参考文献に追加訂正をいたします。

　小児深頸部膿瘍は成人例と異なり, 保存的治療で治癒に至る症例が多いため, 穿刺や切開排膿等の外科的治療の適応について判断に苦慮することがある. 小児ではリンパ節炎が成因であることが多く, 抗菌薬治療等の保存的治療が有効である一方で, 扁桃炎や唾液腺炎などリンパ節炎以外の原因で生じたと思われる症例では, 外科的治療が必要となる場合がある. 外科的治療の適応について, これまで感染部位や成因から検討した報告はない.

　今回われわれは, 当科で治療した小児深頸部膿瘍の11例について検討した. 感染部位は, 咽頭後間隙4例, 扁桃周囲3例, 耳下腺間隙2例, 顎下間隙1例, 後頸間隙1例であった. 全体で保存的治療のみで治癒に至った症例は11例中7例であり, 4例に外科的治療を施行した. 感染部位に応じた検討をしたところ, 咽頭後間隙の症例は全例保存的治療で軽快したが, 扁桃周囲・耳下腺間隙・後頸間隙の症例では, 4例に穿刺排膿を施行し, 3例は軽快したが生後1カ月の女児の1例は排膿不十分で頸部外切開を要した. 咽頭後間隙膿瘍では保存的治療を第一選択とするが, 扁桃周囲および耳下腺間隙など部位によっては, 早い段階での穿刺排膿が有用であると考えられた.

Postcricoid vascular abnormalities are rare causes of chronic dysphagia and dyspnea in infants and children. A postcricoid cushion is a mass that becomes obvious when children cry because of venous flux dilation in the postcricoid lesion. The condition can present as a sucking or respiratory disorder, attributable to laryngeal stenosis caused by venous pressure imparted by the mass. The epidemiology and pathophysiology of a postcricoid cushion are poorly known; many cases are asymptomatic and many are often diagnosed as hemangiomas or vascular malformations. Herein, we report a case of an infant in whom postcricoid cushion was diagnosed by laryngoscopy under sedation, considering the unique pressure-dependent characteristics of the lesion.

A 9-month-old female presented with intermittent stridor associated only with crying. Flexible laryngoscopy revealed a spherical bluish mass in the postcricoid area. Magnetic resonance imaging did not reveal the mass, so that no definitive diagnosis could be made. As we suspected the presence of a pressure-dependent vascular mass (a postcricoid cushion), we performed flexible laryngoscopy with the child under sedation. The lesion was difficult to visualize. We made the diagnosis of postcricoid cushion and followed the patient for 2 years by only serial laryngoscopies. The mass became smaller over time.

Postcricoid cushion in an infant was diagnosed by laryngoscopy under sedation. It is important to be aware of this unique condition when examining the upper aerodigestive tract. No treatment for postcricoid cushion is needed in the majority of cases, as most patients can be safely observed.

　TIPIC syndrome は, 頸動脈周囲の一過性の炎症が原因となり頸部痛を来すまれな疾患である. これは以前から carotidynia として扱われてきた疾患であるが, 近年ではその画像所見に関する報告が増えたことで徐々に病態が解明され, 診断基準とともに名称を変えつつある. 今回われわれは, TIPIC syndrome の2例を経験した. 2症例とも特徴的な頸部圧痛 (Fay 徴候) を認め, 超音波検査と造影 CT 検査にて患側の総頸動脈遠位部に全周性の軟部組織陰影を認めた. いずれも NSAIDs の内服で経過観察をしたところ, 1週間後に症状は軽快した. 今回, これらの症例について文献的考察を加え検討した.

Carotidynia is a relatively rare disorder characterized by unilateral neck pain or swelling, without physical dysfunction. Although it is thought to arise from nonspecific inflammation of the carotid artery tissue, the precise cause remains unknown.

The patient was a 40-year-old man who presented with electric shock-like pain coursing along the left carotid artery when he applied pressure on the neck, became angry, or was swallowing. Physical examination showed no evidence of organic dysfunction and hematological examination revealed no abnormalities. On the other hand, cervical ultrasonography revealed a low-echoic lesion and local thickening of the wall of the left common carotid artery. Contrast-enhanced T2-MRI revealed a high-intensity lesion and local thickening of the soft tissues surrounding the left common carotid artery. Based on the findings, we administrated only anti-inflammatory agents, considering that there was no evidence of infection. The pain resolved completely after 7 days of treatment and has not recurred. At this time, the patient was definitively diagnosed as having suffered from carotidynia, because the symptom rapidly disappeared with only anti-inflammatory drugs, and no evidence of organic disorder was found.

It is important for otolaryngologists to bear in mind the possibility of carotidynia in the differential diagnosis of acute neck pain. Ultrasonography and MRI examinations are most useful for a precise diagnosis.