慢性副鼻腔炎の病理特にその骨病變と臨床的意義に就いて

　緒言

　慢性副鼻腔炎の病理組織学的研究は，Zuckerkandl以來，多くの学者の研究の対照となり，その業績は枚挙に遑がなく，特にその粘膜病変に関しては種々檢索されているが，骨部の変化に関しては，Domochowsky，Berberich，Uffenorde，Manasse，Nühsmann，天野等の記載を見るのみであり，その所見に就いても未だ議論の余地があり，又，臨床上に於いても，諸家の等閑視している所である．

　抑々，慢性副鼻腔炎は，年余にわたる頑固な症例が多く，その手術所見では，いづれも強度の粘膜の浮腫，細胞浸潤等を見るものであり，此等の炎症が骨壁に波及する事は想像に難くない所である，実際，手術時に，骨壁の赤色点形成，粗糙化，贅骨形成，遊離骨形成等の所見をしばしば見るがこれ等は骨炎の合併を考えさせるものである．

　Niho and his associates report on interesting findings in pathological changes that have been observed upon bones and mucous membranes in the diseased paranasal sinus. Histological preparations in this study embrace 45 specimens taken from 40 maxillary sinuses and 48 from 34 ethmoids. It is noted that, in disease conditions, ciliated mucous membranes are denuded of the cilia; vascular walls are markedly thickened by firotic hypertrophy. Majority of bone specimens show evidence of osteitis and among them 24 show areas of bony necrosis and sequestration. Basing upon these findings the authors assume that such histological changes contribute important determining factors for onset, progress and prognosis of paranasal sinusitis which, when well established, would require expedient choice in the method of treatment. Particularly, with presence of sequestration treatments, which would be dependent upon chemotherapy and/or use of biotics alone, without operative measures, might be expected to attain at the most temporary remissions only.