上顎洞性後鼻孔ポリープにおける内視鏡下犬歯窩アプローチの有用性

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  • Endoscopic Antrochoanal Polyp Removal Using Endoscopically Guided Canine Fossa Puncture

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Antrochoanal polyps arise mostly from the maxillary sinus and are relatively common in children and young adults. The most important point during surgery for antrochoanal polyp is to remove it completely from its base. For this purpose, various techniques such as inferior meatal approach, endoscopic nasolacrimal duct inferior turbinate swing technique or canine fossa approach have been considered. The canine fossa approach is minimally invasive but risks trocar injury to infraorbital nerve branches. To avoid this, we use endoscopically guided canine fossa trephination. In some patients, nerve branches are clearly visible and a trephination site can be chosen that avoids these. Otherwise, anatomic landmarks least likely to risk injury to the nerve are the intersection of midpupillary line and a line through the nasal floor. In 10 subjects undergoing this approach, non experienced postoperative upper lip and/or tooth numbness or paresthesia. Endoscopically guided canine fossa trephination is thus useful in antrochoanal polyp removal due to fewer neurological complications than occur using a conventional approach.

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