咽旁間隙之迷走神經鞘瘤－病例報告

Parapharyngeal Vagal Schwannoma - Case Report

王文哲(Wen-Jer Wang) ； 蕭振仁(Jenn-Ren Hsiao) ； 黃澤人(Tzer-Zen Hwang) ； 蔡森田(Sen-Tien Tsai)

《中華民國耳鼻喉科醫學雜誌》 35卷6期 (2000/12) Pp. 414-418

https://doi.org/10.6286/2000.35.6.414

摘要

咽旁間隙內的迷走神經輎流並不多見。由於位置特殊，病患常是以頭部或咽喉內腫脹來表現。臨床上常須合腮腺腫瘤、副神經結瘤等作鑑別診斷。影像學的檢查可以幫助我們判斷腫瘤之特性、大小及擬定開刀之適當的方法。本院1998年5月間經歷1明61歲男性，主訴吞嚥時有明顯異物感約有1年之久。經視診影像學檢查，疑為一巨大之咽旁間隙內迷走神經輎瘤。病患先在外院接受經口腔方式。我們採取經下頜股併經翼狀方式(transmandiblar transptergoid)將5*4*3 cm 大小的腫瘤完整取出。術後病患有極厲害的嗆食(choling)情形導致吸入性肺炎。在保守療法及實施內注射後，嗆食情形獲得改善。追蹤迄今，病患情形良好。我們認為對於巨大咽旁間隙內的迷走神經輎瘤，影像學檢查往往足以提供初步的診斷何手術的計畫。而冒然施行經口腔腫瘤切片可能造成危險。經下頜骨倂經翼狀骨之術式，能提供安全而清楚的手術視野以利腫瘤的切除。此外，對一個高位的迷走神經病變，由於會有極嚴重的嗆食情形，術中即之聲帶複健也相當重要。

關鍵字

迷走神經 ； 神經鞘留 ； 咽旁間隙

並列摘要

Parapharygeal vagal schwannomas are a rare,benign tumir of neural sheath origin. With their unusal lcations, such tumors tyically present as smooth firm, painless masses in the lateral aspect of the neck pharnx theat need to be distinguished from parold tumors and paragaangliomas by the clinicuian. Imaging stdies as CT or MRI not only reveal the nature and seze of such tumors, but also help selection of the most approptiate surgi-cal approach for excision. On May 9, 1998, a 61-year-old man presented with a one year history of a lump-like feeling in his throat when swallowing. After a series of physical examinations and imaging studies, what was believed be vagal schwannoma was dien-tified in the right parapharygeal space with extension into the jugular foramen. Aonther hospital unsuccessfully attempted surgical excision of the tumor via a transoral approach After a tumor biopsy was obtained that confitmed the diagnosis of schwannoma, the patient was teferred to our clinic. The tumor measured 5×4×3 cm, and was successfully extirpaed via a transmandiblar transpterygoid approach. Post-operative vagal dysfunc-tion resulting from nerve resection ressction caused severe choking and led to aspiration pneumo- nia. The choking was improved by vocal cord augmentation followine coservative treat-ment of the aspiration pneumonia. No tumor recurrence was observed over a 24-month follow-up period. The transmsndibular traspterygoid approach seems appropriate for the excision of large paraphryngeal vagal schwannomas, as it provides a clear visual field, increasing opertive safety. Immediate vocal cord rehabilitation is essential during such operations owing to the high incidence of marked choking after the excision high vagal lesons.

並列關鍵字

Vagus nerve ； schwannoma ； parapharyngeal space