副鼻腔手術における内視鏡下鼻中隔部分切除

Abstract

Reconstruction of a deviated nasal septum, submucous resection or septoplasty, is frequently required prior to endoscopic sinus surgery (ESS). This macroscopic septal operation has been performed in all types of deviation including total deviation of the C- or S-configuration, partial deviation of the spina or crista, and so on. We developed a new endoscopic method to correct a partially deviated nasal septum. This new method has been devised to provide a wide endonasal route for observation and for free surgical management of the ethmoid sinus.We have attempted this septal operation prior to ESS in five cases. The pattern of deviations were anterosuperior (localized to the border between the septal cartilage and the perpendicular plate of the ethmoid) (cases 1, 2, and 3), spina (case 4), and crista (case 5). Paranasal sinus lesions included unilateral chronic sinusitis in the deviated side (cases 1, 2, and 4), bilateral chronic ethmoiditis (case 3), and postoperative ethmoid cyst in the deviated side (case 5). All steps of this septal operation were carried out under rigid nasal endoscopic control. After topical anesthesia and vasoconstriction in the bilateral nasal cavities, a local anesthetic was injected into the deviated side. A small incision was made through the mucosa and perichondrium just in front of the deviated portion. The septal cartilage and bones were freed from the overlying mucoperichondrium and mucoperiostium. An area approximately 2cm2 or less of the deviated cartilage and/or bone was removed. The mucoperichondrial incision was not sutured.The time required for this septal operation was as little as 10 minutes except in case 5 in whom the surgery took approximately 20 minutes because of a very thick perpendicular plate in the ethmoid. Subsequent ESS was accomplished with a wide operative route. All patients experienced uneventful postoperative courses with excellent healing of the affected paranasal sinuses.We concluded that the present method to correct a partially deviated nasal septum is extremely helpful in performing ESS as a minimally invasive technique.