耳下腺腫ようにおける臨床上の問題点

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タイトル別名
  • Clinical Problems in Treating Parotid Gland Tumors.
  • ジカセン シュヨウ ニ オケル リンショウジョウ ノ モンダイテン

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Progress in diagnosis and surgical treatment of parotid gland tumors in recent years has led to increased numbers of operations in Japan.<br>The surgeon must make an exact preoperative evaluation of the parotid tumor. Several auxiliary procedures have been used; for example, scintigraphy using 99mTc pertechnetate and 67Gacitrate, computed tomography (CT), and ultrasound and magnetic resonance imaging (MRI). CT and MRI are effective for detecting the location of a tumor. In addition, MRI makes possible visualization of the facial nerve in the parotid gland. Scintigraphy and ultrasound were beneficial for diagnosing malignancy. Synthetic preoperative diagnosis using these procedures helped to determine the method of operation.<br>The fundamental philosophy of benign parotid tumor surgery is; 1) prevention of tumor recurrence, 2) preservation of the facial nerve, 3) prevention of occurrence of Frey's syndrome, 4) prevention of salivary gland fisula and 5) preservation of salivary gland function. Surgical approaches that meet all these criteria are ideal. A partial parotidectomy was performed in 350 cases of benign parotid tumors. Of the 350 cases, there was one operation for recurrence (0.3%). Temporal facial paresis occurred in 5.8% of 276 cases and Frey's syndrome occurred in 17% of 194 cases. A comparison of the reported results of lateral or superficial parotidectomy with the results of partial parotidectomy with preservation of the facial nerve shows that the latter method seems preferable for treatment of patients with benign tumors.<br>In addition, the usefulness of fine needle aspiration biopsy, the possibility of facial nerve preservation in malignant cases, and the necessity of postoperative irradiation are also discussed.

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