嫌気性菌による耳下腺膿瘍と合併症としての血栓性海綿静脈洞炎

ANAEROBIC INFECTION OF THE PAROTID GLAND, AND CAVERNOUS SINUS THROMBOSIS AS ITS COMPLICATION

　I．はじめに

　近年急性化膿性耳下腺炎，耳下腺膿瘍の頻度は減少しており，かつて恐れられた合併症も今日では問題にされることはない。

　昭和30年から34年までの千葉大学耳鼻咽喉科学教室における急性化膿性耳下腺炎の頻度は外来統計の0.2％にあたる57名であり，その起炎菌のほとんどは黄色葡萄球菌であつた^1）。昭和50年より52年までの2年間に秋田大学耳鼻咽喉科唾液腺外来を訪れた炎症性疾患の総数は千葉大学症例と大差はないが，耳下腺膿瘍は5例にすぎず，好気性菌培養ではいずれも菌の増殖は認められなかつた。嫌気性菌培養を行なうようになつた過去1年間3症例の全例で嫌気性菌が検出されており，peptostreptococcus2例，peptococcus 1例であつた（第1表）。

　Staphylococcus aureus had been the main etiologic microorganism of abscess of the parotid gland, but in 3 cases of abscess of the parotid gland we encountered in the past year anaerobic bacteria such as peptostreptococcus and peptococcus were isolated. A 66 years old male with an abscess of the parotid gland due to peptostreptococcus was complicated with cavernous sinus thrombophlebitis and orbital abscess and the patient was treated by chemotherapy and drainage of abscess. The orbital abscess cavity was irrigated with antibiotics daily through silicone tube retained in the cavity. CT scann was most effective to elucidate formation of abscess and its site in the orbital cavity. The early decompression of the orbit through the maxillary and the ethmoid sinuses was done to prevent the degenerative change of the orbital contents due to the elevated intraorbital pressure frequently seen in cavernous sinus thrombophlebitis. In the recent era of antibiotics, the complications of abscess of the parotid gland have never been seriously apprehended. But abscess of the parotid gland can occasionally cause severe dehydration, hypoprotenemia, anemia and electrolyte imbalance unless the patient is properly treated with antibiotics, fluid therapy and surgery. This makes of the patient vulnerable to secondary infection. Deep and multiple abscesses of the parotid gland communicated to the oral cavity can be a focus of infection of anaerobic bacteria which is difficult to be eliminated with chemotherapy alone. And the chance of septic thrombus transfered to the cavernous sinus via the deep pterygoid plexus becomes large. In the diagnosis and treatment of the abscess of parotid gland the importance of anaerobic infection with a potential danger of thrombophlebitis which may cause serious complications should be considered.