副鼻腔嚢胞手術症例の臨床検討

Abstract

This study retrospectively analyzed the clinical features of patients with paranasal sinus cysts. Between April 1995 and March 2008 at Hyogo College of Medicine, we performed sinus surgery on 218 patients with paranasal sinus cysts. There were 125 men and 93 women with the mean age of 57.5 years (17-85 years old). Diagnosis was based on the preoperative endonasal and radiological findings as well as surgical findings. The patients were followed for 6 months or more after surgery. Of 218 patients, postoperative cysts were observed in 173 patients (79.4%), and idiopathic cysts were found in 45 patients (20.6%). In postoperative cysts, the maxillary sinus was the most common lesion (124/173 patients, 71.7%). Most patients (53.8%) presented with cheek swelling and pain. The mean interval between the first and most recent surgery was 31.2 years (4-55 years). Among idiopathic cysts, anterior ethmoid sinus (19/45 patients, 42.2%) and frontal sinus (15/45 patients, 33.3%) were common lesion sites. More than a half of them (53.3%) presented with ophthalmologic symptoms. For treatment, endoscopic sinus surgery (ESS) was performed on 206 patients. The navigation system for ESS was utilized in 6 patients (2.8%). External approaches were required in 23 patients (10.6%). The Caldwell-Luc procedure for maxillary sinus cysts and Killian's procedure for frontal sinus cysts were performed on 18 and 5 patients, respectively. Dacryocystorhinostomy (DCR) with the endonasal approach was additionally performed on 4 patients with epiphora due to postoperative maxillary sinus cysts. Recurrence of cysts was observed in 5 patients (2.3%) at the mean interval of 25 months after surgery, comprising three patients with maxillary sinus cysts, one patient with a frontal sinus cyst, and one patient with a sphenoid sinus cyst. In conclusion, most paranasal sinus cysts (approximately 80%) occurred postoperatively. Symptoms were predominantly ophthalmologic. Selecting an endoscopic and/or an external approach is critical, considering minimally invasive surgery and risk of recurrence.