錐體炎に就て

　緒言

　側頭骨岩樣部即ち錐体の化膿性炎症は既に前世紀から称えられた所であるが，1904年にGradenigoが所謂同氏症候群を提唱して以來症候学的には一新紀元を盡され，更に1930年頃よりBelinoff，Balan；山下教授，下田氏等の錐体の組織解剖学的研究或はKraus等のレ線学的研究に依り其全貌の一部を現し，又Marx，Tobeck等が耳性腦膜炎の約半数以上は錐体内の炎症に依り惹起せられる事を提唱して以來，全く世の耳科医の注目を惹くに到つた．

　而して從來は錐体炎は乳樣突起炎と同樣に中耳炎の合併症とされ，乳樣突起炎との関係も稍々隔絶されていた観があつた．

　Niho and his associates maintain that petrositis is, definitely not a separate entity of disease but, a part of over-all picture of the osteitis of temporal bone which, if transposed tobetter known terms, would be a part of otitis media in broad sense of this term. Heretofore, diagnosis of petrositis was mainly based upon findings of persistent stay of infections in the temporal pone that could not be brought to remission by ordinary means of drainage but which called for direct surgical approach to the petrosal pyramid; and also, by manifestations of neurologic symtoms, such as, paresis of the abducens, trigeminal neuralgia, or, by presence of retropharyngeal abcess the results of which were caused by bressure effects from edematous changes of diseased foci upon the course of the nerves running nearby, in the former case, or, by extension of abcess to remoter parts of body, in the latter.

　PETROSITIS.

　Shôji Niho, Shinji Hirano and Miyoji Niho. Niho and his associates maintain that petrositis positively not a separate entity of disease but, a part of over-all picture of the osteitis of temporal bone which, when transposed to formerly known terms, would be a part of otitis media in the broad sense Heretofore, diagnosis of petrositis was mainly based upon finding of stay infectious processes in the temporal bone, that could not eradicated by ordinary measures of drainage bot called for direct surgical approach to petrosal pyramid; and manfes tations of neurologic symptoms, such as, paralysis of abeluceus. trigeminal neuralgia, or, retropharyngeal abcess the result of pressure effects from edematous changes of diseased foci upon the nerves which run nearby or of extention of abcess to remoter parts of the body.

　This concept of petrositis however, in authors' opinion, is erroneous. It is much too inclusive an application which embraces even slight infections of petrosal air cells that generally heal spontaneously without specific measures, as well as. various degrees of more serious endosteal involvement in the petrosl pyramid. Petrositis in their opinion is infectious involvement of the bone, endostiums and mucous membranes of petrobl pyramid.

　For practical purposes anatomical division of petrosal cells into various groups, such as, anterior-superior, antericor, anterior-inferior, posteri or-superior posterior, and posterior-inferior ones is recognized. Reference is made to various authors, as, Voss, Ramidier, Niho, Freckner, Yamashita, and Kramm in connection with the methods of operation on the petrosal pyramid.

　In view of the fact that osteitis of temporal bone may be composed of various stage of infectious process, authors believe that, due to lack of proper care many petrositis have been necessarily allowed to run a chronic course, and that, many delayed healings of temporal bone infections might be belonging to this group of cases. Gradinigo's syndromes, rather than being regarded as crucial signs of petrositis, should be considered as attendent complications of the disease. There are no specific symptoms by which diagnosis of petrositis may be established excepting those which may be ascribed to otitis media and mastoiditis, therefore, diagnosis of this disease be usual means is quite impossible.

　Osteitis of temporel bone -Superficial involvement -Petrositis.

　On treatment both chemotherapy and anti-biotics are fully considered, Authors' method of operation is discussed at length additional review of literature on the subject.

　The paper is concluded with emphasis that, when petrositis is suspected the diagnosis of the disease and indication for operation should be derived by use of above formula of diagnosis. Under no occassion should the disease be over-estimated by apparent severity of the case nor be under-estimated by number of spontaneous remissions therein but, it should be regarded as a part of osteitis tempoial bone and the treatment, thereof, should be effected by beginning with elimination of simpler involvements first which are to be followed in gradation by more complicated ones. Such attitude in treatment is highly efficacious for simplifying matters and when applied, even in simple mastoidectomies the wound healing would be much more so augmented.