부비동 모형에서 하비갑개의 구조적 변화와 비중격의 천공이 상악동 환기에 미치는 효과

Background and Objectives: Inferior turbinectomy has been known to have the possibility of inducing sinusitis. The perforation on septum occurs mostly by septal surgery, and its effect on the ventilation of sinus has not been known. The aim of this study is to measure the changes of maxillary sinus ventilation in conditions of inferior turbinate hypertrophy, inferior turbinectomy or septal perforation. Materials and Methods: From a healthy volunteer with no evidence of sinonasal pathology, one millimeter-thickness axial images of computed tomogram of paranasal sinuses were obtained. Margins between soft tissue and air density in each images were expressed with lines using computer programs, and one millimeter-thickness acrylic plates were cut according to these lines with computerized laser cutting system. They were attached sequentially to make a complete model. The conditions of inferior turbinectomy or septal perforation were expressed with a drill, and the hypertrophy of inferior turbinates was made with silicone. It was fitted with pressure sensors in left nasal cavity, maxillary, sphenoid and frontal sinuses, and with a sensor for oxygen concentration in left maxillary sinus. The pressure changes of each sinonasal cavities and the changes of the oxygen concentration in left maxillary sinus were measured during respiration with 600 milliliter tidal volume and at the rate of 15 times per minute. Results: The alternation of positive and negative pressures was observed according to respiration in the sinonasal cavities. The differences between highest and lowest pressures were increased in the model representing inferior turbinate hypertrophy, and diminished in the models representing inferior turbinectomy and septal perforation. And the times required for the decrease in oxygen concentration were increased in the models of inferior turbinectomy and septal perforation. Conclusion: Extensive resection of inferior turbinate causes the decrease of maxillary sinus ventilation, and it is strongly suggested that septal perforation can reduce the sinus ventilation. This model study is helpful in understanding the influences of the structural changes in sinonasal cavities upon the ventilation of sinuses. (J Clinical Otolaryngol 2003;14:92–99)