過去8年間に当科にて治療した耳下腺腫瘍の15例を検討した。これらは良性腫瘍または腫瘍類似疾患が11例と悪性腫瘍が4例であった。病理組織学的には, 多形性腺腫が8例, リンパ上皮性嚢胞が1例, 嚢胞を形成した良性リンパ上皮性疾患が1例, グロムス腫瘍が1例, 粘表皮癌が2例, 腺様嚢胞癌が1例, 腺癌が1例であった。
これらの症例を臨床的に検討し, 臨床経過を報告する。

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The sialolith occurres most commonly in ages from twenty to fifty years old, and rare in children. We have recently encountered a case of sialolith in children.
The patient, an 8-year-old boy, was referred to our department, with chief complaint of the swelling in right oral floor. In radiographic examination, a sialolith measuring about 4mm in diameter was noticed at the duct of right submandibular gland.
The stone was removed by intraoral approach and examined by Computer Aided Microanalyzer (CMA) and x-ray diffraction analyzer. In the specimen, components of Ca, P, S, Mg, Na and Cl were disclosed. The stone contained a large amount of Ca and P consisting of hydroxyapatite. Many reports showed that the salivary stone in submandibular gland was composed of hydroxyapatite.

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Osteoma is a benign tumor and rarely arises peripherally on the mandible. A case of peripheral osteoma arising on the left coronoid process of the mandible was reported.
A 65-year-old woman was referred to our department. Her chief complaint was swelling of the left cheek. Radiological examination revealed a well-defined, round radiopaque mass (about 2cm in diameter) on the left coronoid process of the mandible. Clinically, a peripheral osteoma was suspected. Under general anesthesia, the tumor was resected by the intraoral approach. This histopathological examination revealed compact osteoma.

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Sialolithiasis is a common disease in adults, but in childhood it is rare. It frequently occurs in the submandibular gland, but seldom arises in the minor salivary gland. We report a case of sialolithiasis in the buccal mucosa of the minor salivary gland in a child. An 8-year-old girl visited our department because of a painless swelling in the right buccal mucosa. The clinical diagnosis was a mucous cyst and excision was performed. Histopathological examination of the surgical specimen showed a salivary calculus in the mucous mass of the connective tissue, and the tumor was diagnosed as sialolithiasis in the minor salivary gland. Post operative finding has been good, with no evidence of recurrence as of 8 months after the operation.

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腺様嚢胞癌は, 頭頸部のいかなる部位にでも発生するが, その発生頻度は比較的まれな腫瘍である。特に, 舌下腺原発腺様嚢胞癌の症例報告はまれである。本報告では, 高齢者に発生した舌下腺原発腺様嚢胞癌を報告した。
80歳・男性が左側口底から舌にかけての知覚麻痺と硬結を主訴として来科した。左側口底に, 約27×15mmの弾性硬, 不動性の腫瘤を認めた。臨床診断を左側口底悪性腫瘍とした。試験切除時の病理組織像は, 腺様嚢胞癌であった。全身麻酔下に, 気管切開術・局所拡大切除術・上頸部郭清術をおこなった。術中, 神経周囲浸潤が疑われたため, 舌神経および舌下神経を切除した。また, 顎下およびオトガイ下リンパ節転移が認められたが, 高齢者であったため, 上頸部郭清にとどめた。欠損腔は残存舌にて閉鎖した。術後, 放射線治療が選択された。局所および頸部リンパ節は制御されたが, 術後観察中に多発性微小肺転移が認められた。
摘出物の病理組織像は, リンパ節転移・静脈侵襲・神経周囲浸潤を伴った舌下腺原発腺様嚢胞癌であった。
本邦における文献では, 本症例を含めて18例の舌下腺原発腺嚢胞癌が報告されている。一般的に, 舌下腺原発腺様嚢胞癌は, 頸部郭清術と局所拡大切除がおこなわれている。しかし, 高齢者では術後の合併症や機能障害の防止のために, 局所切除および頸部郭清は制限される。

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Odontoma is a tumor arising from the dental enamel, dentin and dental cementum where the majority is of the harmartoma type. At times, the components of the enamel epithelia may be identified at the marginal regions. We herein report a case of infantile odontoma with concomitant ameloblastoma that was histopathologically identified.
A 9-year-old boy sought dental consultation at the Department of Dentistry and Oral Surgery, Toho Hospital with the chief complaint of abnormal tooth eruption of the anterior maxillary tooth. Clinical diagnosis for odotoma was established with radiographic examination. The lesion was enucleated under local anesthesia. Histopathological examination identified cellular foci of ameloblastoma in both the ondontogenic solid and soft tissues and was diagnosed as compound odontoma. The post-operative course has been uneventful.

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高分化型扁平上皮癌の1亜型である疣贅状癌は, 1948年にAckermanによって最初に報告された。日本においては, 1990年に浅海らが52例を報告している。
われわれは, 頬粘膜, 舌, 下顎歯肉の3例の疣贅状癌を報告した。頬粘膜および舌の2例は切除し, 下顎歯肉の1例はレーザー切除と蒸散をおこなった。
本腫瘍においては, 未分化転換がしばしば起こるため, 化学療法と放射線治療は一般的には行なわれない。われわれの3例では, 外科療法が選択され, 局所制御が得られた。

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The sialolith most commonly occurs in the submandibular salivary gland.We have recently encountered a case of large sialolith in the duct of submandibular gland.The patient, a 65-year-old male, was referred to our department, complaining of a tooth-like object in right oral floor.A sialolith measuring about 8×22mm projected from the duct of the right submandibular gland.And we noticed a verrucous carcinoma, measuring about 20×35mm, on the left lateral side of the tongue. In radiographic examination, a salivary stone, measuring about 8×48mm, existed on the right oral floor.
The stone was removed by intraoral approach and examined by Computer Aided Microanalyzer (CMA) and X-ray diffraction analyzer.Ca, P, S, Mg, Na, K and Cl were found in the specimen. The stone contained a large amount of Ca and P.That was composed of hydroxyapatite.Many authors reported that the salivary stone in the submandibular gland composed of the substance.

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腺房細胞癌は唾液腺に発生するまれな腫瘍であり, 全耳下腺腫瘍の2～4%を占める。
上唇粘膜に発生した腺房細胞癌の1例を報告し, 文献的考察を行った。
44歳の男性が右側上唇の無痛性腫脹を主訴として当科を受診した。局所のリンパ節腫脹は認められなかった。腫瘍は初診時に約20×20mmの大きさであり, 病理組織学的には腺房細胞癌であった。
全身麻酔下に, 腫瘍を口腔内より根治的切除し, 分層植皮にて再建した。術後, 再発および転移は認めていない。
1955年から1991年までの, 日本での文献では54例の小唾液腺由来の腺房細胞癌が認められた。好発部位は口蓋 (19例) であった。次いで, 臼後三角部 (9例) , 口唇 (7例) , 頬粘膜 (7例) , その他 (12例) に発生していた。文献例による再発率は21.6%であった。

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多形性腺腫は唾液腺の中では一般的な腫瘍である。大唾液腺, 特に耳下腺にしばしば発生する。小唾液腺においては, 普通は口蓋に発生し, 口唇の発生は比較的まれである。上唇に発生した多形性腺腫の3例を報告した。それらは, 境界明瞭で可動性であり, 局所麻酔下に容易に切除できた。再発は認めなかった。病理組織学的に多形性腺腫と診断された。日本語文献上われわれが渉猟しえた限りでは, 小唾液腺腫瘍919例のうち上唇多形性腺腫は39例 (4.2%) であった。口唇の術後の変形や機能障害が起こることを考慮して安全域を設定する必要がある。

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Four cases of parotid gland tumors, three pleomorphic adenomas and one mucoepidermoid carcinoma, were presented. The three pleomorphic adenomas were treated by superficial parotidectomy, and in two of the cases the exposed facial nerve was covered with sternomastoid muscular flap to prevent the Frey syndrome, which often occurred after parotidectomy.
The mucoepidermoid carcinoma was treated by total parotidectomy with preservation of the facial nerve. In this operation, a sternomastoid muscular flap was also used.
The pleomorphic adenoma case which was operated without muscular flap, and the mucoepiermoid carcinoma case that complatined of Frey syndrome, but the other two cases were free from Frey syndrome.
The use of sternomastoid muscular flap can prevent the Frey syndrome, postoperative facial deformity. and salivary fistula that may occur after parotidectomy.

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One hundred and twelve cases of salivary gland tumors, 53 from parotid glands, 16 from submandibular glands, 1 from sublingual gland, and 42 from minor salivary glands, were studied. They were composed of 79 cases of benign tumors and 33 cases of malignant tumors. Pleomorphic adenomas, which comprised 62.5% of all the tumors and 88.6% of the benign tumors, were most common. Generally, these tumors were found more frequently in females than in males.
Mucoepidermoid tumors were the most common tumor among the malignant tumors.
Parotid gland tumors were most common, which comprised 48.4% of all the cases.
The incidence of the submandibular gland tumors in this study is higher than those reported in the English literatures.
Pleomorphic adenomas were classified according to Shirakawa's classification with some modification by Sakasita. W e suggested that these tumors should be classified into four subclasses. W e found that the presence of adipose tissue in theses tumors was more common in minor salivary gland tumors than in the tumors of other sites. The capsules of these tumors were complete in almost all the cases, but eruptions and daughter tumors in the capsule were seen in 41.9 % of the cases. The surgical treatment of these gland tumors should be partial or total resection of the involved salivary gland because of the high recurrent rate after only enucleating the tumor mass.

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A case of gustatory sweating following excision of lymphoangioma in the submandibular region, was reported.
A 45-year-old male had complained of right submandibular swelling. About 10 years ago, he was incised by a otolaryngolist, to relieve swelling in the same area.
After clinical investigations, the lesion was diagnosed as a benign tumor of the submadibular gland. Under the general anesthsia, the lesion was removed with the submandibular gland. Histopathological examination revealed a picture of lymphoangioma.
A benign, congenital proliferation of lymphatic tissue is termed lymphoangioma. This tumor usually is discovered in children. But, the case report of this tumor in an abult is rare.
About 7 months after the operation, the gustatory sweating of the operation area with an approximate that of 2.5×1.5 cm had occurred. The case report of gustatory sweating following submandibular gland excision was unusal. Based on the phenomenon in this case, it was considered that submandibular gland secretory nerve fibers were misdirected to the sweat glands of the covering skin during healing after the surgery.

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Four hundred and seven cases of salivary gland tumors, obtained from Ishikawa Prefectural Central Hospital and Kanazawa University Hospital were studied. They were composed of 277 cases of benign tumors and 130 malignant tumors. Histologically they consisted of 224 pleomorphic adenomas, 40 monomorphic adenomas, 35 mucoepidermoid tumors, 8 acinic cell tumors, 40 adenoid cystic carcinomas, 17 adenocarcinomas, 8 epidermoid carcinomas, 6 undifferentiated carcinomas, 9 malignant pleomorphic adenomas (carcinoma in pleomorphic adenoma), 8 hemangiomas, 6 malignant lymphomas and others. The frequency of the malignant tumors of the minor salivary glands was higher than that of the major salivary glands. Eleven tumors (2.7%) were noticed under age of 15. Histopathologically they were composed of 6 hemangiomas, 2 pleomorphic adenomas, one neurilemmona, one rabdomyosarcoma and one adenocarcinoma. The frequency of hemangioma in children was higher than that in adult. And the frequency of malignant tumors in children (18%) was lower than that in adult (32.3%). Ten tumors in children occurred in parotid and other one tumor occurred in submandibular gland. No tumor occurred in minor salivary gland.

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Malignant tumor arising in the submandibular gland occur frequently as compared with other major salivary glands, however, squamous cell carcinoma is uncommon.
A case of squamous cell carcinoma arising in the submandibular gland was reported.
A 62-year-old man was referred to our department with the chief complaint of a painless mass in the right submandibular area. Clinical diagnosis was a malignant tumor of the right submandibular gland (T4bN0M0). Under general anesthesia, right radical neck dissection, extensive excision of the submandibular gland tumor with partial mandible and covered skin, and reconstruction with vascularized free composite peroneal bone graft were carried out. The regional control was obtained, but lung metastasis was noticed. A partial recection of the lung was carried out. Finally, the tumor metastasized to the vertebras and the patient was died.
Histopathlogical examination revealed a picture of squamous cell carcinoma arising in the submandibular gland (pT4aN0M0).
On diagnosis, it is important that squamous cell carcinoma arising in the submandibular gland is distinguished from the metastatic tumor of the submandibular region and mucoepidermoid carcinoma arising in the submandibular gland. Most cases in literatures were resected surgically.

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Thyroglossal duct cyst (TGDC) generally arises from the remnant of the thyroglossal duct that connects the foramen cecum of the tongue to the thyroid gland. We describe a rare case of TGDC associated with small calcification grains in the cystic cavity.
A 39-year-old man was referred to our hospital for further evaluation of a tumor in the submental region. At presentation, the tumor, which measured 4 cm in diameter, was found in the subhyoid region as a rounded, well-circumscribed, painless, mobile, and elastic-soft mass. He had no clinically significant family or medical history of TGDC. Ultrasonography demonstrated a poorly-demarcated cystic lesion about 2 cm in diameter with a heterogeneous internal echo pattern that was partly hyperechoic. Computed tomography and magnetic resonance imaging also showed a demarcated and round cystic mass with a diameter of 2 cm. A clinical diagnosis of TGDC was made, and we performed surgical removal of the tumor with the Sistrunk procedure under general anesthesia. Histopathologically, the cyst was covered with pseudostratified ciliated columnar epithelium within stratified squamous epithelium in some areas. In addition, lamellar-structured small calcification grains were found within the cystic cavity. A histopathological diagnosis of TGDC was made. These small calcification grains apparently developed by a process similar to the generating mechanism of a sialolith. Recurrence of the original TGDC was not found 3 years or more after surgery.

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顎関節内障における関節腔内の病変を把握することは, 本症の治療法を検討し, 予後を知る上で重要である。今回われわれは, 微細径ファイバースコープを顎関節診断鏡として臨床応用し, その有用性について検討したので報告した。
(1) 微細径ファイバースコープは, メディカルサイエンス社製のMS-611Sを用いた。本ファイバースコープの外径は0.8mmであった。
(2) 局所麻酔下での顎関節腔二重造影断層検査と同時に施行できるため, 人体への侵襲も最小限に抑えられた。
(3) 本検査による上関節腔の観察において, 滑膜炎や線維化の診断については有用であった。また, 癒着の性状の観察が可能であった。しかし, 関節円板の転位, 変形および後部結合組織の穿孔についての診断は不可能であった。
(4) 下関節腔内の観察については, 上関節腔と比較して十分な視野が得られず改良の必要があると考えられた。
(5) 本検査において合併症は認められず, 安全な方法であると考えられた。

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嚢胞性リンパ管腫は, 頭頸部ではまれな腫瘍である。6歳・男児の右側顎下部に発生した嚢胞性リンパ管腫の1例を報告する。腫瘍は8×4cmの大きさで, 初診時の臨床診断を顎下型ガマ腫として, 口内法で開窓した。病理組織学的には, 嚢胞性リンパ管腫であった。腫瘍は口腔外切開にて完全に切除した。術後, 再発は認められていない。

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Frey's syndrome is a complication of parotid gland surgery. We reported a method for preventing Frey's syndrome following parotid gland surgery and evaluated its effect.
Thirteen parotid gland tumors were operated on. They included 10 benign tumors or tumor-like lesions and 3 malignant tumors.
The operative defects after superficial or total parotidectomy were covered with superiorly based muscular flaps from the sternocleidomastoid in 10 cases. The operative defect after a deep lobectomy was covered with an inferiorly based fascial flap from temporal muscle in one case. Lyophilized human dura was inserted between the operative defect and the skin flap in two cases.
Frey's syndrome was noted in two cases.

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