耳下腺深葉から発生し副咽頭間隙へ進展したいわゆる混合腫瘍の1例

A MIXED TUMOR OF THE DEEP LOBE OF THE PAROTID GLAND WITH PARAPHARYNGEAL EXTEN-TION, A CASE REPORT

　I．緒言

　副咽頭間隙は解剖学的に複雑であり，疾患の発生頻度が低いために，疾患に対する発生，診断，治療法などの統一見解が確立されていない部位である。

　1916年，Bond^1）はこの部位におこつた，いわゆる混合腫瘍を最初に報告し，1933年，Figi^2）は神経鞘腫を，1935年，Stout^3）は非クローム親和性旁神経節腫を初めて報告した。また悪性リンパ腫がこの部位に発生することもある。これらのほかにも，この部位にさまざまな腫瘍が発生したという報告がある^4）〜7）。

　A man, aged 31, was admitted in Feb. 1978, with a swelling of the left side of the face and a hearing loss of the left ear.

　Examination revealed a mass of the left parotid region (approximately 4.5 × 4.5cm. in size) and a large intraoral tumor pushing the left side of palate, the left tonsil and the left lateral wall of the nasopharynx. The conductive hearing loss of the left ear was detected by audiogram and serous fluid was obtained by paracentesis of the left eardrum. Involvement of the cranial nerves was not observed.

　Roentogenography, sialography, radioisotope scanning, CT-scan and arteriography were useful in this case, and by those studies a tumor of the parapharyngeal space and the parotid region was disclosed. The diagnosis of a benign mixed tumor was confirmed by an exploratory excisional biopsy.

　During the operation, a regular S-sharped incision extending into the neck was made, and the tumor of the deep lobe of the parotid gland with parapharyngeal extention was removed. The facial nerve was remained intact and the post-operative course was uneventful. The removed tumor had the typical dumbbell. structure.

　This interesting case proved that tumors of the parapharyngeal space could be arise from the deep lobe of the parotid gland.