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Õ“°“√§—¥®¡Ÿ° (Nasal Obstruction)

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Õ“°“√§—¥®¡Ÿ° (Nasal Obstruction) π“π“ “√– § ≈‘ π‘ ° Õ“°“√§—¥®¡Ÿ° (Nasal Obstruction) Õ“°“√§¥®¡— °Ÿ (Nasal Obstruction) Õ“°“√§—¥®¡Ÿ°‡ªìπÕ“°“√∑’Ëæ∫‰¥â∫àÕ¬„π‡«™ªØ‘∫—µ‘ ´÷ËßÕ“®‡ªìπÕ“°“√∑’Ëæ∫‰¥âµ“¡ª°µ‘ (´÷Ëßæ∫‡ªìπ à«ππâÕ¬ ‰¥â·°à Õ“°“√§—¥®¡Ÿ°∑’ˇ°‘¥®“°°“√∑’Ë®¡Ÿ°∑”ß“π ≈—∫¢â“ß°—πµ“¡∏√√¡™“µ‘ ∑’ˇ√’¬°«à“ nasal À√◊Õ turbinate cycle À√◊ÕÕ“°“√§—¥®¡Ÿ°∑’ˇ°‘¥®“°°“√‡ª≈’ˬπ∑à“∑“ß ‡™àπ πÕπµ–·§ß·≈⫧—¥®¡Ÿ°¢â“ß∑’ËπÕπ∑—∫Õ¬Ÿà ‡¡◊ËÕµ–·§ß‰ªÕ’°¥â“πÀπ÷Ëß ¥â“π∑’ˇ§¬§—¥®–°≈—∫‚≈àߢ÷Èπ ´÷Ë߇°‘¥®“°·√ߥ÷ߥŸ¥¢Õß‚≈°) À√◊Õ‡°‘¥®“°‚√§¢Õß®¡Ÿ°À≈“¬Ê ™π‘¥ (´÷Ëßæ∫‡ªìπ à«π¡“°) ·≈– ‡ªìπÕ“°“√∑’Ëæ∫∫àÕ¬Õ’°Õ“°“√Àπ÷Ëß∑’Ëπ”ºŸâªÉ«¬¡“À“·æ∑¬å ‡π◊ËÕß®“°¡—°∑”„À⺟âªÉ«¬√”§“≠ ·≈– ∑π∑ÿ°¢å∑√¡“π ·≈–¡’§ÿ≥¿“æ™’«‘µ·¬à≈ß „πª√–‡∑» À√—∞Õ‡¡√‘°“‰¥â‡§¬¡’ºŸâª√–‡¡‘π«à“¡’§à“„™â ®à“¬„π°“√√—°…“Õ“°“√§—¥®¡Ÿ° Ÿß∂÷ß 5 æ—π≈â“π‡À√’¬≠ À√—∞µàÕªï ·≈–¡’§à“„™â®à“¬ Ÿß∂÷ß 60 ≈â“π ‡À√’¬≠ À√—∞µàÕªï „π°“√∑”°“√ºà“µ—¥√—°…“Õ“°“√§—¥®¡Ÿ°1. §”®”°¥§«“¡— Õ“°“√§¥®¡— °‡ªŸ πÕ“°“√∑ì º’Ë ªŸâ «¬√É Ÿâ °À√÷ Õ‡¢◊ “„®«â “≈¡À√à ÕÕ“°“»∑◊ º’Ë “π‡¢à “À√â ÕÕÕ°®“°®¡◊ °Ÿ πâÕ¬°«à“ª°µ‘ ‚¥¬∑’Ë¡’≈¡À√◊ÕÕ“°“»∑’˺à“π‡¢â“À√◊ÕÕÕ°®“°®¡Ÿ°πâÕ¬®√‘ß (objective restriction of nasal cavity airflow) ‡π◊ËÕß®“°¡’§«“¡º‘¥ª°µ‘¢Õ߇¬◊ËÕ∫ÿ®¡Ÿ° À√◊Õ¡’ª√‘¡“≥πÈ”¡Ÿ°‡æ‘Ë¡¡“° ¢÷Èπ2 °“√∑’ˇ¬◊ËÕ∫ÿ®¡Ÿ° “¡“√∂√—∫√ŸâÕ“°“»∑’˺à“π‡¢â“À√◊ÕÕÕ°®“°®¡Ÿ° ‡™◊ËÕ«à“ºà“π∑“ßµ—«√—∫√Ÿâ —¡º— ·≈–Õÿ≥À¿Ÿ¡‘ (tactile and thermoreceptors) ∑’ËÕ¬Ÿà„π nasal vestibule ·≈–‡¬◊ËÕ∫ÿ®¡Ÿ° ´÷Ëß §«“¡‰«¢Õßµ—«√—∫√Ÿâ¥—ß°≈à“«®–πâÕ¬≈߇√◊ËÕ¬Ê ®“°¥â“πÀπⓉª¥â“πÀ≈—ß ‡ âπª√– “∑∑’Ë√—∫√ŸâÕ“°“» ª“√¬– Õ“»π–‡ π æ.∫., √Õß»“ µ√“®“√¬ å “¢“‚√§®¡°·≈–‚√§¿Ÿ ¡Ÿ ·æ‘ â ¿“§«™“‚ µ‘ π“ °‘ ≈“√ß´‘ «å ∑¬“‘ §≥–·æ∑¬»“ µ√»å √‘ √“™æ¬“∫“≈‘ ¡À“«∑¬“≈‘ ¬¡À— ¥≈‘ §≈‘π‘° ªï∑’Ë 29 ©∫—∫∑’Ë 4 ‡¡…“¬π 2556 235 ∑’˺à“π‡¢â“À√◊ÕÕÕ°®“°®¡Ÿ° §◊Õ ª√– “∑ ¡ÕߧŸà∑’Ë 5 Õ“°“»„ÀâÕÿàπ·≈–™◊Èπ¢÷ÈππâÕ¬°«à“§πª°µ‘, ºŸâªÉ«¬‚√§ (ophthalmic and maxillary branch of trigeminal ®¡Ÿ°Õ—°‡ ∫¿Ÿ¡‘·æâ™π‘¥ƒ¥Ÿ°“≈∑’ËÕ¬ŸàπÕ°ƒ¥Ÿ°“≈À√◊Õ nerve). ‰¡à¡’Õ“°“√ (asymptomatic seasonal allergic rhinitis), ºªŸâ «¬‚√§®¡É °ÕŸ °‡ ∫¿— Ÿ¡‘·æâ™π‘¥‡ªìπµ≈Õ¥ªï º≈°√–∑∫∑“ߧ≈‘π‘°¢ÕßÕ“°“√§—¥®¡Ÿ° (perennial allergic rhinitis)8 · ¥ß«à“‡¡◊ËÕ®¡Ÿ°¡’ ‡π◊ËÕß®“°®¡Ÿ°‡ªìπÕ«—¬«–∑’ËÕ¬Ÿà à«πµâπ¢Õß §«“¡ “¡“√∂„π°“√ª√—∫Õ“°“»„ÀâÕÿàπ·≈–™◊ÈπµË” ®–¡’ √–∫∫∑“߇¥‘πÀ“¬„® Õ“°“√§—¥®¡Ÿ°®÷ß¡’º≈µàÕ∑“ß ‚Õ°“ ‡°‘¥°“√Õ—°‡ ∫‡√◊ÈÕ√—ߢÕß∑“߇¥‘πÀ“¬„® à«π ‡¥‘πÀ“¬„® à«π≈à“ß‚¥¬‡©æ“–À≈Õ¥≈¡·≈–ªÕ¥ ≈à“߉¥â¡“°¢÷Èπ πÕ°®“°π—Èπ°“√»÷°…“π’ȉ¥âæ∫§«“¡ πÕ°®“°π—ÈπÕ“°“√§—¥®¡Ÿ° Õ“®∑”„À⇰‘¥Õ“°“√πÕπ —¡æ—π∏å√–À«à“ߧ«“¡ “¡“√∂¢Õß®¡Ÿ°„π°“√ª√—∫ °√π·≈–/À√Õ¿“«–À¬◊ ¥À“¬„®¢≥–À≈ÿ ∫‰¥— 3â ‡¡Õº◊Ë ªŸâ «¬É Õ“°“»„ÀÕâ π·≈–™ÿà π¢◊È π°÷È ∫§«“¡√— π·√ߢÕß‚√§Àÿ ¥¥◊ «¬â §—¥®¡Ÿ°¡“°∑”„ÀâµâÕßÀ“¬„®∑“ߪ“° Õ“®∑”„À⺟⠰≈à“«§◊Õ¬‘Ëߧ«“¡ “¡“√∂¢Õß®¡Ÿ°„π°“√ª√—∫Õ“°“» ªÉ«¬¡’Õ“°“√‡®Á∫§Õ‡√◊ÈÕ√—ß, §Õ·Àâß À√◊Õ√–§“¬§Õ‰¥â „ÀâÕÿàπ·≈–™◊ÈππâÕ¬≈߇撬߄¥ ®–æ∫«à“¡’§«“¡√ÿπ·√ß ßà“¬. ¢Õß‚√§À◊¥¡“°¢÷Èπ‡∑à“π—Èπ8 · ¥ß∂÷ߧ«“¡ ”§—≠¢Õß º≈°√–∑∫¢ÕßÕ“°“√§—¥®¡Ÿ°µàÕ√–∫∫µà“ßÊ ¡’ ®¡Ÿ°µàÕ√–∫∫∑“߇¥‘πÀ“¬„® à«π≈à“ß. ¥—ßπ’È ºŸâªÉ«¬∑’Ë¡’‚√§ªÕ¥ Õ“°“√§—¥®¡Ÿ° Õ“®∑”„Àâ¡’ °“√‡æ‘Ë¡¢÷Èπ¢Õß pulmonary resistance, ¡’°“√≈¥≈ß 1. √–∫∫∑“߇¥‘πÀ“¬„® ¢Õß compliance ¢Õߪե, √–¥—∫ÕÕ°´‘‡®π„π‡≈◊Õ¥ ‡π◊ËÕß®“°®¡Ÿ°¡’Àπâ“∑’ËÀ≈—°„π°“√ª√—∫Õ“°“» ·≈– forced expiratory volume „π 1 «‘π“∑’ (FEV1) ∑’ËÀ“¬„®‡¢â“„ÀâÕÿàπ·≈–™◊Èπ¢÷Èπ°àÕπ≈߉ª ŸàÀ≈Õ¥≈¡·≈– ‰¥â ´÷ËßÕ“®ºà“π∑“ß nasopulmonary reflex9,10 ´÷Ëß ªÕ¥4 ‡¡◊ËÕ¡’Õ“°“√§—¥®¡Ÿ° ®÷ß®”‡ªìπµâÕßÀ“¬„®∑“ß ‡ªìπªí≠À“∑’Ë·æ∑¬å§«√„À⧫“¡√–¡—¥√–«—ß„πºŸâªÉ«¬ ª“°´÷Ëß®–∑”„ÀâÕ“°“»∑’˺à“π≈߉ª„π∑“߇¥‘πÀ“¬„® ‚√§ªÕ¥∑’Ë¡’Õ“°“√§—¥®¡Ÿ° ‡™àπ ºŸâªÉ«¬∑’Ë¡’‡≈◊Õ¥°”‡¥“ à«π≈à“ß ‡¬Áπ ·≈–¡’§«“¡™◊ÈπµË” ∑”„Àâ√–∫∫∑“߇¥‘π ‰À≈ À≈ß∑”— anterior ·≈–/À√Õ◊ posterior nasal pack- À“¬„® à«π≈à“ßµâÕß∑”ß“πÀπ—°¢÷Èπ ∑”„Àâ¡’‚Õ°“ ing À√◊ÕºŸâªÉ«¬À≈—ßºà“µ—¥®¡Ÿ°·≈–/À√◊Õ‰´π— ·≈â«¡’ ‡°‘¥°“√Õ—°‡ ∫À√◊Õ°“√√–§“¬‡§◊Õ߇√◊ÈÕ√—ߢÕß∑“߇¥‘π nasal packing. À“¬„® à«π≈à“߉¥âßà“¬‚¥¬‡©æ“–ºŸâ∑’Ë¡’§«“¡‰«¢Õß ∑“߇¥πÀ“¬„® ‘ «π≈à “ßÕ¬à ·≈Ÿà «â ‡™πà ºªŸâ «¬‚√§ÀÉ ¥◊ À√Õ◊ 2. √–∫∫À—«„®·≈–À≈Õ¥‡≈◊Õ¥ ºŸâªÉ«¬‚√§®¡Ÿ°Õ—°‡ ∫¿Ÿ¡‘·æâ∑’Ë¡’¿“«–À≈Õ¥≈¡‰«‡°‘π ºŸâªÉ«¬∑’Ë¡’Õ“°“√§—¥®¡Ÿ° Õ“®∑”„Àâ¡’Õ“°“√ ‚¥¬‰¡à¡’Õ“°“√ (asymptomatic bronchial hyper- πÕπ°√π ·≈–/À√◊Õ¿“«–À¬ÿ¥À“¬„®¢≥–À≈—∫‰¥â3 responsiveness)5,6 ¡’°“√»÷°…“∑’Ë· ¥ß„Àâ‡ÀÁπ«à“ºŸâ∑’Ë ‡¡◊ËÕ¡’°“√§—¥®¡Ÿ° ≈¡∑’Ë«‘Ëߺà“π™àÕß®¡Ÿ°∑’ËÕÿ¥°—Èπ ®– ‡≈àπ °’Õ¬Ÿà„π∑’Ë∑’Ë¡’Õ“°“»‡¬Áπ‡ªìπª√–®” ®–¡’Õÿ∫—µ‘- ‡°‘¥°“√À¡ÿπ«π (turbulent flow) ∑”„Àâ‡æ¥“πÕàÕπ °“√≥¢Õß°“√Õå °‡ ∫‡√— Õ√◊È ß„πÀ≈Õ¥≈¡ — ß°«Ÿ “§πª°µà 7‘ ¡’°“√ —Ëπ –‡∑◊Õπ πÕ°®“°π—Èπ°“√欓¬“¡À“¬„® · ¥ß„Àâ‡ÀÁπ«à“ Õ“°“»∑’Ë¡’§«“¡™◊ÈπµË”·≈–¡’§«“¡‡¬Áπ ‡¢â“‡æ◊ËÕ‡Õ“™π–™àÕß®¡Ÿ°∑’˵’∫·§∫ ®–∑”„À⇰‘¥§«“¡ Ÿß ·¡â‰¥â√—∫°“√ª√—∫Õ“°“»‚¥¬®¡Ÿ° ‡¡◊ËÕ≈ß Ÿà∑“߇¥‘π ¥—π∑’ˇªìπ≈∫„π∑“߇¥‘πÀ“¬„® à«π∫π ´÷Ëß®–∑”„Àâ À“¬„® à«π≈à“ß °Á¡’‚Õ°“ ∑”„À⇰‘¥°“√Õ—°‡ ∫‡√◊ÈÕ√—ß ‡π◊ÈÕ‡¬◊ËÕÕàÕπ„π§ÕÀÕ¬¬ÿ∫µ—«‡¢â“¡“¡“°¢÷Èπ ∑”„À⬑Ëß ¢Õß∑“߇¥‘πÀ“¬„® à«π≈à“߉¥âßà“¬ πÕ°®“°π—Èπæ∫ ¡’°“√µ’∫·§∫¢Õß∑“߇¥‘πÀ“¬„® à«π§ÕÀÕ¬ ·≈–‡¡◊ËÕ «à“ ºŸâªÉ«¬‚√§À◊¥ ¡’§«“¡ “¡“√∂¢Õß®¡Ÿ°„π°“√ª√—∫ ºŸâªÉ«¬µâÕßÀ“¬„®∑“ߪ“° (‡π◊ËÕß®“°Õ“°“√§—¥®¡Ÿ°) 236 §≈‘π‘° ªï∑’Ë 29 ©∫—∫∑’Ë 4 ‡¡…“¬π 2556 ®–∑”„Àâ¡’°“√À¬àÕπµ—«¢Õß°≈â“¡‡π◊ÈÕ≈‘Èπ ∑”„Àâ∑“ß 4. º≈¥â“πÕ◊ËπÊ ‡™à𠇥‘πÀ“¬„®∫√‘‡«≥§ÕÀÕ¬‚¥¬‡©æ“–À≈—ß‚§π≈‘Èπµ’∫ - Õ“°“√§—¥®¡Ÿ°∑’Ë∑”„À⇰‘¥Õ“°“√°√π ·≈–/ ·§∫‡¢â“¡“Õ’° ´÷Ëßªí®®—¬‡À≈à“π’È®–∑”„À⇰‘¥Õ“°“√ À√◊Õ¿“«–À¬ÿ¥À“¬„®¢≥–À≈—∫ Õ“®∑”„À⺟âªÉ«¬‡¥Á° πÕπ°√π·≈–/À√◊Õ¿“«–À¬ÿ¥À“¬„®¢≥–À≈—∫ ´÷Ëß ¡’ªí “«–√¥∑’ËπÕπ‰¥â, ºŸâªÉ«¬Õ“®¡’Õ“°“√ßà«ß¡“° ¿“«–π’È®–¡’º≈µàÕ√–∫∫À—«„®·≈–À≈Õ¥‡≈◊Õ¥‰¥â ‚¥¬ º‘¥ª°µ‘„π°≈“ß«—π ∑”„À⇰‘¥Õÿ∫—µ‘‡Àµÿ‰¥âßà“¬, ¡’ ∑”„Àºâ ªŸâ «¬¡É Õ’ µ√“‡ — ¬ß∑’Ë ®–‡°’Ë ¥‚√§§«“¡¥‘ π‚≈À— µ ‘ ß,Ÿ §«“¡‡ ’ˬß∑’Ë®–‡ªìπ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õ߉¥â ·≈–¡’ ‚√§À—«„®≈⡇À≈« (‚¥¬‡©æ“–´’°¢«“) ®“°°“√∑’Ë¡’ ¡√√∂¿“æ∑“߇æ»∑’ËπâÕ¬≈߉¥â, ºŸâªÉ«¬¡’ poly- §«“¡¥π‡≈— Õ¥„πªÕ¥ ◊ ߟ (pulmonary hypertension), cythemia ®“°°“√¢“¥ÕÕ°´‘‡®π‡√◊ÈÕ√—߉¥â. ‚√§À—«„®‡µâπº‘¥®—ßÀ«–. - Õ“°“√§—¥®¡Ÿ° Õ“®∑”„À⺟âªÉ«¬µâÕß„™â¬“ πÕ°®“°π—ÈπºŸâªÉ«¬∑’˧—¥®¡Ÿ°π“πÊ Õ“®„™â¬“À¥ ‡µ’¬√Õ¬¥å™π‘¥√—∫ª√–∑“π‡ªìπ‡«≈“π“π Õ“®∑”„Àâ À≈Õ¥‡≈◊Õ¥ ‡™àπ ephedrine, pseudoephedrine ‡°‘¥º≈¢â“߇§’¬ß¢Õß ‡µ’¬√Õ¬¥å‰¥â ‡™àπ °≈â“¡‡π◊ÈÕ ‡ªìπ√–¬–‡«≈“π“π ´÷Ë߬“¥—ß°≈à“«¡’ƒ∑∏‘Ï alpha-adr- ÕÕπ·√ß,à °√–¥°ºŸ ∫“ß,ÿ ¿¡Ÿ §‘ ¡°ÿâ π¢Õß√— “ß°“¬∫°æ√à Õß.à energic activity ∑”„Àâ¡’§«“¡¥—π‡≈◊Õ¥ Ÿß À√◊Õ¡’ -‡π◊ËÕß®“°™àÕß®¡Ÿ°¡’≈—°…≥–‡ªìπ‚æ√ß ∑” À—«„®‡µâπ‡√Á«‰¥â. Àπâ“∑’Ë¢¬“¬§«“¡¥—ߢÕ߇ ’¬ß∑’ˇª≈àßÕÕ°¡“®“°°≈àÕß ‡ ’¬ß (vocal resonance) „π‡«≈“ª°µ‘ Õ“®‰¡à‰¥â 3. °“√√∫°≈— ‘Ëπ —߇°µ∂÷ßÀπâ“∑’Ëπ’È ¢≥–∑’Ë¡’Õ“°“√§—¥®¡Ÿ° ‡ ’¬ß查 ‡π◊ËÕß®“°‡´≈≈åª√– “∑∑’Ë√—∫°≈‘Ëπ (olfactory ®–‡ª≈’ˬπ·ª≈߉ª ‡ªìπ‡ ’¬ßÕŸâÕ’È À√◊Õ‡ ’¬ß¢÷Èπ®¡Ÿ°∑’Ë epithelium) Õ¬Ÿà¥â“π∫π¢Õß‚æ√ß®¡Ÿ° (nasal vault) ‡√’¬°«à“ nasal voice. °“√∑’Ë¡πÿ…¬å®–√—∫°≈‘Ëπ‰¥â µâÕßÕ“»—¬Õ“°“»∑’ËÀ“¬„® - „π¿“«–ª°µ‘ ®–¡’°“√∂à“¬‡∑Õ“°“» ·≈– æ“°≈‘Ëπ¢÷Èπ‰ª∑’ˇ´≈≈åª√– “∑√—∫°≈‘Ëπ¥—ß°≈à“« ·≈– àß “√§—¥À≈—Ëß®“°‰´π— ‡¢â“¡“„π™àÕß®¡Ÿ° ‡¬◊ËÕ∫ÿ®¡Ÿ°∑’Ë µàÕ‰ª¬—ߪ√– “∑ ¡ÕߧŸà∑’Ë 1 (olfactory nerve) ·≈– ∫«¡®“°Õ“°“√§—¥®¡Ÿ° Õ“®‰ªÕÿ¥°—Èπ√Ÿ‡ªî¥¢Õ߉´π— ‰ª Ÿà ¡Õß à«π°≈“ß Õ“°“√§—¥®¡Ÿ°®–∑”„ÀâÕ“°“» „π‚æ√ß®¡Ÿ° ∑”„Àâ¡’‰´π— Õ—°‡ ∫µ“¡¡“‰¥â À√◊Õ æ“°≈‘Ëπ¢÷Èπ‰ª Ÿà∫√‘‡«≥¥—ß°≈à“«‰¥âπâÕ¬ ∑”„À⺟âªÉ«¬¡’ ‡¬◊ËÕ∫ÿ®¡Ÿ°∑’Ë∫«¡ Õ“®¡’°“√∫«¡‰ª∂÷ß∫√‘‡«≥‡¬◊ËÕ∫ÿ §«“¡ “¡“√∂„π°“√√—∫°≈‘ËππâÕ¬ (hyposmia) À√◊Õ √Õ∫∑àÕ¬ ‡µ‡™Ÿ ’¬π ´÷Ë߇ªìπ∑àÕ∑’ˇ™◊ËÕ¡√–À«à“ß‚æ√ßÀ≈ß— ‰¡à‰¥â°≈‘Ëπ (anosmia) ‡≈¬ ®“° ∂‘µ‘¢Õߧ≈‘π‘°°≈‘Ëπ ®¡°·≈–ÀŸ ™Ÿ π°≈“ß—È ∑”„À°“√ª√â ∫§«“¡¥— π√–À«— “ßÀà ™Ÿ π—È ·≈–√ ¢Õß¿“§«‘™“‚ µ π“ ‘° ≈“√‘ß´å«‘∑¬“ §≥– °≈“ß·≈–‚æ√ßÀ≈—ß®¡Ÿ°‰¡à¥’ ∑”„Àâ¡’Õ“°“√ÀŸÕ◊ÈÕ, ‡ ’¬ß ·æ∑¬»“ µ√廑√‘√“™æ¬“∫“≈æ∫«à“ ‚√§¢Õß®¡Ÿ° ¥—ß„πÀŸ, ‡«’¬π»’√…– À√◊Õ‡°‘¥πÈ”¢—ß„πÀŸ (otitis media ·≈–/À√◊Õ‰´π— ´÷Ëß∑”„À⺟âªÉ«¬¡’Õ“°“√§—¥®¡Ÿ° ‡ªìπ with effusion) À√◊ÕÀŸ™—Èπ°≈“ßÕ—°‡ ∫µ“¡¡“‰¥â. “‡Àµÿ∑’Ëæ∫‰¥â∫àÕ¬∑’Ë ÿ¥ (√âÕ¬≈– 66.7) ∑’Ë∑”„À⺟âªÉ«¬ - ª°µ‘∂ÿßπÈ”µ“∑’ËÕ¬Ÿà∫√‘‡«≥À—«µ“∑—Èß 2 ¢â“ß ¡’ªí≠À“¢Õß°“√√—∫°≈‘Ëπ ·≈–µâÕß¡“æ∫·æ∑¬11å . ®–¡’∑àÕπ”πÈ”µ“∑’ˉ¡à„™â·≈â« ¡“∑‘Èß≈ß„π™àÕß®¡Ÿ° ‡¡◊ËÕ °“√√—∫°≈‘Ëπ∑’ˇ ’¬‰ª®–∑”„Àâ§ÿ≥¿“æ™’«‘µ¢Õß ¡’Õ“°“√§—¥®¡Ÿ° ‡™à𠇪ìπÀ«—¥ À√◊Õ¡’Õ“°“√¢Õß ºŸâªÉ«¬·¬à≈ß‚¥¬‡©æ“–§«“¡æ÷ßæÕ„®‡°’ˬ«°—∫°“√ ‚√§®¡Ÿ°Õ—°‡ ∫¿Ÿ¡‘·æâ¡“°¢÷Èπ À√◊ÕÀ≈—ß∑” anterior ‰¥â°≈‘Ëπ ·≈–∑”„À⧫“¡ “¡“√∂„π°“√√–¡—¥√–«—ß nasal packing ®–∑”„À⺟âªÉ«¬¡’πÈ”µ“´÷¡Õ¬Ÿà∑’˵“‰¥â. Õ—πµ√“¬®“°Õ“À“√∑’Ë∫Ÿ¥‡πà“‡ ’¬, Õ“À“√ ·≈–·°ä ∑’ˇªìπæ‘…≈¥πâÕ¬≈ß. “‡Àµÿ¢ÕßÕ“°“√§—¥®¡Ÿ° Õ“°“√§¥®¡— °‡ªŸ π‡æì ¬ßÕ“°“√’ ‰¡„™à °“√«à π‘ ®©‘ ¬— §≈‘π‘° ªï∑’Ë 29 ©∫—∫∑’Ë 4 ‡¡…“¬π 2556 237 ‚√§ ·æ∑¬å§«√À“ “‡Àµÿ¢ÕßÕ“°“√§—¥®¡Ÿ° ´÷Ëß¡’ ®√‘ß (objective restriction of nasal airflow) À≈“¬ “‡Àµÿ∑—Èß∑’ˇªìπ¿“«–ª°µ‘ (physiologic con- ´÷Ë߇°‘¥®“°‡¬◊ËÕ∫ÿ®¡Ÿ°∑’Ë∫«¡¡“°¢÷Èπ·≈–¡’°“√‡æ‘Ë¡ dition) ·≈–¿“«–∑’˺‘¥ª°µ‘ §◊Õ ‡°‘¥®“°‚√§µà“ßÊ ª√‘¡“≥¢ÕßπÈ”¡Ÿ° ‡™àπ ‚√§®¡Ÿ°Õ—°‡ ∫¿Ÿ¡‘·æâ, ‚√§ (pathologic condition) (µ“√“ß∑’Ë 1) ·≈–ºŸâªÉ«¬ ®¡Ÿ°Õ—°‡ ∫™π‘¥‰¡à·æâ, ‚√§‰´π— Õ—°‡ ∫, ‚√§√‘¥ ’¥«ß §πÀπßÊ÷Ë Õ“®¡ “‡Àµ’ ¢ÕßÕ“°“√§ÿ ¥®¡— °À≈“¬ “‡ÀµŸ ÿ ®¡°.Ÿ √à«¡°—π‰¥.â 2. Õ“°“»∑º’Ë “π‡¢à “À√â ÕÕÕ°®“°®¡◊ °πŸ Õ¬≈ß®√â ß‘ “‡Àµÿ¢ÕßÕ“°“√§—¥®¡Ÿ° Õ“®®”·π°‰¥â‡ªìπ 3 (objective restriction of nasal airflow) ´÷Ë߇°‘¥ “‡Àµ12ÿ §◊Õ ®“°§«“¡º‘¥ª°µ‘∑“ß°“¬«‘¿“§ ‡™àπ °√–¥Ÿ°‡∑Õ√å- 1. Õ“°“»∑’˺à“π‡¢â“À√◊ÕÕÕ°®“°®¡Ÿ°πâÕ¬≈ß ∫‘‡π∑Õ—π≈à“߬◊Ëπ‡¢â“¡“„π‚æ√ß®¡Ÿ°¡“°º‘¥ª°µ‘, ºπ—ß µ“√“ß∑’Ë 1.
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    Bibliography 1 A with special reference to the movements and fusion of the Abbe R (1898) A new plastic operation for the relief of defor­ palatine processes. Acta Anat 68:473 mity due to double hare-lip. Med Reg 53:477 Anderson JR (1960) Rhinoplasty and the otolaryngologist. Abdalhady MR, Ghannamb B (1981) Pathological changes of South Med J 53:321 the nasal mucosa after surgical treatment of atrophic Anderson JR (1969) The dynamics of rhinoplasty. Proceedings rhinitis. Rhinology 19:209 of the Ninth International Congress in Otorhinolaryngol­ Abonsheled WH, Moustafa HM (1985) Correction of nasal sep­ ogy. (Excerpta Medica international congress series) Ex­ tal perforation through external rhinoplasty approach cerpta Medica, Amsterdam, p 206 (abstract). 13th World Congress on Otolaryngology, Mia­ Anderson JR (1974) Philosophical considerations in revising mi, 1985, p 112 cosmetic surgical operations. Otolaryngol Clin North Am Aboulker T (1951) La voie d'abord palatine dans les 7:57 interventions sur les choanes, Ie cavum et eventuellement Anderson JR (1975) On the selection of patients for rhinoplas­ la sphenoide. Ann Otolaryngol 68:255 ty. Otolaryngol Clin North Am 8:685 Abramson M, Harker LA (1973) Physiology of the nose. Ota­ Anderson JR (1976) Symposium: the supra-tip in rhinoplasty: laryngol Clin North Am 6:623 a dilemma. Laryngoscope 86:53 Aiach G (1974) Interet d'une dissection extra-muqueuse dans Anderson JR (1984) A reasoned approach to nasal base sur­ Ie traitement de certaines stenoses vestibulaires. Ann Chir gery. Arch Otolaryngolllo:349 Plast Esthet 19:273 Anderson JR, Dykes ER (1962) Surgical treatment of rhinophy­ Aiach G (1982) Modifications de I'angle naso-Iabial au cours ma.
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