Clinical and Radiographic Examination

The most common presenting symptom is otalgia; the most common presenting sign is a mass in the external auditory canal.10 Other clinical manifestations are detailed in Table 53-2. Binocular microscopic otoscopy, a complete head, neck, and cranial nerve examination, and audiometry are then performed. Since SCCA of the temporal bone routinely invades bone and soft tissues within and near the temporal bone, most patients should ideally undergo CT of the temporal bone as well as magnetic resonance imaging (MRI) of the head and neck.

Although no consensus has been reached on the ideal staging system for SCCA of the temporal bone, one of the better systems is from the University of Pittsburgh11 and is summarized as follows: T1, tumor limited to the external auditory meatus without bone or soft tissue extension; T2, tumor with

TABLE 53-2

Clinical Manifestations of Patients with Squamous Cell Carcinoma of the Temporal Bone

Symptoms: Otalgia Hearing loss Headache Facial numbness Hoarseness Dysphagia

Signs:

EAC mass Bloody otorrhea Facial nerve paralysis Other cranial nerve deficits Parotid and/or cervical mass Temporal mass

SOURCE: Leonetti JP, Smith PG, Kletzker R, Izquierdo R. Invasion patterns of advanced temporal bone malignancies. Am J Otol 1996;17: 438-442.

limited bone and soft tissue extension; T3, full-thickness external auditory meatus erosion, middle ear or mastoid extension, and facial nerve paralysis; and T4, tumor eroding cochlea, carotid canal, jugular foramen, dura, petrous apex, or extensive (>0.5 cm) soft tissue extension. Nodal and metastatic disease is staged according to the American Joint Committee System. Most pa-tients present with stage T3 and T4 lesions. T1 and T2 lesions have cure rates of 50 to 70%, whereas T3 and T4 lesions have a 35% cure rate.12

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