頭痛, 顔面痛を訴える患者が, 第一に耳鼻咽喉科を受診することは少ないが, 他科において原因が分からない場合に, 原因診断のために紹介されることは少なくない. 耳鼻咽喉科疾患の中でも鼻副鼻腔の炎症をはじめとする疾患では, 頭痛, 顔面痛を生じることが少なくないため, 耳鼻咽喉科医としては鼻副鼻腔の疾患を見落としてはならない. 副鼻腔疾患による疼痛は, 三叉神経の分枝である眼神経 (V₁) と上顎神経 (V₂) に関連することが多く, 支配領域に応じた部位の疼痛が生じる. したがって, 三叉神経の分枝の走行と支配領域を理解することは重要であり, さらに分枝と各副鼻腔との位置関係を理解することも必要である. 特に蝶形骨洞は, 多くの分枝と関連しており, その支配領域も広範に及び, なおかつ洞の発育により症状の表れ方が異なっている. 診断には画像診断, 特に CT が副鼻腔と三叉神経との関連を把握するために有用である. 本論文では, 副鼻腔と三叉神経との関連を解剖学的ならびに画像診断的に解説するとともに, 頭痛, 顔面痛を来す代表的疾患を提示した.

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急性の前額部痛, 眼周囲痛を主訴とし, X-Pにおいて前頭洞陰影を認めて, 急性前頭洞炎と診断した24症例を治療した。前頭洞陰影は23例 (96%) に片側性に発生していた。副鼻腔全体のX-P陰影も片側性にのみ認めるものは18例 (83%) であり, 前頭洞陰影を認める患側の節骨洞, 上顎洞陰影は23例 (96%) に陽性を示した。薬剤の内服療法で痛みの改善は全症例で1週間以内に得られた。さらに前頭洞と篩骨洞の洞内陰影も改善する例が多かったが, 上顎洞の洞内陰影の改善は遅れる例が多く, このような例で上顎洞の穿刺洗浄療法を18例 (75%) に施行し, 17例 (71%) に膿汁の貯留を認め, その中に5例の乾酪性上顎洞炎が含まれ, 10例の歯性上顎洞炎が疑われた。以上の結果より, 上顎洞の非急性の炎症が存在することが, 急性前頭洞炎発症の一因となる可能性が示唆された。このことは急性前頭洞炎の治療や予防に参考になると考えられる。

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The nasal pit of the early human embryo appears in the Streeter's horizon XV, in the next horizon XVI it becomes a nasal fossa which is surrounded by mesenchymal tissue of the socalled medial, lateral nasal and maxillary processes. This nasal fossa deepens in the next horizon XVII and in the horizon XVIII the thin bucco-nasal membrane at the bottom of the fossa gives way and disappears. Thus the primitive choana is open in this stage.
This structure of the primitive nasal cavity is visible in the author's 10 to 20 mm long embryos, by which the absolute thickness of the nasal septum does not change, while the dimensions of the cavity increase twice in this period. During this period of the primitive nasal cavity the palate process on the pharyngeal surface of the maxillary process is becoming prominent and at the end of this period the anterior end of this swelling visible on the maxillary process lateral to the primitive palate, which structure is missed in the succeeding more developed embryos.
Among three elder embryos a 35 mm long have a distinct secondary palate, by which the palate processes of both sides are above the tongue, the incisive canal at the anterior third is surrounded by osseous tissue of the maxillary and premaxillary processes. By the other two 22 and 27 mm long embryos the palate processes of both sides are lateral and under the tongue, their anterior parts protruding not vertically, but horizontally under and before the tongue and continued to the palate. By these two embryos the Jacobson's organ comes more foreward on the hinder third (22 mm) or middle (27 mm) of the palate, which condition is not by the primitive palate, by which the organ comes above the posterior margin of the palate.
The olfactory fibers are from the beginning of the nasal pit discernible, the terminal nerve later before the perforation of the primitive choana. The nasopalatine nerve comes from the maxillary on the surface of the nasal septum under the epithelium and reaches the anterior naris early in the horizon XV, the palatine nerves a little later in the horizon XVII, when the palatine processes are becoming eminent. The anterior ethmoidal and infratrochlear nerves are also in the latter stage observed.
During the primitive nasal cavity is the maxilloturbinale alone visible on the lateral surface, the ethmoturbinale later in the 22 mm long embryos, also the maxillary sinus.
The precartilage of the wall of the nasal cavity appears first in the nasal septum in the horizon XVIII, then in the lateral wall a little later. The precartilageous septum becomes cartilageous first in the 27 mm, then the laterawall in the 35 mm long embryo.

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The materials used for this study consisted of 61 cases, (ranging between viviparity 5 months to 79 years of age).
The cases in which the diseases of the nose, mouth, pharynx and larynx were the direct cause of death were excluded.
Most of the ethmoid, nasal septum and concha nasalis media were extirpated intracranially between the posteior end of the crista frontalis and the sulcus faciculi optici without injuring the face.
After embedding in celloidin, a gross and microscopic examination of their frontal section was made. The form was complicated between the beginning portion of the conch nasalis media and the canopy of the ethmoid. Especially, the operative significance of the inner wall of the attic of the ethmoidal sinuses has been stressed from a clinicoanatomical point of view.

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鼻閉を主訴とした57歳男性の鼻腔原発の神経鞘腫の1例を経験した。術前の生検により神経鞘腫の病理診断が得られ、lateral rhinotomyにて摘出し良好な結果を得た。鼻副鼻腔原発の神経鞘腫の本邦報告例は自験例を含め64例であったが、発生母神経を同定し得た報告は稀で自験例でも不明であった。鼻副鼻腔原発の神経鞘腫の中には局所再発や悪性変化を認めた報告もあり、完全摘出が必要である。

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The anterior ethmodial nerve (a.e.n.) was examined in 10 human adults (40-89 years old) and 5 fetuses (7 months). a.e.n. arises from the nasociliar nerve, which is the first division of the trigeminal nerve. From this point to the crista galli, a.e.ns. were observed under a dissection microscope in relation to their direction and distribution.
The following results were obtained:
1) The number of a.e.n.
i. The number of a.e.n. was 1 to 3 (1.45 on average) when they arose from the nasociliary nerve in the adults.
ii. In the fetuses, the number of a.e.n. was 1 to 2 (1.1 on average).
2) The length of a.e.n.
i. The length was 12.0mm to 24.0mm (17.3mm on average) in the adults.
ii. In the fetuses, the length was 2.0mm to 7.0mm (5.0mm on average).
3) The anterior ethmoidal branch (e.b.).
The anterior ethmoidal branch (e.b.) supplies the mucous membrane of the ethmoidal sinus.
i. The number of e. bs. was 20 on the right side and 22 on the left in 8 adult cases. In the upper wall of the ethmoidal sinus, the number of e. bs. was 1.0 on average. In the medial wall of theethmoidal sinus, the number of e. bs. was also 1.0 on average. In the lateral wall of the ethmoidal sinus, the number of e. bs. was 0.2 on average.
ii. The number of e. bs. was 3 on the right side and 2 on the left in 3 fetus cases. In the upper wall of the ethmoidal sinus, the number of e. bs. was 0.2 on average. In the medial wall of the ethmoidal sinus, the number of e. bs. was 0.3 on average. No e. bs. were found in the lateral wall.
4) The anterior ethmoidal foramen.
The anterior ethmoidal foramen was examined to determine its positional relation to the angle of the crista galli.
i. The angle was 40.0° to 10.0° and 30.0.. on average in the adults.
ii. In the fetuses, the angle was 50.0° to 20.0° and 43.2° on average.

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  For better understanding of the structures comprising the human body and in view of the possible need for future revision, Latin anatomical names of skeletal foramina in Terminologia Anatomica were analyzed and classified, and compared with the corresponding Japanese anatomical names.

  The words following Foramen or Foramina indicated : 1) the form of the foramen, 2) the state of the foramen, 3) the absolute size of the foramen, 4) the structure to which the foramen belongs, 5) the position of the foramen in the skeletal system, 6) the part of the human body in which the foramen exists, 7) the structure that transmits the foramen, or 8) the function of the foramen.

  Analysis of Latin names and comparison with Japanese names clarified some characteristics of both names and revealed some problems in them.

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Orbital cellulitis and abscess formation in pediatric patients usually arises as a complication of acute rhinosinusitis, and if untreated, may cause visual loss or life-threatening intracranial complications.

We report a pediatric case of orbital subperiosteal abscess secondary to acute rhinosinusitis.

An 11-year-old boy presented with purulent nasal discharge, periorbital swelling and proptosis on the right side. A head computed tomography (CT) showed a medial subperiosteal orbital abscess and destruction of part of the medial wall of the orbital bone. The patient was treated with intravenous antibiotics for four days, however, the periorbital swelling and proptosis persisted. Therefore, we performed endoscopic sinus surgery and drained the subperiosteal abscess through the bony dehiscence. The swelling and proptosis resolved, and the patient was discharged on postoperative day 6. A repeat CT performed during the postoperative follow-up period showed complete resolution of the orbital and nasal lesions.

This case demonstrated that surgical treatment is effective and necessary in patients with an orbital subperiosteal abscess in whom conservative therapy proves ineffective.

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