Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition. Recommendations • All patients with more than one of: chronic otalgia, bloody otorrhoea, bleeding, mass, facial swelling or palsy should be biopsied. (R) • Magnetic resonance and computed tomography imaging should be performed. (R) • Patients should undergo audiological assessment. (R) • Carotid angiography is recommended in select patients. (G) • The modified Pittsburg T-staging system is recommended. (G) • The minimum operation for cancer involving the temporal bone is a lateral temporal bone resection. (R) • Facial nerve rehabilitation should be initiated at primary surgery. (G) • Anterolateral thigh free flap is the workhorse flap for lateral skull base defect reconstruction. (G) • For patients undergoing surgery for squamous cell carcinoma, at least a superficial parotidectomy and selective neck dissection should be carried out. (R).
Highlights
Primary cancers of the temporal bone (TB) and lateral skull base are comparatively rare, accounting for 0.2 per cent of all head and neck cancers
Carotid angiography is recommended in select patients. (G)
Clinical presentation Late diagnosis of patients with cancers of the external auditory meatus (EAM) and middle ear (ME) is not uncommon and this should be considered in any patients with: chronic otalgia, bloody otorrhoea, bleeding, mass, facial swelling or palsy.[1]
Summary
Primary cancers of the temporal bone (TB) and lateral skull base are comparatively rare, accounting for 0.2 per cent of all head and neck cancers. They consist of different sites of cancer with a range of pathologies. Over ten times more frequent are cancers of the skin and parotid invading the TB Despite this there is even less evidence of best practice. Clinical presentation Late diagnosis of patients with cancers of the external auditory meatus (EAM) and middle ear (ME) is not uncommon and this should be considered in any patients with: chronic otalgia, bloody otorrhoea, bleeding, mass, facial swelling or palsy.[1] Clinical findings of excoriation, ulceration and granulation tissue should be considered as suspicious. Tumours of the infratemporal fossa may present with a subtle mass or fullness immediately above the zygoma or with pain (which can be misdiagnosed as temporal mandibular joint pain)
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