鼻涙管狭窄症に対する逆行性（経上顎洞的）鼻涙管開放術

TRANSMAXILLARY DACRYOCYSTOTOMY FOR STENOSIS OF NASOLACRYMAL DUCT

　I．はじめに

　鼻涙管狭窄ないし鼻涙管閉塞は種々の原因によつて生じるが，慢性副鼻腔炎の術後に併発することも少なくない。今回，われわれは慢性副鼻腔炎の手術（sinuectomy）後に生じた鼻涙管閉塞の2症例に経上顎洞的に下鼻道への鼻涙管開放術（transmaxillary dacryocysotomy）を施行して好結果を得たので報告し，合せてsinuectomyの場合の鼻涙管の問題について若干の考察を行なつた。

　The satisfactory results of two patients with stenosis of the nasolacrimal duct caused by sinuectomy for chronic sinusitis who underwent transmaxillary dacryocystotomy in which the lacrimal sac was drained into the inferior meatus of the nasal cavity were reported, and the operative technique was described.

　The advantages of this procedure were as follow;

　1. The complete exposure of mucous membrane of the nasolacrimal duct was feasible by removing its bony covering of the duct was also possible.

　2. By removal of the lateral bony wall of the inferior meatus, the cicatricial process around the opening of the duct could be expected to facilitate the further widening of the opening in the inferior meatus in the nasal cavity.

　3. Transmaxillary or retrograde approach to the nasolacrimal duct made a surgeon possible to introduce a drain tube into the duct, and the tube could promote the renewal of the epithelium in the duct.

　This procedure, therefore, is the most suitable for surgical treatment in cases presented with a stenosis of the duct below the lacrimal sac or around the ostium of the duct in the inferior meatus of the nasal cavity.