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4 耳展 長 32:6 舩 宏 隆,他 表2 症状 の改 善率 と臨床 病型 表3 レ線 的改 善率 と臨床 病 型 M.N. 14歳 臨 床 症型:浮 腫茸 状 型 手 術 法:両 前篩 骨 洞 開放 術 両 下鼻 道 開 窓術 治療 効 果:両 側著 明改 善 2年 術 前 術 後 症 例1 40 (550)
5 上 顎 洞 開 窓 術(小 児) 耳展 32:6 M.H. 13歳 臨床 病 型1浮 腫 茸状 型 手 術 法:両 前 篩 骨洞 開 放術 両 下 鼻 道開 窓 術 治療 効 果:両 側 改 善 2年6ヶ 月 術 後 術 前 症例2 T.H, 10歳 臨床 病 型:浮 腫 茸 状型 手術 方 法:両 前 篩 骨洞 開 放術 両 上 顎 洞 開 窓術 治療 効 果:両 側 改 善 3年5ヶ 月 術 後 術 前 症 例3 4) 5) 総 合 的 改 善 と 臨 床 病 型(表4) 症 状 改 善 とレ線 的 改 善 よ りみ た 総 合 的改 善 で は,有 効 率 は61.7%,不 変38.3%で 病 型 別 で は,浮 腫 茸 状 型 で57.8%,不 び ま ん カ タ ル 型 で は,有 22.2%で 症 例 を年 少 児(7 11歳)と あ り,臨 床 歳)に 変42.2%, 52.7%,年 効 率77.8%,不 変 あ っ た これ は い ず れ も レ線 的改 善 と ほ ぼ 同 率 で あ り,症 状 と レ線 と 両 方 よ り判 定 し て い る こ と よ り,こ の 値 が 開 窓 術 の実 際 的 な 有 効 率 を 示 し て い る と思 う 手 術 時 年 齢 と総 合 的 改 善(表5) 年 長 児(12 15 分 け 検 討 し た 年 少 児 で は,有 効率 長 児 で は,有 効 率70%で,年 少児 ほ ど有 効 率 が 低 い傾 向 が み られ た 6) 手 術 後 経 過 期 間 と総 合 的 改善(表6) 術 後 期 間 を1年 以 内,1 2年,2年 以上 に 分 け検 討 し た 1年 以 内 の 有 効 率56.3%,1 2年 の 有 効 率57.2%,2年 以上 の有 効 率 (551) 41
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9 2) Mikulicz, J. Zur operativen Behandlung des Empyems der Highmoreshohle, Arch Klin Chir., 34: , 1886.
10 3) Lund, V. J.: Fundamental considerations of the design and function of intranasal antrostomies, Rhinology, 23: 231 `236, ) Tarkkanen, J., et al: Intranasal antrostomy for chronic maxillary sinusitis, The Eye. Ear. Nose and Throat Monthly, 48: 79 ` ) Hellmich, S.: Die operative Behandlung von N asennebenhohlen erkrankungen im Kindesalter, HNO, 32: 91 `98, ) Alan, J., et al: Intranasal antrostomy- Causes of failure, Laryngoscope, 92: , ) Mann, W., et al: Wie gut ist die endonasale Fensterungsoperation bei chronisher Sinusitis Maxillairs? Arch Otorhinolaryngol., 219: 345 `347, ) Anders, T., et al: Effects of intranasal antrostomy and antral lavage upon unerupted permanent teeth. J. Laryngol Otol., 93: 883 `887, ) Barford, CP., et al: Injury to developing canines as a complication of intranasal antrostomy. Int. J. Oral Surg., 13: 445 `-447, Summary FENESTRATION OF MAXILLARY SINUS IN THE TREATMENT OF PEDIATRIC CHRONIC SINUSITIS Hirotaka Osafune, et al. Department of Otolaryngology, Toho University School of Medicine, Tokyo We performed fenestration of the maxillary sinus in 27 pediatric patients (49 sinuses) with chronic sinusitis who had not responded to conservative therapies (medications, irrigation and etc,). Nasal polypectomy or ethomoidectomy was added in some patients. The symptoms improved in 70.4% of the patients and did not improve in 29.6%. The radiological examintions showed 61.2% of improved cases and 38.8% of failed ones. On overall evaluation (symptoms plus radiological findings), 59.2% of the cases were successful and 40.8% were unsuccessful. The therapeutic efficacy was lower in patients of younger ages and the degree of the improvement was higher with the time after the operation. The sinus window was patent in 42 sinues (85.7%) and closed in 7 sinues (14.3%). Mean postoperative period in the patent cases was 18.4 months. Key words: pediatric chronic Sinusitis, treatment
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