Nasal septum perforation occurs via many causes such as during surgery head trauma or through systemic disease.
Crusting or hemorrhage occurs from the perforated region, and a lot of cases decrease the quality of life of patients remarkably.
In addition, a perforation choke operation is chosen for cases whereby control is poor only by conservative treatment such as a topical treatment or chemical administration as therapy. As for the perforation choke operation, various operation methods have been reported. Perforation cause, size, and perforation ambient histionic property vary among cases leading to difficulty in the choice of operation methods.
We report one example of nasal septum perforation that we were able to close by isolation via auricular cartilage transplant.
The case was a 64 year old woman. The chief complaint was recurrent epistaxis. We completely closed the nasal septum perforation by isolation auricular cartilage transplant and achieved symptomatic improvement.
As we were able to close the perforation good cartilaginous survival with the perichondrium was suggested.

抄録全体を表示

Using T & T Olfactometer which had been developed and standardized for clinical use in Japan recently, measurements of olfactory thresholds of odor detection and of odor recognition were carried out on 33 subjects (26 males and 7 females), who had worked in a chromate producing factory. The subjects had left the factory before 7 years or more. Five kinds of test odors were used; beta-phenyl ethyl alcohol, methyl cyclopentenolone, iso-valeric acid, gamma-undecalactone, and scatol. The degree olfalfaction loss was expressed with the number of powes of 10 in series of multiple concentrations by 10 of each test odor with reference to the concentration of the detection threshold of young normal people. Seventeen of 33 subjects (51.4%) had a perforation of the nasal septum. Middle and high grade decrease of odor recognition faculty were found in 18 (54.5%) including 2 anosmia, one of whom complained also the disorder of taste. Any specific patern of olfactogram chracterizing them were not found, namely, chromates impair olfactory sense for all kinds of odors, which means the impairment of olfactory epithelium itself. The degree of olfaction loss was related to the duration of employment in the chromate producing facory. The existence of septal perforation had no direct relation to the degree of olfaction loss.

抄録全体を表示

A microdebrider system is used also as bur of ESS in many cases. Septoplasty bur for the nasal plastic surgeries was used for the advanced deviation of nasal septum cases.
There is also no involvement of nasal-septum membrane in the case of a crista, a spina, and vomer excision, it was a good feeling of use, and bony deletion could be easy and was able to cut efficiently rather than having used a chisel depending on a case. Septoplasty bur can be comparatively introduced on a low budget.

抄録全体を表示

Nasal septal perforation can occur from a variety of traumatic, iatrogenic, caustic, or inflammatory causes. Although some cases are asymptomatic, some patients complain of crusting, bleeding, and neuralgia, leading them to seek medical care. We report a patient whose septal perforation was closed using an inferior turbinate mucosal flap and a septal mucosal flap.
A 14-year-old girl that had received epistaxis and electrocautery of the bilateral septal membrane at a hospital experienced pain in her nasal area and a small amount of bleeding a few days later. The patient visited another hospital and was diagnosed as having a nasal septal perforation. She then visited our hospital to have the perforation closed on June 17, 1996. Surgical closure of the septal perforation was performed using an endonasal approach under local anesthesia. A mucosal incision was made in the right nasal cavity along the inferior turbinate edges, leaving the anterior surface intact. The anterior based mucosal flap was then elevated from the inferior turbinate bone. The mucosal flap was swung anteriorly and sutured to the edge of the septal perforation. On the opposite side, the septal mucosal flap was rotated anteriorly to close the perforation. About 6 weeks later, the inferior turbinate mucosal flap was resected. The nasal septal perforation had closed completely, and the patient's nasal complaints have been resolved.
Septal perforation closure is a difficult surgical procedure, and various surgical techniques for closing the perforation have been reported. Septal perforation closures require a well vascularized mucosal flap. We conclude that the inferior turbinate mucosal flap is a useful tissue for closing septal perforations because of its good vascularization.

抄録全体を表示

The authors reported three cases of the foreign bodies of button batteries in the nasal cavity. The first patient was a 2-year-old boy who put a small alkaline cell into his nostril, and septal perforation and the nasal atresia was observed due to chemical burn. The second patient was a 2-year-old girl, and alkaline cell caused the nasal atresia. The third case was a 5-year-old boy, who put the button battery into his nostril, but neither septal perforation nor nasal atresia was observed.
The foreign bodies of button batteries in the nasal cavity caused the specific clinical symptoms by alkali burn. It was suggested even if there were no leakage of the alkaline cell contents, the button battery might give rise to a current external to the battery and generate sodium hydroxide at the cathode of the cell.

抄録全体を表示

　鼻腔内異物は日常診療においてしばしば遭遇する疾患の一つであり, 6歳以下の小児が, 好奇心やいたずらにより挿入することが多いとされる。 金属などの無機性異物は異物感染が生じにくいため, 長期留置されたままとなりやすい。 複数個の磁性体異物の場合, 磁力に伴い特徴的な現象を生じることがある。

　症例は7歳男児で顔面外傷にて偶発的に頭部 CT を施行した際に両側鼻腔内異物を指摘された。 右側鼻腔内異物は目視可能であり, 直ちに摘出可能であったが, 左側鼻腔内異物は鼻中隔粘膜下に存在しており, 摘出困難であったため全身麻酔下での経鼻内視鏡下摘出術を施行した。 2つの鼻中隔内の磁性体異物は感染兆候もなく, 少なくとも数ヵ月以上の間, 鼻中隔を圧迫しており, 異物周囲の軟骨は一部欠損を認めていた。

　鼻腔内異物はよく遭遇する疾患であるが, 複数の磁性体異物の場合, 長期に留置されていることがあり, 組織の一部欠損を生じる場合がある。 そのため

のリスクを避けるためにも切開部位を考えて手術を施行することが大切であると考えられた。

　今回, 偶発的に発見された鼻中隔粘膜下の磁性体異物の1例を経験したので報告する。

抄録全体を表示

近年，鼻弁の狭窄が鼻閉症状の要因となることが知られてきた。また，

も鼻閉症状をきたし，手術治療の対象となる場合がある。当科で経験した，内鼻弁狭窄にを伴う鼻閉症例に対し，閉鎖術と鼻中隔外鼻形成術を同時に施行し良好な結果を得たので，文献的考察を加え報告する。症例は61歳男性，30年前に鼻中隔の手術の既往があった。数年前から鼻閉症状が出現，悪化したため，当科初診となった。吸気時の両鼻弁部の陥凹，鼻中隔前方にある13×8 mmの，左への鼻中隔弯曲を認めた。Cottle test陽性であり，内鼻弁狭窄とによる鼻閉と診断し，鼻中隔外鼻形成術と閉鎖術の同時手術を行った。経鼻柱切開による皮膚翻転を行い，大鼻翼軟骨，上外側鼻軟骨，鼻中隔軟骨を露出した。穿孔上部の鼻中隔粘膜は上外側鼻軟骨内側面まで，下部は鼻腔底から下鼻道まで鼻中隔および鼻腔粘膜を剥離し，鼻腔底粘膜にはコの字型の切開を入れ上下の粘膜弁を移動して穿孔部を縫縮した。右側頭筋膜と耳介軟骨を採取し，それぞれ穿孔部の介在グラフトとSpreader graftとして使用した。術後は閉鎖し，鼻閉症状も消失した。近年，様々な内視鏡下の閉鎖術が開発されているが，鼻弁狭窄を合併している場合，閉鎖術と鼻中隔外鼻形成術の同時手術も検討すべきと考えられた。

抄録全体を表示

原因が様々な39症例を経験した. 穿孔の大きさが測定可能であったものに関しその検討を行い, 年齢, 性別, 推定される原因を示した. 年齢は8歳から85歳まで, 平均35歳であり, 男性26人女性13人であった. 原因は鼻中隔矯正術のみ9例, 他の鼻副鼻腔手術17例―内鼻中隔矯正術重複が2例―, 特発性5例, 鼻内の焼灼またはタンポン, 職業性, 膠原病とその関連疾患各2例, 炎症性と血液疾患各1例であった. 穿孔の主症状は鼻出血5例, 鼻内乾燥感4例, 鼻閉, 鼻漏各3例, 笛声音1例がみられた. 他の23例は無症状であった. 穿孔の大きさは長径が10mm以下7例, 11～20mm 13例, 21mm以上が6例であった. 穿孔の大きさは, 大部分の症例が30mm以下であるが, 膠原病関連疾患2症例は35mm以上だった.

抄録全体を表示

本症例は18歳の男性で，鼻ほじりが原因と考えられる13mm大のを認め，Unilateral mucosal advancement flap techniqueを使用して穿孔閉鎖施行した。術後は穿孔が閉鎖し，自覚症状が消失した。Unilateral mucosal advancement flap techniqueは片側鼻腔で穿孔の下方と上方に二つのflapを作成し，そのflap同士を縫合することで穿孔を閉鎖する方法である。Flapは双茎で血流もよく，Interposition graftと組み合わせることで，1cmを超える中等度の大きさのの閉鎖に有効な方法と考えられた。

抄録全体を表示

　Rendu-Osler-Weber 病 (遺伝性出血性毛細血管拡張症; Hereditary Hemorrhagic Telangiectasia: HHT) の鼻出血に対して, 脳神経外科の協力のもと超選択的に血管塞栓をすることができた1例を経験したので報告する。
　症例は74歳男性。 7年前より繰り返す鼻出血のため東京慈恵会医科大学附属柏病院耳鼻咽喉科外来にて処置を行っていた。 HHT と診断され, 4年前より週に一度の頻度で鼻出血の治療を行ってから, 比較的鼻出血は落ち着いていた。 しかし, 半年前より外来経過観察中に, 出血のコントロールが困難となったため, 出血量を減らす目的で, 左蝶口蓋動脈の枝に対して超選択的血管塞栓術を予定した。
　今回, 脳神経外科の協力のもと, 出血源となっている血管のみを選択処置することで, 粘膜障害を最小限に抑える治療ができた。 術直後より鼻出血の訴えは消失し, 4ヵ月経過した時点で明らかな合併症を含め鼻出血は認めない。 オスラー病による難治性鼻出血の治療として, 超選択的血管塞栓術が有効であると考えられた。

抄録全体を表示