頭頚部神経鞘腫手術例の臨床的検討 下位脳神経麻ひによるえん下障害について

Abstract

Neurinoma occasionally arises in the head and neck region. It is histologically benign; however, neural deficits can be critical problems following surgical extirpation of such lesions. Lower cranial nerve deficits are especially frequently accompanied by dysphagia and dysphonia. This paper contains clinical analyses of 14 patients with neurinomas in the head and neck, and discusses therapeutic strategies for postoperative dysphagia. Fourteen patients with neurinoma in the head and neck, excluding acoustic and facial neurinomas, were operated upon in our clinic between 1975 and 1998. They consisted of 6 males and 8 females with a mean age of 46.6 years. The tumors were located at the parapharyngeal space in 8 patients, lateral cervical region in 4, and oral cavity in 2. Their nerves involved were sympathetic nerves in 3 patients, vagal nerves in 2, hypoglossal nerves in 2, glossopharyngeal nerve in 1, accessorius nerve in 1, brachial plexus in 1, and unknown in 4. In 4 patients, paralysis of a nerve different from the originated nerve of the tumor appeared postoperatively. Lower cranial nerve paralysis causing oropharyngeal dysphagia occurred in 50% (7/14) of the patients. Restoration of oral alimentation through the use of compensatory maneuvers and changes in diet was achieved in 4 patients, while it was not in 3 others. Functional surgery for dysphagia, which consisted of cricopharyngeal myotomy, laryngeal suspension, or medialization of the paralyzed vocal fold, was performed in those 3 patients, resulting in successful outcomes. Conclusively, surgical management should be considered when patients continue to experience dysphagia in spite of rigorous conservative treatment following the removal of neurinoma of the head or neck.