下位脳神経と交感神経の麻痺をきたし，Tornwaldt病の感染が原因として疑われた咽後膿瘍の1例

A case of suspected retropharyngeal abscess due to Tornwaldt's disease-associated infection, with multiple lower cranial and sympathetic nerve palsies

はじめに

　咽後膿瘍は咽後間隙に膿瘍が形成される疾患であるが，近年，抗菌薬の使用や脊椎カリエスが減少したことなどにより，発症が少なくなっている。通常は発熱や咽頭痛を伴い，中咽頭〜下咽頭後壁の腫脹を認めることが多いが，上咽頭に発生して神経麻痺症状をきたす例は稀である。

　今回われわれは，下位脳神経麻痺と交感神経麻痺をきたし，Tornwaldt病の感染が原因として疑われた上咽頭の咽後膿瘍例を経験したので報告する。

　We report a case of suspected retropharyngeal abscess associated with Tornwalde's disease, along with multiple lower cranial and sympathetic nerve palsies. A 70-year-old male visited our hospital with the chief complaint of articulation disorder. CT and MRI showed a gas-forming abscess in the posterior wall of the nasopharynx. Palsies associated with the right glossopharyngeal, hypoglossal, and sympathetic nerves were observed. Through endonasal approach, the abscess was opened and necrotic tissue with sequester was resected as much as possible using a rigid fiberscope under general anesthesia. We presumed that the palsies may have occurred due to spread of inflammation to the nerves located in the cervical carotid space and abscess formation associated with Tornwaldt's disease.