耳下腺と副咽頭間隙に多発し悪性化を疑い下顎骨離断を行ったワルチン腫瘍例

概要

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Facial palsy is generally recognized as a symptom of malignancy among parotid tumors. We report herein on multiple Warthin's tumors involving the parotid and parapharyngeal region accompanied with facial palsy. A 45-year-old man visited our clinic complaining of right parotid swelling. No other symptom was observed except the swelling. CT revealed multiple tumors involving the right parotid and parapharyngeal region. Fine needle aspiration cytololgy indicated Warthin's tumor. He did not accept the proposal of surgical removal of the tumor. Six years and 8 months later, he had acute onset of right facial palsy and severe pain of the right half of the face. We performed surgery suspecting malignant transformation because of the accompanying facial palsy. The tumors were removed visibly by the cervical and parotid approach with a midline mandibulotomy (i.e.; mandibular push up method). The right facial nerve was preserved because of the lack of malignancy as demonstrated by the intraoperative rapid histopathological diagnosis. The postoperative histopathological examination failed to show malignant transformation of the Warthin's tumors. No evidence of recurrence of the disease was observed and the facial palsy had almost regressed a year after the surgery.