수술 전 이하선 종괴의 위치파악에 이용하는 해부학적 경계표의 유용도

Preoperative Prediction for the Location of Parotid Gland Tumors by Using Anatomical Landmarks

  • 임치영 (연세대학교 의과대학 외과학교실) ;
  • 김국진 (연세대학교 의과대학 외과학교실) ;
  • 임성주 (연세대학교 의과대학 외과학교실) ;
  • 이잔디 (연세대학교 의과대학 외과학교실) ;
  • 남기현 (연세대학교 의과대학 외과학교실) ;
  • 장항석 (연세대학교 의과대학 외과학교실) ;
  • 정웅윤 (연세대학교 의과대학 외과학교실) ;
  • 최홍식 (연세대학교 의과대학 이비인후과학교실) ;
  • 박정수 (연세대학교 의과대학 외과학교실)
  • Lim Chi-Young (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim Kook-Jin (Department of Surgery, Yonsei University College of Medicine) ;
  • Lim Sung-Ju (Department of Surgery, Yonsei University College of Medicine) ;
  • Lee Jan-Dee (Department of Surgery, Yonsei University College of Medicine) ;
  • Nam Kee-Hyun (Department of Surgery, Yonsei University College of Medicine) ;
  • Chang Hang-Seok (Department of Surgery, Yonsei University College of Medicine) ;
  • Chung Woong-Youn (Department of Surgery, Yonsei University College of Medicine) ;
  • Choi Hong-Shik (Department of Otorhinolaryngology, Yonsei University College of Medicine) ;
  • Park Cheong-Soo (Department of Surgery, Yonsei University College of Medicine)
  • 발행 : 2006.05.01

초록

Background: The location of parotid gland tumors can influence the duration and the difficulty of the operation. If the information about tumor location was available preoperatively, it would allow accurate operative planning and counseling of patients in terms of the length of the operation and the potential morbidity. Methods: This study was based on a retrospective review of 100 patients with parotid gland tumors underwent parotidectomy from January 2000 to October 2005 at Yong-Dong Severance Hospital. Based on computed tomographic(CT) scan findings, 4 landmarks such as facial nerve(FN) line, Utrecht(U) line, Conn's are(CA), and retromandibular vein (RV) were drawn on the scans in same plane. The location of tumors were determined by the landmarks and confirmed by the operative findings. The accuracy of each landmarks was evaluated. To find out the accuracies according to tumor size, the tumors were divided into 2 groups; less than 2 cm and larger than 2 cm in diameter. Results: U line was the most accurate(94%), sensitive(89.3%) and specific(97.7%) in predicting tumor location of the parotid gland. However, in small tumors less than 2cm, FN line (p=0.022) and RV criteria (p=0.028) were more reliable in accuracy. Conclusion: CA, FN line, U line, and RV are all useful landmarks in preoperative prediction for the location of parotid gland tumors. However, U line was the most accurate, but we must consider that proper landmark should be used in prediction according to the size of tumor because the accuracy of landmark may change.

키워드

참고문헌

  1. DelBalso AM, Ellis GE, Hartman KS, Langlais RP: Diagnostic imaging of the salivary glands and periglandular regions. Philadelphia: WB Saunders, 1990;409-510
  2. Smith JRG, King WWK, Tang WYM, Metreweli C: Differentiating tumours of the deep and superficial lobes of the parotid gland by computed tomographic sialography. Clin Radiol. 1987;38 (4): 345-349 https://doi.org/10.1016/S0009-9260(87)80205-2
  3. Stone DN, Mancuso AA, Rice D, Hanafee WN: Parotid CT sialography. Radiology. 1981;138 (2):393-397 https://doi.org/10.1148/radiology.138.2.7455119
  4. Rice DH, Mancuso AA, Hanafee WN: Computerized tomography with simultaneous sialography in evaluating parotid tumors. Arch Otolaryngol. 1980;106 (8):472-473 https://doi.org/10.1001/archotol.1980.00790320024006
  5. Sone S, Higashihara T, Morimoto S, et al. CT of parotid tumors. AJNR Am J Neuroradiol. 1982;3 (2):143-147
  6. Bryan RN, Miller RH, Ferreyro Rl, Sessions RB: Computed tomography of the major salivary glands. AJR Am J Roentgenol. 1982;139 (3):547-554 https://doi.org/10.2214/ajr.139.3.547
  7. Eracleous E, Kallis S, Tziakouri C, Blease S, Gourtsoyiannis N: Sonography, CT, CT sialography, MRI and MRI sialography in investigation of the facial nerve and the differentiation between deep and superficial parotid lesions. Neuroradiology. 1997;39 (7):506-511 https://doi.org/10.1007/s002340050455
  8. Conn IG, Wiesenfeld D, Ferguson MM: The anatomy of the facial nerve in relation to CT/sialography of the parotid gland. Br J Radiol. 1983;56 (672):901-905 https://doi.org/10.1259/0007-1285-56-672-901
  9. Ariyoshi Y, Shimahara M: Determining whether a parotid tumor is in the superficial or deep lobe using magnetic resonance imaging. J Oral Maxillofac Surg. 1998;56 (1):23-26; discussion 26-27 https://doi.org/10.1016/S0278-2391(98)90909-0
  10. de Ru JA, van Benthem PP, Hordijk GJ: The location of parotid gland tumors in relation to the facial nerve on magnetic resonance images and computed tomography scans. J Oral Maxillofac Surg. 2002;60 (9):992-994; discussion 995 https://doi.org/10.1053/joms.2002.34402
  11. de Ru JA, Bleys RL, van Benthem PP, Hordijk GJ: Preoperative determination of the location of parotid gland tumors by analysis of the position of the facial nerve. J Oral Maxillofac Surg. 2001;59 (5):525-528; discussion 529-530 https://doi.org/10.1053/joms.2001.22682
  12. Ragbir M, Dunaway DJ, Chippindale AJ, Latimer J, Mohammed F, McLean NR: Prediction of the position of the intraparotid portion of the facial nerve on MRI and CT. Br J Plast Surg. 2002; 55 (5):376-379 https://doi.org/10.1054/bjps.2002.3873