頭頸部癌の上頸部郭清時に下顎後静脈を利用した顔面神経同定法の有用性の検討  [in Japanese] Usefulness of an excellent guide of the retromandibular vein identifying the facial nerve in upper neck dissection of head and neck cancer  [in Japanese]

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Author(s)

    • 横山 純吉 YOKOYAMA Junkichi
    • 順天堂大学医学部耳鼻咽喉科・頭頸科 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine
    • 伊藤 伸 ITO Shin
    • 順天堂大学医学部耳鼻咽喉科・頭頸科 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine
    • 大峡 慎一 OHBA Shinichi
    • 順天堂大学医学部耳鼻咽喉科・頭頸科 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine
    • 春山 琢男 HARUYAMA Takuo
    • 順天堂大学医学部耳鼻咽喉科・頭頸科 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine
    • 藤巻 充寿 FUJIMAKI Mitsutoshi
    • 順天堂大学医学部耳鼻咽喉科・頭頸科 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine
    • 池田 勝久 IKEDA Katsuhisa
    • 順天堂大学医学部耳鼻咽喉科・頭頸科 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine

Abstract

頭頸部進行癌の治療は予後の向上と機能温存が重要である. 顔面神経周囲に腫瘍の浸潤がある場合, 同神経を同定し確実に腫瘍を切除することが予後の向上と機能と整容性の温存に重要である. 目的) 頭頸部癌の上頸部郭清時に下顎後静脈を利用した顔面神経同定法の有用性を検討する. 対象) 2006年8月より2008年9月に上頸部郭清時に下顎後静脈の交差部で顔面神経を同定した59例である. 口腔癌24例, 耳下腺癌10例, 顎下腺癌6例, その他19例であった. 新鮮例26例, 再発例33例であった. 方法) 外頸静脈を温存し, 耳下腺内に約2cm切離し同神経を同定した. 上頸部郭清時の場合は末梢に追跡し, 郭清した. 耳下腺深部の郭清や耳下腺全摘時には中枢側へ進め本幹を剖出した. 結果) 全例で顔面神経は同定可能であった. 結論) 上頸部郭清時に下顎後静脈を利用した顔面神経同定法は巨大な癌や再発癌で顔面神経下顎縁枝同定の困難な場合, 特に有用であった.

Improving prognosis and preserving functions such as swallowing are of particular importance in head and neck cancer treatment, because those with facial paralysis suffer from both facial asymmetry and swallowing problems. Objective: We studied the usefulness of the retromandibular vein as a guide for identifying the facial nerve in upper neck dissection of head and neck cancer. Subjects and methods: Subjects were 59 men and women with tumor invasion around the facial nerve, who underwent neck dissection from August, 2006 to September, 2008. Cases were 24 of oral cancer, 10 of parotid cancer, 6 of submandibular cancer, and 19 others. Fresh cases numbered 26 and recurrent cases 33. The parotid gland was cut 2 cm along the external jugular vein and the facial nerve was identified on the vein with dissection done along the periphery. Results: The facial nerve was identified in all cases in this way, and complications were fewer than with previous methods. Conclusion: Using the retromandibular vein as a guide above is especially useful in dissecting recurrent cases and large fixed tumors on the facial nerve trunk.

Journal

  • Stomato-pharyngology

    Stomato-pharyngology 23(2), 195-199, 2010-06-10

    Japan Society of Stomato-pharyngology

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