両側先天性後鼻孔閉鎖症の1例

A Case of Bilateral Congenital Choanal Atresia

　I．はじめに

　先天性後鼻孔閉鎖症は1755年頃にドイツのRoedererがはじめて記載したといわれており，その後1830年にOttoが剖検時に本症を見出し，より詳細な報告をしている．本邦では1918年に柳沢^1）が外傷による後天性後鼻孔閉鎖症を報告し，1924年に木村^2）が先天性後鼻孔閉鎖症を最初に報告した。以来，本邦での先天性後鼻孔閉鎖症の報告例は50数例をかぞえるのみであり，耳鼻咽喉科医が日常臨床で遭遇することは極めて稀である。

　最近われわれは成人の両側先天性後鼻孔閉鎖症の1例を経験し，手術的に治癒せしめた。また本症例の術前，術後の鼻粘膜，嗅覚，呼吸機能，音声言語などの諸検査で興味ある所見がえられたので若千の考察を加えて報告する。

　A 22-year-old female had been suffered from nasal obstruction and anosmia since her birth, and she was found bilateral choanal atresia. Reconstructive operation of bilateral choanal atresia was performed through the transpalatine approach under general anesthesia. The choanae were found occluded with membraneous connective tissue which contained no bony elements. Silicone tubes were inserted into the opened choanae for 12-20 days after surgery. The choanae were kept patent for 2 years postoperatively. The inferior turbinate mucosa was investigated by means of SEM, and the ciliated columnar epithelium was clearly found on the posterior portion of the inferior turbinate, but scarcely on the anterior tip.

　She had gained nasal breathing after surgery. However, no improvement was obtained in the denasality of speech, which required speech training for 3 months.

　At present, two years after the operation, the patient has no problems on nasal breathing and speech, but anosmia.