7
臠腱腳腪腵腯腺膀臬膉臁臆 Vol. 34, pp. 9399, 2006 腜腛腑腔腐腀腆腅腞腖腜腛腑腈腋腓腃腀腁腇腟腒腖腛腟腌腄 腎腘腝腉 腗腕腍腂腄腚腊腏腙ΐῑ : 18 5 25 腑腇膱臐膫臔腑腇膱腻臔腖腛膏膶腛膞臫致腽腜腣腈臯腤腧腕腁腦腆腇腧腛膞臫致腽腚腔腁腕腜膵腆腙腈膷膃腊腧腤腚腄腉腦膶臜腇腧腛膞臫腩膌 膠臨腌臞臗膛腗膈膤臶腌腑自臕腜腑腇膱臐膫 89 155 腑腇膱腻 48 臞臗 40 腱腴腮腭腲腫腭腰腳腬腴 CT 腩臂DICOM server 臖腖腇腧膋腛膟腄腣腝 腇腧腛膶腛膬腋腇腧膋腛膝臊膇腙腘腩膠臨腌腐腛膞臫腩膌臀腌腑腇腧膋膟 腜臖腗腡腚臐膫膛腖腹腚膆臲腌腑腇膱腻膛腖腜臖腖腛腹膹腜腙腅腓腑腄腣腝腇腧膋腛膶腛膬腋腡臐膫膛腖腜腁腏腧腡臞臗膛腣腥腹腚膬腌腕腁腑腆腑腇膱腻膛腚腔腁腕腜腇腧膋臖腹膹腆腙腅腓腑腊腛腊腗腜臜腻臔腖腜 腹腚腜臟腍腙腁腇腧膋臖腛膞臫膉致腽腆臐膫腖腜腹腚臟腍腦腊腗腩腹腕腁腦腟腑腇腧膋腛膝臊膇腜臐膫膛腖腜膅腼腑腇膱腻膛腖腜臺腼腚臤膭腆 腷腎腦膝膭腆腀腓腑膥膓腛膢膁腅腤腑腇膱臐膫腖腜腛膶腗腅腐腇腧膋腛 膞臫腽腆臟腍腢腎腈臜臖膊臷腻腖腜腢膶臜腇腧膋臖腚自腌腕膞腜膡腖腀腦 腊腗腆腨腅腓腑膨膽膮腈膒腎腦腣腂腚腙腓腑臺臅膗腼膞臝臐腢腑腇膱臌 臐腚腄腁腕腊腧腤腛臔腖腜臐臣臘腗腌腕膶腛臙臫腩膤臶腎腦腊腗腆腈腥腗膰腃腦ῐῌ῏ lacrimal fossa, nasolacrimal canal, CT, postoperative status 膂膔腛腩腓腢臑臡腖腑腇膱臐膫腢腑腇膱腻 腛臔腖腜臖膊臷腛膖臒腽至腛 腜腘腷腙腘腛膏膶腛膞臫腽腆臟腍腦腗膩腨腧 腕腄腥 1῏ῐ3臻臗臓腖腡腊腧腤腚腜腌腃腚臥膙腎 腇腧膋腜膎臺腼腼臮腚臃腟腥膊臷腛臣臺臧腩臤膭腌臸腚膄腈臐膫腄腣 腑腇膱腻腚腣腦臖膊臷腛膞臫致腽腚腇腧膋腛腽腡臇膸腋腧腦腆臐膫膴臔腗腌腕腛 膖膾膺腚腔腁腕腛膐膼腜臼腠腤腧腦腡腛腛 45臵膠腗腌腕腛腾腜臋腆膤膿腌腑膪腥臼腠腤腧腙 膻膟臺臅膗腛臭腚膞臝 臐腢腑腇膱腻腛腑腇膱臌臐腜臺臅膗腼腚膲腨腧 腦腊腗腆臩腈腙腥腶臣腗腞臌臐臚臏腜臱腌腈膡 膧腌腑 6腌腅腌臺臅膗腖腜腇腧膋腢膱臺腛腝腎腒腆腩臹腦腊腗腆腖腇腏臐臣腛膤臶膳腗腌腕膶腢臎腸膯臦腗腛腷臰膍膜 腛臘腈腥腗腙腦膥膓腖腜腱腴腮腭腲腫腭 腰腳腬腴 CTDigital Imaging and Communica- tions in Medicine DICOMserver 腚腣腦 Multi 臠腱腳腪腵腯腺膀臬膉 臉臢腺膉膕臈 93 35

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Page 1: ˘ˇ ˆ˙˝˛igakukai.marianna-u.ac.jp/idaishi/www/342/07-34-2Kurihara...Planar Reconstruction MPR ˘ˇ ˆ˙ ˝˛˚ ˜ !16 5 " #$!18 3 "%& ’() * CT +,-. / 01 *23/ 89 4 66 423 ; Caldwell-Luc

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��*23�1554�� ����*F�964�� MN�804���P����L/0�� ���=/0������������ ���L/�=/��*4���� ;AABCB�C°� Table 1 &��cA

Table 1. Mean Diameter of NLC, Wall Thickness of LF and NLC in Postoperative group �only on PostoperativeSides�, Chronic Sinusitis Group and Normal Subjects

Fig. 1. Thin and uniform bony wall of LF in a 37-

year-old woman with chronic sinusitis.

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����� ������ ��� ��� 5.6mm, �� 6.0 mm ��������� �������� 4.7 mm, 4.9 mm, ������� 4.4mm�� �� !�"#$%� ���������&'%�()*+"#�� ����������������()*�������� �� �,&-()*�"#./���t�0.13�� ��0�12�34�� � 0.63 mm, ������ 0.40 mm,�� 0.37 mm�� �����56()�73�-&��� �������,&-� t�0.49�()*�./��� �����������812�34�9%:%� 0.64�0.78mm, ������ 0.45�0.59 mm, �� 0.44�0.50 mm �� ����������56()�73�-&�� �Fig. 2�� �������,&-� t�0.49�����()*�.;� ����<().73+"#�� ���� � ��0�2

3� ����23�=6-�� ����>?����56()� � @A1273��������������������0�12�34� ������B CDE12�34�C&-()*�"#$%./��� �����FG��=�HIJ�� K8LMN�HI+�� O8HI+P�JQ���RS� � 0.92 Q� �������4.3 Q� �� �2.9 Q�� ������K�LN�TM� ��������O�LN�TM�HM����� ���56��� ���()*�"#$%��� UVW*�X�@Y; over-lap=�Z[�/.�\]=����012�34�^_`�,&-�� ���� 53�155�34.2��� ������ 11�96�11.5��� �� 14�80�17.5����>?�abQ�������0273�c�de���0fL 78� fL/$Fg� 78� Fg� 38� Fg�/$L 48� L 328����� h�� �����02�ij73 28� kl�.���� 18�����12��dmn�-&��� 38�oh%-&�� p1q�rs���0O8�tu��>?��� 2 8� ������� 1 8"#$%��vL� w8����� �������������xy�K2gz{�|_X�9%:%�39.4� 32.9� 32.1 cm ���� w8�������(). @+}���� ��������()*�./�� �Table 2���~q�@Y4�,&-� Table 3 ��C�����q�����& grade 34 � 63�9� +�#����� �Fig. 3�� ���������'/� 1��� grade 0� grade 1 ��� 84.4�� 14.6�\]���

Table 2. Mean Distance between Outer Wall of Lower NLC in Postopera-

tive Group �Cases with Bilateral Operation�, Chronic SinusitisGroup and Normal Subjects

Fig. 2. A thickened bony wall of left LF �arrow� in a85-year-old man after operation.

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37

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�������� Unger1� ��� ����� � ��������� Caldwell-Luc ������������ ����� !� "#$�%&� '�(�)*+,� ����-./012�3�� 45� 67���8 ��������� !9:7�� "#$�%&/012�3�1��3�� ;21 <���=�>?� @3�����A�B�C����D��� EF7GH ����=IJ�KL4�/M12����� ��=�NO�P>?��QRS�T�5��UV�WX�5YZ[�51P3� '�C\� 0.2�0.4mm�'���]��^���� ���_*/"#�_`ab� �*/�� �Z>cd2�3��

"#����e�_�����*�������e������_*��>cd2�����fgd 5�17 mm�KLd2�3�7�� hij���������!d� ��k 0.63 mm ���k/�l !��3�/� ;2 Caldwell-Luc ���mn ��$op�/qr2�D�/stuvw�;�/Fx�N@�yz12�� ��$op�� CT

"� ��{|����}~�����d2� ;2 ������"���=�����\������/��d2����=��S"#���e/� C�"�S���� C�)�S)���/>c��3�8�� �7��=�d 17�20 mm�7�� ����"��1)� ��� @2� C\ 3��5����/�Z��* 5 ��30 ����S�@��r29�� ���W�����k�C\ 2.9 ���������3�� hW����D����/�l �)* +,��35/� ;2������"#$�%&/��� ����C\�/�* ��w����� ��=��,��+,� ��=)��\� ¡�¢f/��5�yz12�� ���"#$�fgd�£¤�� ¥1� %&��tm¦§¨P4� %&�5��/��k� 6©Sªz5� «��67���8k�%&/¬­12P3�� �®��r¯�P%&/°�±²�� ¥1�P%&S�wD� 1��M��Z� 67���8����C\���*+, ³1P3´¨7/yz12�� ��k���=�\� ¡/�l ¢f��35� «�� 67���8k�)���=�µ�¢¶�l��®5���� ��=�\� ¡ �����l·/Pt� ��¸��)*��+,��S¬­P�®5� ;21�;��1�"�´¨7/��d2��¹_�Zqr2�35 Caldwell-Luc � «��

Table 3. Size of Maxillary Antrum in Postoperative Group �only on Postoperative Sides�, ChronicSinusitis Group and Normal Subjects

Fig. 3. A 58-year-old woman with bilateral postopera-

tive sinuses. Contraction of the maxillary antrum

and thickened wall are noted on the right side.

Right NLC shows dilatation and thickened wall.

Left side shows neither antral contraction nor

dilated NLC.

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38

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������������� ��������� ������ �FESS; functional endoscopicsinus surgery�� Caldwell-Luc����� ��������10�� ����� Caldwell-Luc � �!"�#�$�% !"�&&��'()��*�� � +� FESS �,-�./�0&���Caldwell-Luc � �0&�,-�%1�234�� +56��� ��56�!"�7�8�9��'()���:;���<������ =>����?����� �@�A�����B�� C� 10D���E�FG� ������HI�JK�L� #HM��N�L�OP4B�6�� ����4����� ���� �@�A���4� ���Q������=R��S��T��11�� Russell)5��� ?U ���VWX�J�<#��RY�CT 4�Z[� #��RY�S� CT� ��\]��^���_`�����a[<��� �� �4����b/� ��\]��^RY�S� c��T4B��4� ���K)��S�d!#�e��fg��"#��� h�� �������J�<ij$4B��?�Qk�������lm� �� ������ 1980�nK)%o[<m�� ����i#�e�Q&pA�q_'��rstu�e��([������ /)v�[<���Vwxyz�G�<�� {8|*��-�+}~�,�-��i��G�<�WX%!.���&� �,i�T4B����a�B�12�� [K[� ���� v/�0�#�4��Vwxyz�!"�b/��� �����V�� 1��B��-�� w����<��������HK2K�23A�"#�B�� ��3�#$����� v/4%!A���������4�A������ �4�������� =>�Q�����4���4B�� 58����v/4i��V��4�����#����$�B��-� ��VWX������b/���6�#e��77���� �� ����� =>����V����mv/48��9���6��:234�K������V��������;A�� v/4��� ��;��T4B�� [K[�)� #�$��-����� K)�<����44m�� #��=>�id!��A7�8�!"�� I���W�4B�������� =>

��56�=�G���13�� ��3�#$�I��7�>�kpG��?�L4B�� :���56�����!L�� �¡¢A��-�e������ �4�������J�<#e���T��S4m� CT�� 2£�[<¤�@4� � �CT �¥�A��4� $�RY��44m� �HKG¦§����¨©4m��ª(�� [K[� ��3K)��V� CT2£�«¬­�AB�C(�i�4B�� ���� �����3���V�1=� #$®�¯°±�i�v/�¥�A����D²[��'(��

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���� v/Q58����v/4���3���V�=Y1��³¡�´µ[�� ¶�+� c[� ��)�v/4�=Y1�����!�����E)K��� ����3���V�=Y1��x·��a��<J)�� %1�4���¸���� $� ¹��Fr�4�A����� º&G»A������� ����� =>�Q�� ���������� ¢��[<iHIG�'()���

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1� Unger JM. The paranasal sinuses. In: Paul LWand Juhl JH �eds�, Paul and Juhl’s Essentials ofRoentgen Interpretation, 5th ed, J. B. Lippin-

cott Company, Philadelphia, 1987: 1051�1065.2� Mancuso AA and Hanafee WN. Computedtomography and magnetic resonance imaging

of the head and neck, 2nd ed, Williams &

Wilkins, Baltimore, 1985: 20�41.3� Som PM. CT of the paranasal sinuses. Neuro-ladiology 1985; 27: 189�201.

4� Massoud TF Whittet HB and Anslow P. CT-dacryocystography for nasolacrimal duct ob-

struction following paranasal sinus surgery. Br

J Radiol. 1993; 66: 223�227.5� Russell EJ Czervionke L Huckman M DanielsD and McLachlan D. CT of the inferomedial

orbit and the lacrimal drainage apparatus:

Normal and pathologic anatomy. AJR 1985;

145: 1147�1154.

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Abstract

Deformation of Lacrimal Fossa and Nasolacrimal Canal after

Paranasal Sinus Operation and in Chronic Sinusitis.

Yoshiko Kurihara

Objective: As have been already described in the literature, the bony wall of maxillary antrum is

thickened and sclerotic, and antral contraction may occur in chronic sinusitis and after paranasal sinus

operation. However, bony nasolacrimal canal �NLC� is also deformed, but no quantitative data have beenpublished on bony NLC in patients with postoperative status and chronic sinusitis. In the present study, I

have measured the diameter and the wall thickness of lacrimal fossa �LF� and NLC.Materials and methods: Eighty-nine post-operative cases of paranasal sinuses �bilateral 66 cases,

unilateral 23 cases, mean 60.1 years; male�female�59�30�, 48 cases with chronic paranasal sinusitis �mean52.9 years; male�female�32�16,� and 40 normal subjects �mean 44.7 years, male�female�18�22� weremeasured. The diameter of NLC �upper and lower portions�, medial wall thickness of LF and NLC weremeasured. The outer distance between distal end of bilateral NLC and angle of inclination of NLC were also

measured. CT examination was performed with multidetector CT with 0.5 mm collimation and measure-

ment was performed on Exavision �Ziosoft�, with reconstruction.Results: The mean diameter of NLC in the post- operative group �upper; 5.6 mm, lower; 6.0 mm� was

statistically enlarged as compared with that of normal subjects �4.4 mm both�. The chronic sinusitis group�4.7 mm, 4.9 mm, respectively� showed no statistical deference from the normal group in upper diameter ofNLC. The wall thickness of LF and upper NLC in post-operative groups were statistically thick �post-operative; 0.63, 0.64, normal; 0.37, 0.44 mm, respectively�, however, those in chronic sinusitis group were not�chronic sinusitis; 0.40, 0.45 mm, respectively�. The angle of the inclination of NLC showed outer deviationin the postoperative group and inner deviation in the chronic sinusitis group.

Conclusion: After the operation of paranasal sinuses, dilatation of NLC and thickening of bony wall of

LF and NLC occurred definitely, and these phenomena were confirmed statistically. It is said that both

postoperative sinus and chronic sinusitis have sclerotic and thickened bony wall of maxillary antrum,

however, consequence of statistical deformation of LF and upper NLC occurs only in the former. Currently,

dacryocystorhinostomy and sinus surgery have been performed endoscopically. This technique can reduce

surgical invasion dramatically, but there is no information on bony structure. The structural change of

lacrimal drainage apparatus should be considered and ensured before these operations. Evaluation of

postoperative NLC and LF with CT scan is an adequate technique which will avoid technical trouble during

the operation and complications.

Department of Radiology, St. Marianna University of Medicine

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