- 著者
-
古川 仭
- 出版者
- 耳鼻咽喉科臨床学会
- 雑誌
- 耳鼻咽喉科臨床 (ISSN:00326313)
- 巻号頁・発行日
- vol.86, no.3, pp.305-310, 1993-03-01 (Released:2011-11-04)
- 参考文献数
- 7
- 被引用文献数
-
3
1
Squamous cell carcinoma accounts for approximately 98 per cent of all malignant neoplasms that occur in the nasopharynx. The high incidence of nasopharyngeal carcinoma (NPC) is a characteristic of the Oriental races. Viral and environmental factors appear to have an etiologic impact on this disease. The most common sites are the lateral wall followed by the roof. NPC spreads primarily by local infiltration and regional metastases. Local infiltration of the eustachian tube is evidenced clinically when the patients presents with a unilateral conductive hearing loss secondary to the development of a secretory otitis media. Multiple cranial nerve deficits can develop. The maxillary and mandibular branches of the trigeminal complex (V2 and V3) are the most commonly involved cranial nerves and indicate extension of the tumor through the foramen rotundum and foramen ovale. Lateral rectus deficits cause the patient to complain of diplopia, especially on lateral gaze, indicating tumor involvement along the course of cranial nerve VI. More extensive internal and external ophthalmoplegias suggest orbital or cavernous sinus involvement. Lateral extension or spread into the pterygomaxillary fossa and the infratemporal fossa can easily affect the lower cranial nerves (IX, X, XI, XII), indicating that the tumor has progressed into the area of the jugular foramen. Lack of significant tumor bulk in the nasopharynx or parapharyngeal spaces with paralysis of the lower cranial nerves usually indicates involvement of adjacent lymph nodes surrounding the jugular foramen rather than direct extension from the primary tumor. Lymphatic spread from the nasopharynx may be either unilateral or bilateral. When the tumor has spread into the upper deep cervical lymph nodes, a cervical mass usually first becomes detectable clinically.