上顎癌の広汎性上顎部全摘出術
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概要
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The iron bound law in surgical treatment for cancer, i. e. complete removal of cancer including normal surrounding tissue was applied to the therapy for the upper jaw cancer by the author and the expected results were achieved. Namely, the maxillary bone, the muscles of mastiction with the temporal muscles, and the orbital contents were resected en bloc without splitting the upper jaw with cancer, and further the greater part of the roof of the frontal sinus, that of the orbita, that of the ethmoidal sinus, the median wall of the temporal fossa, and the roof of the sphenoidal sinus, all of which formed the bony base of the skull, were removed to explore the meninges and thus the bony walls surrounding the tumor were completely removed.After these procedures, cleaning of the temporal fossa, pterygopalatine fossa and muscles of mastication as well as the ethmoidal sinus was perfectly conducted under direct vision.Continual drainage of cerebrospinalfluid was induced by an incision of the meninges in the anterior cranial fossa in order to prevent postoperative meningism and meingitis.This method of operation was employed in 35 patients with uppe jaw cancer who visited the Department of Otolaryngology, the Faculty of Medicine, Keio University from 1953 till 1959.The 5-year survival rate was 40%. The extent of indication of this operation method, however, is very wide and can be applied to cancer even involving the muscles of mastication or the base of the skull, which has been considered to be inoperable before, except the cases with poor general condition.In other words, it can be undertaken almost unconditionally so long as the general condition permits.