逆行性顏面神經剝離法於全腮腺切除之應用－病例報告

口腔鱗狀上皮細胞癌(OSCC)轉移至腮腺的病例相對於腮腺的原發性惡性腫瘤而言，較為罕見。本文報告一例轉移的OSCC，侵犯到腮腺下淋巴結及腮腺淺葉。我們利用全腮腺切除術，完整移除腫瘤，手術方法於耳前區域設計－S形切線，接著分離頰部皮膚及腮腺包膜，往前至咬肌後緣顯露為止。此時在4倍的手術放大鏡，及神經刺激器配合下，利用尖銳的小尖剪，分離顏面神經五大分支，利用逆行性剝離法(retrograde dissection)，沿五大方支反向往主幹分離，同時切除腮線淺葉及深葉，即Keiji於1998年提出的“hamburger technique”。加上立即冷凍切片確保安全距離，保留顏面神經功能，病人於術後一年的追蹤，局部並無復發的跡象，也無顏面神經麻痺的現象。所以對於轉移至腮腺之鱗狀細胞癌，利用逆行性剝離法施行全腮腺切除術，謹愼地剝離出顏面神經五大分支，完整移除腮腺淺葉及深葉，可兼顧腫瘤安全距離及預防顏面神經痳痺等後遺症。

關鍵字

全腮腺切除術；逆行性剝離法

並列摘要

The incidence of oral squamous cell carcinoma (SCC) metastatic to the parotid gland is less than that of primary parotid neoplasms. A total parotidectomy is the standard treatment for a parotid neoplasm. This article reports a victim of metastatic SCC to the parotid gland. A total parotidectomy was our treatment approach using an S-shaped incision in the preauricular region. The skin above the parotid sheath was elevated until the posterior border of the masseter muscle was exposed. All 5 branches of the facial nerve were identified and dissected with sharp scissors under a four-fold magnitude surgical loupe. The ”hamburger technique” was used to excise the superficial and deep lobes of the parotid gland with retrograde dissection, Compared to a standard parotidectomy, a retrograde parotidectomy requires less operative time, and there is less intraoperative blood loss. An intermediate frozen biopsy was used to check the safety margin of the tumor and to preserve the function of the facial nerves. No evidence of recurrence or facial palsy was observed after 1 year of follow-up. There have been no signs of gustatory sweating or flushing, or hyperhidrosis in the check with saliva secretion postoperatively. In summary, a valuable method for a total parotidectomy for excising a metastatic SCC of the parotid gland without facial palsy is proposed.

並列關鍵字

total parotidectomy ； retrograde dissection

國際替代計量

逆行性顏面神經剝離法於全腮腺切除之應用－病例報告

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