Therapeutic performance of nasal and paranasal operations in recent years.

In this survey of the postoperative therapeutic performance of 555 cases of nasal surgery, particularly conservative fiberscopic endonasal sinusectomy, it was found that conservative nasal operations accounted for 87.8% of the entire sample population and the therapeutic effects, (in terms of subjective symptoms) were found to be favorable in 91.5% of cases. These results suggest that conservative nasal operations will become the dominant form of nasal surgery in the future.

Severe visual disturbance after exposure of the optic canal during intranasal ethmosphenoidectomy.

The cause of disturbed visual acuity associated with intranasal ethmosphenoidectomy is, on the one hand, a direct injury to the optic nerve. In this case, the disturbance in visual acuity develops immediately after the operation, and severe visual complications with a poor prognosis are found. On the other hand, in the two cases presented in this paper, the disturbed visual acuity develops postoperatively. In this case, it is necessary to take various possibilities into consideration, such as indirect effects of intraorbital bleeding, and damage to the lamina papyracea due to indirect and direct injury. Moreover, effects on the peri-optic nerve area and small blood vessels within the osseous optic canal should be considered. After thorough consideration and observation of the response to conservative therapy, such complications should be treated by investigating whether or not decompression of the optic nerve is effective.

Fronto-ethmoidal mucocele--observation of its mode of enlargement.

From a study of the roentgenographic findings of fronto-ethmoidal mucoceles and anatomical specimens of the paranasal sinuses the authors surmised that many of the fronto-ethmoidal mucocele probably originate either in one of the deeply seated supra-orbital frontal or ethmoidal recesses, or in an ethmoid cell whose ostium has been obstructed by postoperative, post-traumatic or post-inflammatory osteoneogenesis or cicatrization. When isolated, the cell with secreting mucosa would increase its cavity slowly but steadily, and eventually blocks the naso-frontal duct from without. The characteristic localization of the mucoceles, frequent erosion of the superomedial wall of the orbit with inferolateral displacement of the globe, our roentgenographic findings of a mucocele within the frontal sinus, pseudostratified columnar epithelium that lines the mucocele, occasional multilocularity, and the long interval, over ten years, that is required for the mucocele to show any symptoms in most instances would support this hypothesis.

Surgical anatomy of the nasal cavity and paranasal sinuses.

The knowledge acquired by the following method can be useful not only comparison with computerized tomographs which are frequently used in otorhinolaryngology, but also will make a highly effective contribution to surgical anatomy and the prevention of complications in surgery of the nose and paranasal sinuses. The sphenoid sinus and the adjacent tissues were studied on specimens removed en bloc from 12 cadavers. Horizontal sections were made and were macroscopically and microscopically observed for surgical and anatomical studies. The optic nerve was frequently in contact with the lateral wall of the paranasal sinus which was paper-thin in sinuses with marked pneumatization. In some sinuses with marked pneumatization, the course of the internal carotid artery was in contact with the posterior wall of the sphenoid sinus. The clinical anatomy should be kept in mind to avoid complications during operative procedures. Knowledge of clinical anatomy is also useful in understanding the images of CT scanning of the paranasal sinuses.

Clinical effects of endonasal sinusectomy with reconstruction of the nasal cavity (Takahashi's method).

A follow-up investigation of the results of endonasal sinusectomy with reconstruction of the nasal cavity (Takahashi's method) was carried out in 535 of 1,338 patients who underwent endonasal sinusectomies during the 6-year period from 1967 to 1972. The results of subjective symptoms were as follows: cured 196 (36.6%); improved 234 (47.5%); unchanged 69 (12.9%); aggravated 12 (2.2%). In other words, 450 (84.1%) of the patients were satisfied with the results of the operations. Good results have similarly been obtained in cases of nasal allergy which shows increasing tendency of late, and concomitant reconstruction of the nasal cavity and desensitization therapy have resulted in improved responses.

Clinical effects of endonasal sinusectomy with reconstruction of the nasal cavity (Takahashi's method).

A follow-up investigation of the results of endonasal sinusectomy with reconstruction of the nasal cavity (Takahashi's method) was carried out in 535 of 1338 patients who underwent endonasal sinusectomies during the 6-year period from 1967 to 1972. The subjective results were as follows: cured 196 (36.6%); improved 234 (47,5%); unchanged 69 (12.9%); aggravated 12 (2.2%). In other words, 450 (84.1%) of the patients were satisfied with the results of the operations. Good results have similarly been obtained in allergic nasal disorders spreading in Japan of late, and concomitant reconstruction of the nasal cavity and desensitization therapy have resulted in improved response.

Traumatic intracavernous aneurysm of the internal carotid artery following surgery for chronic sinusitis.

A case of traumatic intracavernous aneurysm is presented. The aneurysm at the siphon of the internal carotid artery was produced as a result of injury during an operation for chronic sinusitis. In addition to the formation of the aneurysm, the angiogram showed an irregular intimal dissection along the internal carotid artery distal to the aneurysm. To prevent disastrous bleeding from the aneurysm and further progression, a trapping operation was made in combination with a superficial temporal-middle cerebral artery anastomosis.