耳下腺腫傷周辺の諸問題

SOME PROBLEMS CONCERNING TUMORS IN AND AROUND THE PAROTID GLAND

　Ⅰ．緒言

　最近われわれは耳下腺およびその周辺に発生し，耳下腺腫瘍とよく似た臨床症状を示す疾患を経験した。耳下腺深部の鰓原性嚢腫，下顎骨横枝の外傷性骨嚢胞，および下顎骨上行枝に発生した骨肉腫である。これらはいずれも耳下腺部に腫脹があり，過去に一度は耳下腺腫瘍の診断を受けたことがある。全例，顔面神経保存耳下腺腫瘍摘出術に準ずる手術法を行なつて，腫瘍を顔面神経（以下顔神と略す）と分離して摘出することができたが，骨肉腫の場合は，顔神をいつたん主幹の部で切断し，腫瘍摘出後再び縫合した。

　以上の症例に，やはり最近経験した耳下腺腫瘍亜鈴型を加えて，耳下腺腫瘍周辺の問題点を探つてみたいと思う。

　Four tumors in and around the parotid gland are reported. These tumors consisted of a parotid tumor, branchial cyst, traumatic bone cyst and an osteosarcoma of the mandible, all of which were clinically similar to narotid tumor.The parotid tumor and the branchial cyst were extirpated by means of socalled conservative parotidectomy. In cases of the traumatic bone cyst and osteosarcoma of the mandible hemimandibullectomies were performed after the initial parotoidectomy. In the latter case, particularly, the trunk of the facial nerve was temporarily severed which was repaired with end to end suture after the removal of the tumor.

　The origin of the parotid tumor that extended into the pharynx and the operative technic employed were discussed.

　The authors emphasized that conservative parotidectomy is very useful as a preliminary operation when the procedure require extension into the deeper portion of the neck.