摘要
中耳腔之唾液腺迷離瘤爲組織學上正常的唾液腺體異常的出現在中耳腔內，是相當罕見的疾病。本文報告一8歲女性因左側傳導性聽障就診而被發現在左側正常耳膜後上方有一淡紅色腫塊，純音聽力檢查結果左耳有60 dB的氣導聽損、氣骨導差50 dB。顳骨電腦斷層掃描顯示左側中耳腔內有軟組織腫塊。在疑爲先天性膽脂瘤或其它可能腫塊的診斷下，患者接受左側鼓室探查手術。術中發現中耳腔後上方有黃色軟組織腫塊包覆砧骨長突及鐙骨，且與顏面神經不易區隔；周遭骨質被擴展外推，然鼓索神經未受波及。中耳腔另有三橢圓狀有莖的腫塊與主腫塊相連。冷凍切片檢查結果爲正常的唾液腺組織。由於腫塊與顏面神經緊密相鄰，不易分離，故在取得足夠檢體後中止手術。術後病理報告確定爲中耳異位性唾液腫塊。臨床上發現單耳聽損、完整耳膜後腫塊、顳骨電腦斷層檢查發現中耳腔軟組織位於顏面神經管周遭時，正確的鑑別診斷即有其重要性。因中耳異位性唾液腺體並不會持續增長或有惡性變化，且多位於顏面神經管周遭，故冒險完全切除並無必要，爲與先天性膽脂瘤、顏面神經瘤、肉芽腫、息肉、頸靜脈球瘤等作鑑別診斷，術中的冷凍切片檢查，便爲決定正確的後續手術步驟之重要因素。
並列摘要
Salivary gland choristoma of the middle ear is rare. It is characterized by a heterotopic rest of histologically normal salivary gland tissue appearing in the middle ear. An eight-year-old girl came to our hospital with the impression of left conductive hearing loss. Physical examination revealed a pinkish mass appearing faintly behind the normal left tympanic membrane. Pure tone audiogram showed left 60 decibel (dB) conductive hearing loss with air-bone gap of 50 dB. CT scan of the temporal bone revealed soft mass localizing at the post-superior portion of tympanic cavity. Exploratory tympanotomy was performed through a postauricular approach under the impression of congenital cholesteatoma. During the operation, the mass in the middle ear was found to be encapsulated and smooth in surface. The tumor was seemed to originate from the facial nerve and occupied the posterosuperior portion of the tympanic cavity with expanding into the nearby bone. The tumor mass was found to be tightly adherent to the horizontal portion of the facial canal and surround the long process of the incus and stapes. The chorda tympani nerve was not involved. Three separate olive-shaped masses appearing in the middle ear cavity was nearby to the main mass. Frozen section revealed normal salivary gland tissue. No further attempt was made to remove the lesion because the mass seemed to be tightly adhered to the facial nerve and further management may endanger the facial nerve. The postoperative course was uneventful, and her facial movement remained normal. Pathological examination confirmed it is a salivary gland choristoma of middle ear. To determine the consequent surgical procedures, frozen section seems important for the different diagnosis of soft tissue mass in tympanic cavity.
延伸閱讀
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