.手術は両側開頭にて嚢胞切除を行ったが,葉硬膜と嚢胞壁の剥離が困難であり,一部硬膜損傷を来した.嚢胞切除後は一部残存する菲薄化した洞後壁を除去,蓋底と副鼻腔を遮断すべく,頭蓋骨膜弁を挙上,再建を行った.術後,一時的に葉徴候がみられたが,術前に見られた眼症状は消失し,整容的にも満足する結果が得られた.

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Cancer of the frontal sinus has been known for its rare occurrence and poor prognosis.
The authors report a case of primary cancer of the frontal sinus in a 60-year-old male, that initially appeared to be a frontal sinus cyst which had probably been induced by a previous trauma to the frontal region.
Exposure of the frontal sinus revealed a primary cancer of the sinus, histologically a squamous cell carcinoma.
Postoperative irradiation is underway on this patient.

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側頭型認知症（FTD）を有する患者に対して，亜酸化窒素吸入鎮静法にクラシック音楽の聴取を併用することにより，歯科処置を終了しえた症例を経験したので報告する。

　患者は67歳，男性。義歯修理が予定されたが，連続する顎タッピングのために通常の治療は困難と判断され，全身疾患を有する患者の全身管理を専門とする全身管理歯科治療部へ紹介となった。既往歴として3年前にFTDと診断され，神経科精神科で外来加療中であった。

　全身管理を担当する歯科麻酔科医が口腔内を診察したところ，患者は口腔内に飴玉を含んでいた。今回，口腔内の飴玉除去への拒否感が強く，また顎タッピングのために歯科治療の実施が困難であったため，亜酸化窒素吸入鎮静法とクラシック音楽の聴取を併用して精神鎮静を図り，3回の歯科処置を行うこととした。

　1回目の歯科治療では，亜酸化窒素の投与開始3分後に飴玉を容易に吐き出した。2回目および3回目の歯科治療では，経鼻カニューラを装着したところ自発的に飴玉を吐き出した。亜酸化窒素吸入鎮静下で，顎タッピングなく3回の治療を終えた。

　理解度の低い認知症患者に対しては，静脈内鎮静法や全身麻酔法が適応となる。

側頭型認知症患者の歯科治療において，亜酸化窒素吸入鎮静法を用いたところ，円滑に歯科治療を施行できたことから，亜酸化窒素吸入鎮静法も認知症患者の行動調整の一方法となりうることが示唆された。

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To examine a relation of angles among the coronal, sagittal and lambdoid sutures to the size of the calvaria as well as to the remains of the metopic suture, 158 adult Japanese calvae or calottes were observed. The calvae used consisted of four groups: group M composed of 74 male calvae without the metopic suture; group F, of 41 female calvae without the same suture; group Un, of 27 sex-unknown calvae without the same suture; and group Um, of 16 sex-unknown calvae with the same sututre. The angles among the sutures were measured at both bregma and lambda. The size of the calvaria was represented by bistephanic arc and breadth (distance between the stephanions), and by parietal sagittal arc and chord (distance from the bregma to the lambda).
Results obtained were as follows. The distances both between the stephanions and from the bregma to the lambda were larger in M than in F, though these distances in M, F and Un were much the same as those in Um. The bistephanic index (breadth/arc) was higher in Um than in F, Whereas the sagittal parietal indices (arc/chrod) in M, F and Um were similar to one another. Apical angle of the frontal squama was larger in M than in F, and was larger in Um than in M and F. However, apical angle of the occipital squama showed no difference among M, F and Um. Finally, a positive correlation was found between the bistephanic distance and the apical angle of the frontal squama only in Um, because the course of the coronal suture was more curved in Um than in M and in F.
Thus it was concluded that in either sex the angles among the sutures at both bregma and lambda are almost constant without distinction of the size of the calva, and that the apical angle of the frontal squama is larger in males than in females, and further that in both sexes the frontal squama between the stephanions becomes swollen and its apical angle increases when the metopic suture remains.

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Our recent studies of the human frontal sinus indicated that occurrence of naso-paranasal inflammation is greatly affected by the extent of sinus development.
The authors studied 74 human frontal sinuses in 61 cases whose age ranged from fetus to 80 years old in order to study the process of pneumatization in the frontal sinus and the etiology of recurrent frontal sinusitis. The conclusions drawn may be summarized as follows:
1. Pneumatization activity of the frontal sinus is mainly dependent upon two major factors. One is proliferation of connective tissue between the mucous membrane and the periostium (submucous connective tissue), which plays an active role in pneumatization and the other is the size of marrow space in the frontal bone. The frontal sinus appeared to develop when the frontal bone has a well developed marrow space plus proliferation of the submucous connective tissue extending into the marrow space. The pneumatization process will be suppressed either when the frontal bone contains underdeveloped marrow space or when proliferation of the submucous connective tissue is depressed.
Heredity, disposition, endocrine activity, local inflammation and local mechanical factors may affect the extent of pneumatization.
2. The authors studied the specimens in regards to the etiology of recurrent frontal sinusitis and deduced that postoperative derangement of the pneumatization process in the frontal bone could be responsible for the condition.
Many specimens showed small ducts that communicated with the frontal sinus and the marrow space located above the frontal sinus.
Submucous connective tissue was often seen to extend into the marrow space through these small ducts. Transformation of the bone at the roof of the frontal sinus for pneumatization seemed to be accomplished in this manner.
Frontal sinusectomy with radical removal of the submucosal tissue may cause obstruction of those small ducts which could leads to recurrent frontal sinusitis provided pneumatization proceeds in the isolated marrow space.

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