Permalink : http://hdl.handle.net/2115/90522

KEYWORDS : 頚椎症;三叉神経障害;オトガイ部異常感覚;cervical spondylosis;trigeminal neuropathy;abnormal sensation in the chin

頚椎症は頚肩部や四肢に痺れなどの症状を生じることが一般的であり，顎顔面領域に症状を呈することは 稀である．今回我々は，頚椎症由来と思われた両側三叉神経障害の１例を経験したので，若干の文献的考察を加えてその概要を報告する． 　患者は68歳女性で，オトガイ部皮膚の痺れを主訴に当科を受診，両側オトガイ神経支配領域の皮膚に安静時のビリビリとした異常感覚を認めた．当科受診の1 か月前より特に誘引なく主訴を自覚しており，1 日数回の頻度で症状が出現していた．既往歴は左側腎癌術後，右側乳癌術後，骨粗鬆症でビスホスホネート製剤注射中，慢性腎不全で血液透析中であった． 　腎癌，乳癌の転移性腫瘍，造血器悪性腫瘍，薬剤関連顎骨壊死，脳病変などを疑い精査を行ったが，いずれも原因の特定には至らず，MRIの撮像範囲内に偶然C 4 / 5 椎間関節の変性変化（変形した椎間板や肥厚した靭帯による脊髄の圧迫所見）を認め，整形外科にコンサルトしたところ，頚椎症の診断となった．趣味である麻雀，オセロなどによる頚部前屈姿勢の時間が長かったため，姿勢の指導で保存的に経過観察したところ，両側オトガイ神経支配領域の異常感覚は消失した．症状改善後1年6か月を経過した現在まで再燃を認めていない． 　顎顔面領域の感覚障害を認めた場合，まれではあるが，頚椎症の可能性も考慮する必要があると考えられた．
Cervical spondylosis generally causes symptoms such as numbness in the neck, shoulders and extremities, but rarely presents in the maxillofacial region. 　We experienced a case of bilateral trigeminal neuropathy thought to be caused by cervical spondylosis. We report the outline of this case with some literature considerations. 　The patient was a 68-year-old woman who visited our department with a chief complaint of numbness in the skin of the chin. Abnormal sensation at rest was observed in the skin of the area innervated by mental nerves on both sides. The patient had been aware of the chief complaint for one month without any particular trigger, and the symptoms appeared several times a day. Her medical history included surgery for left renal cancer, surgery for right breast cancer and was undergoing bisphosphonate injections for osteoporosis and hemodialysis for chronic renal failure. 　We suspected metastatic tumor of renal and breast cancer, hematopoietic malignant tumor, medication-related osteonecrosis of the jaw and brain lesions. A detailed examination was performed but the cause could not be determined. A degenerative change in the C4/5 facet joint was incidentally observed within the imaging range of MRI and an orthopedic surgeon diagnosed cervical spondylosis. The patient spent a lot of time in a forward-bent neck posture due to her hobbies such as Mahjong and Othello. Dysesthesia in the bilateral mental innervation areas disappeared as a result of conservative follow-up with posture guidance. One year and 6 mo nths after symptom improvement, no recurrence has been observed. 　Although rare, cervical spondylosis should also be considered when sensory disturbance is observed in the maxillofacial region.