顎下部膿瘍に進展した慢性硬化性下顎骨骨髄炎の1例

A case of submandibular abscess caused by chronic sclerosing osteomyelitis of the mandible

I．はじめに

　耳鼻咽喉科の日常診療で，歯原性の炎症性疾患に遭遇することは稀ではない。しかし，歯原性であっても，歯牙に関連する症状がない場合や，歯牙および歯周組織に著しい変化のない場合，あるいはほかの症状が顕著に出現した場合，診断に苦慮することとなる。

　今回われわれは，埋伏智歯が原因となって慢性硬化性下顎骨骨髄炎を生じ，その炎症が周囲に波及することによって顎下部膿瘍を惹起したと考えられた症例を経験した。本症例の病態について報告するとともに，慢性硬化性下顎骨骨髄炎の診断と治療法について文献的考察を行ったので報告する。

An 84-year-old woman presented with a 2-week history of the left submandibular region of a painful swelling and fever. She also complained of trismus and left lower toothache. CT scan revealed a ring-enhanced mass contiguous to the osteosclerotic mandible. Pantomography depicted the impacted wisdom tooth and diffuse osteosclerosis of the left mandibular body,which showed marked accumulation of ^99mTc in bone scintigram. She was diagnosed of a submandibular abscess caused by chronic sclerosing osteomyelitis of the mandible. The possible source of infection was the impacted wisdom tooth. She underwent transcutaneous drainage,extraction of the impacted tooth and hyperbaric oxygen therapy along with the administration of intravenous antibiotics. Although the disease took an intractable clinical course,the inflammation gradually subsided,and she was discharged 66 days after admission. The diagnosis and management of chronic sclerosing osteomyelitis in the head and neck region were reviewed.