トルコ鞍近傍腫瘍に類似の症状を呈した後部副鼻腔粘液嚢腫の3例

MUCOCELE OF THE POSTERIOR PARANASAL SINUS:REPORT OF THREE CASES

緒言

　後部副鼻腔は解剖学的に，限窩およびトルコ鞍に接している。この部に発生する粘液嚢腫は，それらの骨破壊と同時に，いわゆる‘orbital apex syndrome’^19），を呈し，トルコ鞍あるいはその近傍部の腫瘍，ことに下垂休腺腫を疑わせることがある。また，この疾患そのものは良性であるが，治療の時期を失すると，失明という重大な障害を残すことがあり，速かに診断を確定して手術的処置をすべきである。最近われわれは，3例の後部副鼻腔粘液嚢腫を経験したので，文献的考察を加えて報告する。

Two cases of mucocele and a case of pyomuco-cele of the posterior paranasal sinus were reported in this paper with review of the literature. The cases, a 58-year-old man, a 31-year-old man and a 45-year-old woman, were admitted to our service with chief complaint of visual disturbances for last 2 years. All of them showed clinical symptomes which were resembled to pituitary tumor or cra-niopharyngioma with orbital apex syndrome '. X-ray examination revealed destruction of the sellarfloor and the lateral wall of the ethmoidal sinus in all cases, and widening of the optic canal and the superior orbital fissure in a case. The narrow-ing of C₁. C₂. C₃ portions of the affected side of the internal carotid artery was demonstrated a angiographically in two cases. Tc-99m-pertech-netate brain scintigram showed abnormal uptake in the medial frontal base unilaterally in all cases. Transmaxillary ethmoidectomy and sphenotomy were performed in two cases. Frontal cranitomy with transmaxillary approach was carried out in the other case. The visual acuity was recovered well after surgery in a case which had minor optic disc change preoperatively. The other two cases, which had long-standing visual impairment with marked disc atrophy for over 18 months preoper-atively, had only minor recovery after surgery.