Temporal Bone Malignancies

"If the lesion is stage T3 or T4, the same protocol is offered as for T1 and T2, followed by removal of all positive and adjacent normal tissue in piecemeal fashion. If disease extends anteriorly into the glenoid fossa, the entire anatomic fossa is drilled out to the dura of the middle fossa, middle meningeal artery, and V3 as needed. The mandibular condyle, masseter, and pterygoid muscles may be removed."

Sam E. Kinney

"In a total temporal bone resection for stage T4 disease, the petrous carotid artery, sigmoid sinus, and involved dura are also resected en bloc. However, recent studies have shown that patients with such advanced disease succumb to it, regardless of therapy."

John P. Leonetti

"The advent of skull base surgery and free tissue transfers has extended the scope of surgery to include previously unresectable tumors, made surgery safer, decreased severe complication (CSF leaks, meningitis), and rendered the concept of piecemeal removal obsolete and indefensible."

Sebastian Arena

Malignancy of the temporal bone is a rare condition in oto-laryngology-head and neck surgery. Conley1 estimates that 1 in 3000 to 5000 patients with otologic disease will have a malignancy of the temporal bone. Manolidis et al.2 reported from a referal otologic practice that 1 in 1167 new cases was an epithelial malignancy of the temporal bone.

The tumors can be divided into primary malignancies of the middle ear and mastoid and those with their origin from squamous epithelium or glandular tissue of the external auditory canal. The primary malignancies will be mentioned, with most of the discussion limited to malignancies with their origin in the external auditory canal.

The need to recognize and diagnose a malignancy early is not a controversial issue, but it must be included in this discussion. One of our obligations as otolaryngology-head and neck surgeons is to inform our colleagues in the primary care specialties to be suspicious of a possible malignancy. Infections of the external auditory canal are frequently treated in outpatient centers and primary care offices.

The usual course of treatment of external canal infections with either drops or wicks, or both, will result in resolution of pain and swelling within 5 to 7 days of treatment. Chronic infections may persist with some edema and discharge, but there is usually no pain.

In the elderly population, any external canal infection with persistent pain must be considered a possible malignancy. Any external canal infections with persistent bleeding, formation of granulation tissue, or lack of improvement with medical treatment, must be considered a possible malignancy. The lesion must be biopsied for histologic evaluation or referred to the otolaryngology-head and neck surgeon for biopsy.

Contemporary issues relative to temporal bone malignancy center on pretreatment evaluation, appropriate TNM staging, and designing appropriate treatment modalities. Recognizing that temporal bone malignancies are relatively rare, there are no large single-institution series.

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