Pedicled Temporalis Muscle Flap Stuffing after a Lateral Temporal Bone Resection for Treating Mastoid Osteoradionecrosis

Abstract

Objective The aim of this study was to compare the outcomes of lateral temporal bone resection and pedicled temporalis muscle flap stuffing with external auditory canal closure with those of canal wall down mastoidectomy for the treatment of mastoid osteoradionecrosis. Study Design Prospective nonrandomized case-control clinical study. Setting Department of Otolaryngology of the First People's Hospital of Foshan. Subjects and Methods Seventy-seven postirradiation nasopharyngeal carcinoma patients with mastoid osteoradionecrosis were included. Forty patients (40 ears) underwent lateral temporal bone resection in the temporalis muscle flap group. Their pedicled temporalis muscle flaps were laid on the surgical cavity, and the external canal opening was simultaneously closed. Thirty-seven patients (37 ears) underwent a canal wall down mastoidectomy in the mastoidectomy group. The surgical wounds and complications following surgery were retrospectively analyzed. Results The patients were followed for 2 years. The percentage of patients with purulent otorrhea and persistent osteoradionecrosis in the temporalis muscle flap group was lower than that in the mastoidectomy group. Conclusion Our preliminary results suggest that lateral temporal bone resection with the pedicled temporalis muscle flap filled into the surgical cavity, followed by closure of the external auditory canal, represents a valuable approach for treating mastoid osteoradionecrosis.

Radiation Necrosis of the Lateral Skull Base and Temporal Bone

“…11,25 The latency period between radiation exposure and the development of ORN-related symptoms averages approximately 8 years, but the range varies widely from 6 months to 48 years. 1,4,10,11,[16][17][18][19] In their series of 33 patients, Sharon et al found no correlation between radiation dose to the primary site and the time to development of ORN. 17 Ramsden et al suggested that patients younger than 40 years at the time of radiation exposure seemed to present after longer latency periods than patients older than 40 years (8 vs. 6 years).…”

“…Overall, the literature demonstrates that males and females are equally susceptible to developing ORNTB. 4,18,19 Presenting Symptoms…”

“…22,26 The most common presenting symptoms of ORNTB are otorrhea, hearing loss, otalgia, tinnitus, headache, and cranial nerve VII palsy. 4,[9][10][11][17][18][19]27 Drainage from the affected ear may be purulent and foul-smelling or sanguinous. The etiology of hearing loss is typically multifactorial with pure tone audiometry demonstrating sensorineural loss resulting from radiation-induced injury to the cochlea, conductive hearing loss secondary to radiation-associated otitis media secondary to Eustachian tube fibrosis, or mixed loss due to the negative impacts of both.…”

“…The etiology of hearing loss is typically multifactorial with pure tone audiometry demonstrating sensorineural loss resulting from radiation-induced injury to the cochlea, conductive hearing loss secondary to radiation-associated otitis media secondary to Eustachian tube fibrosis, or mixed loss due to the negative impacts of both. 1,11,17,19…”

“…Nearly 400 cases are described in the literature, predominantly through the publication of institutional case reports and retrospective case series. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Despite increasing awareness, ORNTB remains a debilitating and potentially lethal condition that continues to challenge patients and treating physicians.…”