Lateral temporal bone resection for extensive pinnal malignancy. Has anything changed in forty years?

Abstract

AbstarctThis paper offers an account of the contemporary surgical approach to advanced tumours of the external ear based on a series of 11 patients. There were eight squamous, two basal cell carcinomas and one mucoepidermoid tumour. The traditional method of excision was slightly modified by performing microsurgical dissection of the lateral part of the temporal bone rather than chisel osteotomies, and then including it en bloc with the involved soft tissues. The defect was then closed using a scalp or myocutaneous flap and this combination of otological and reconstructive expertise has proved satisfactory. Four patients are alive with no evidence of disease a mean of 4.2 (range 1.0–7.0) years from surgery: two patients who remained free of disease have subsequently died of unrelated conditions 12 and 24 months post-operatively, and in three cases death from recurrent disease occurred a mean of 1.4 (range 0.9–2.1) years after our surgery. There were two postoperative deaths. Based on the actuarial survival of 36 per cent and a successful disease clearance rate of 54 per cent, our conclusion is that the outlook of this condition has not dramatically improved since the original descriptions of the management of this problem first appeared, although intervention remains justifiable because of the potential curability and relief of symptoms.

Combined treatment of advanced stages of recurrent skin cancer of the head

“…Recurrent skin cancer of the head in the advanced stage is uncommon, particularly aggressive, and difficult to control, especially when it involves the retroauricular or temporal region. 10,28,33 Radical resection of the extensively involved bone is possible, however, and the use of free flaps allows the plastic surgeon to cover wide defects of soft tissue. Thus some of the hazards that attend this kind of surgical procedure and some difficulties encountered from the oncological point of view have been reduced and a socalled "no man's land" has become a stimulating field for both neurosurgeon and plastic surgeon.…”

Applicability of the Pittsburgh Staging System for Advanced Cutaneous Malignancy of the Temporal Bone

“…Only one study by Shotton et al, 10 available for comparison within the limited literature on the topic, listed the locations and histology of their cases. Their findings do not corroborate with ours as they had two BCCs, one of which was preauricular and one of which was in the EAC.…”

“…Numerous articles have documented that surgical excision with some form of TBR is appropriate and effective for treating these lesions. [8][9][10] Previous literature has also documented improved survival when comparing BCC versus SCC. Our study corroborates both of these previous findings, as our BCC patients tended to have improved postoperative outcomes.…”

“…This has been variously combined with neck dissections, parotidectomy, adjuvant radiation, and/or chemotherapy, depending on the extent of disease, presence of nodal metastasis, histological subtype and features, and physician preference. 6,9,10 In contrast to cutaneous cancers invading the temporal bone, malignancy of temporal bone origin is exceedingly rare with an estimated incidence of six cases per million. 11 SCC is the most common histological type of malignancy in the temporal bone, but the risk factors are different from auricular carcinoma with chronic irritation or inflammation likely playing the major causal role.…”

Applicability of the Pittsburgh Staging System for Advanced Cutaneous Malignancy of the Temporal Bone

“…This has been variously combined with neck dissections, parotidectomy, adjuvant radiation, and/or chemotherapy, depending on the extent of disease, presence of nodal metastasis, histological subtype and features, and physician preference. 6,9,10 In contrast to cutaneous cancers invading the temporal bone, malignancy of temporal bone origin is exceedingly rare with an estimated incidence of six cases per million.…”