耳下腺多形腺腫再発症例の手術 Study of surgical therapy for recurrent pleomorphic adenomas of parotid gland

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我々は6例の多形腺腫の再発例を経験した.再発した耳下腺多形腺腫の再手術時の問題点を検討したので報告する.再発の形態は1例は耳下腺深葉の単発性再発である.5例は多発性再発で, そのうち4例は浅葉に多発再発していた.他の1例は浅葉・深葉両葉に多発性再発していた.また6例中3例は再々発例である.再手術・再々手術までの期間は最短2年, 最長24年経過していた.<BR>手術法では核出術を施行されたと思われる例は6例中4例あり, 核出術は再発の危険がある.再手術時の重要な点は顔面神経を本幹で同定し, 保存するように努力することである.幸運にも, 核出術を施行されている症例は顔面神経本幹の露出は困難ではない.術後の瘢痕化が生じていた例や浅葉切除例は顔面神経の保存に困難を伴う.術後2例に顔面神経麻痺が生じた.1例は一過性で, 瘢痕化が著明であった症例である.永久麻痺を生じた1例は耳下腺両葉に再発腫瘍が多発していた例で顕微鏡下に顔面神経は保存したが結果は悪かった.多形腺腫は再発することがあることを術前十分インフォームドコンセントすることが重要.また顔面神経麻痺を起こしやすいことを再手術時に十分説明しておくことが重要である.

We operated on six recurrent pleomorphic adenomas of the parotid gland, reported the important points of the surgical therapies.<BR>One case was only one recurrence in the deep lobe of parotid gland. Five cases were multiple recurrent pleomorphic adenomas, four cases were a recurrence in the superficial lobe of parotid gland, and one was a recurrence in both lobes of the parotid gland. Three out of six casese were re-recurrences. The period to reoperation or re-reoperation passed after shortest two years, most longest 24years.<BR>Four out of six had been perfomed with enucleation, which was thought to be the most dangerous method for recurrence of pleomorphic adenoma. An important point at re-operation, the trunk of the face nerve is found and it is to make effort for being reserved it.<BR>Fortunately, the exposure of this trunk is not difficult with the case performed enucleation. The cases which scars of postoperation arose and superficial lobectomy was performed were difficult with preserve the facial nerve.<BR>Post-operative facial nerve palsy was seen in two cases. One was temporary, the scars of postoperation were remarkable. The case causing permanent paralysis was multiple recurrences of both lobes. Under a microscope we removed the tumors with a total lobectomy, the facial nerves reserved, but the result was bad.<BR>As the further re-recurres and the injury or sacrifise of the facial nerne are the main pioblems in managing the revision surgery, it is very important to get a patient's infomed consent to carry out the plans.

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  • 口腔・咽頭科 = Stomato-pharyngology

    口腔・咽頭科 = Stomato-pharyngology 13(3), 367-375, 2001-06-01

    日本口腔・咽頭科学会

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