Lateral Temporal Bone Resection Research Articles

Hearing Loss in the Unoperated Ear After High-Speed Drilling in Otologic and Skull Base Surgery.

To evaluate if permanent hearing loss occurred in the unoperated ear of patients undergoing otologic and skull base surgery with high-speed otologic drilling. We retrospectively studied 250 patients (mean age 57.8 yr; 120 males, and 130 females) undergoing otologic or skull base surgery with high-speed drilling between 2013 and 2019. The University of Pittsburgh Medical Center. We evaluated preoperative and postoperative audiograms for patients undergoing surgery for cochlear implantation (95 patients, 38.0%), cholesteatoma or chronic ear disease (88 patients, 35.2%), repair of lateral skull base encephalocele (26 patients, 10.4%), resection of vestibular schwannoma or meningioma of the cerebellopontine angle (23 patients, 9.2%), lateral temporal bone resection (8 patients, 3.2%), microvascular decompression (7 patients, 2.8%), or other operations involving a high-speed otologic drill (3 patients, 1.2%). Hearing threshold shift, measured as the difference between postoperative threshold and preoperative threshold for each frequency. The association of age, gender, tested frequency, and surgery type with hearing threshold shift was investigated with analysis of covariance. A total of 102 patients (40.8%) had a 10-dB or greater worsening of their hearing in at least one frequency on their postoperative audiogram in the contralateral, unoperated ear. One hundred six subjects (42.4%) had no change in hearing of 10 dB or greater at any frequency. Among patients with longitudinal postoperative audiograms, accelerated age-related hearing loss was observed in low frequencies. A significant number of patients demonstrated poorer hearing thresholds in the contralateral, unoperated ear after otologic and skull base surgery.

Radiologic evaluation of the internal carotid artery and jugular bulb in lateral temporal bone resection using 3D computed tomography.

This study investigated the internal carotid artery (ICA) and jugular bulb (JB) structures in terms of lateral temporal bone resection using 3D computed tomography (CT). We retrospectively investigated 80 ears of 40 patients using 3D reconstruction data from normal temporal bone CT. Ten critical points (P) in the temporal bone were marked in the 3D object with reference to the axial, coronal, and sagittal images of the CT scans. An imaginary plane of the facial nerve (PLf) course was also reconstructed in relation to the three points of the chorda-facial junction, P5 (second genu), and P3 (cochleariform) process. The distances (mean ± SD; mm) from points P3 to P1 (the highest level of the JB) and P2 (the posterior wall of the ascending petrous IAC at the level of the Eustachian tube) were 12.03 ± 2.56 and 9.79 ± 1.78, respectively. The distances from point P4 (chorda-facial junction) to P1 and P2 were 10.98 ± 2.70 and 17.66 ± 2.26, respectively. The angles (mean ± SD; degree) between the PLf to the line from Pa (point of the anterior bony canal) to P3 and P4 were 17.80 ± 10.05º and 8.93 ± 5.37º, respectively. The angles between the PLf to the line from P3 to P1 and P2 were - 36.35 ± 13.28º and - 24.78 ± 13.91º, respectively. The angles between the PLf to the line from P4 to P1 and P2 respectively were - 40.35 ± 15.37º and - 13.34 ± 7.63º. Understanding the anatomical relationships of P1 and P2 at P3 and P4 can be helpful in preventing iatrogenic trauma of the ICA and JB.

Lateral Temporal Bone Resection With a High-Riding Jugular Bulb.

A high-riding jugular bulb can complicate standard otologic and neurotologic approaches and must be taken into account during surgical planning.

Fat-augmented Temporal Fascia Flap for Defect Coverage following External Auditory Canal Cancer Resection

Summary: Malignant tumors of the external auditory canal are rare and require surgical interventions such as lateral temporal bone resection (LTBR) for localized cases. This study introduces a novel approach, the lipofilling fascia flap technique, for external auditory canal reconstruction following LTBR or modified LTBR. The technique involves augmenting the temporal fascia flap with autologous fat grafting, aiming to enhance volume and improve outcomes. Two cases are presented, demonstrating successful reconstruction with minimal complications.

Management of External Auditory Canal Squamous Cell Carcinoma in a Tertiary Care Center

Background: Squamous cell carcinoma (SCC) of external auditory canal (EAC) is rare malignancies. They are dealt with a combination of surgery in case they are operable and postoperative treatment with radiotherapy (RT) with/without chemotherapy based on the extent of involvement. The complexity of the anatomy that is dealt with here makes the diagnosis and treatment difficult. Materials and Methods: Four patients of SCC of EAC were reviewed retrospectively between 2019 and 2023. Results: All patients were aged between 50 and 70 years, all patients presented with otalgia, aural fullness, and bloody/blood-stained discharged. One patient presented with preoperative facial nerve palsy; One patient had a history of undergoing surgery for a squamous variety of chronic otitis media; one patient presented with involvement of the pinna along with EAC. Three patients were treated with lateral temporal bone resection and superficial parotidectomy with neck dissection followed by postoperative RT and one patient was sent for palliative RT in view of the skull base and intracranial involvement. Conclusion: A holistic approach is required for SCC of EAC considering it usually mimics other common otological conditions with presentation such as otalgia, blood-stained discharge; preoperative radiology is imperative in deciding the extent of resection. Their lack definitive anatomical landmarks for its progression and hence EAC SCC are aggressive tumors prone for perineural and lymphovascular invasion along with high rates of recurrence.

Exoscope-assisted temporal bone resection: operative videos of the lateral and total techniques.

Skull base malignancies arising from the parotid gland, skin, or external auditory canal (EAC) can potentially involve the temporal bone. Management of these invasive tumors represents a true challenge considering the critical neurovascular relationships. Exoscope-assisted temporal bone resection (TBR) plays a crucial role in addressing such malignancies. The extent of disease is evaluated using the Pittsburgh staging system, which then guides the boundaries of resection. Lateral TBR (LTBR) relies on removal of the EAC and lateral ossicles and is generally appropriate for stage T1 and T2 tumors. Total TBR (TTBR) is reserved for high-grade tumors involving the petrous apex. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23135.

Role of the otologist/neurotologist in managing auricular and periauricular cutaneous malignancies: A 10-year otologic oncology experience.

Auricular/periauricular cutaneous malignancies can be challenging to manage surgically due to the complex anatomy of the region. Otologists/neurotologists have unique skillsets that are well-suited to surgically treat these patients. We aim to highlight the role of otologists and neurotologists in providing surgical care of patients with auricular and periauricular malignancies by describing the experience of a single fellowship-trained neurotologist over a 10-year period. Retrospective chart review of 387 patients with auricular and periauricular malignancy treated by a single neurotologist between 2012 and 2022 was completed. Tumor histology and procedures performed for each patient were extracted. Additional data was collected for a subset of 84 patients with complex cases requiring selective neck dissection, parotidectomy, lateral temporal bone resection, regional advancement or rotational flap reconstruction, and/or free tissue transfer reconstruction. Within the series of 387 patients, squamous cell carcinoma was the most common histology (42.6%, n = 165), followed by basal cell carcinoma (40.8%, n = 158), and melanoma (9.8%, n = 38). Common surgical procedures included wide local excision (61.8%, n = 239), partial/sub-total auriculectomy 18.3% (n = 71), or total auriculectomy 5.2% (n = 20). Within the 84-patient subset, median age at diagnosis was 71.9 years. Dermatologists provided most patient referrals (50.0%, n = 42). Most common tumor locations included: auricular (58.3%, n = 49), pre-auricular (21.4%, n = 18), and parotid (27.4%, n = 23). Revision surgery occurred in 22.6% of cases (n = 19), of which 26.3% (n = 5) for positive margins and 31.6% (n = 6) for recurrence. Mean follow-up was 22.8 months. Disease-specific 5-year survival was 91%. We demonstrate the feasibility of an otologist/neurotologist incorporating the surgical management of auricular and periauricular malignancies into their practice. 4.

Total conservative parotidectomy combined with an extended lateral temporal bone resection

Total conservative parotidectomy combined with an extended lateral temporal bone resection

Hearing loss related outcomes post-lateral temporal bone resection and other oncologic treatment.

e18069 Background: Lateral temporal bone resection (LTBR) is used to treat malignancies originating from the auricle, periauricular skin, external auditory canal, parotid gland, or temporal bone. LTBR is the workhorse of otologic cancer surgery; however, few studies have described audiologic outcomes in a large sample of patients. The current literature focuses on overall survival rates post-surgery; however, hearing loss-related outcomes after surgery and adjuvant therapy are lacking in the literature. Following surgery, patients are expected to have maximal conductive hearing loss in the affected ear which can be augmented by ototoxic effects of adjuvant treatment such as radiation and systemic therapy. This type of hearing loss significantly impacts quality of life, making it difficult to understand speech directed to the surgically closed ear, localize sounds, and understand conversational speech in noisy environments. Less is known about the rate and severity of sensorineural hearing loss (SNHL) following LTBR. Methods: A retrospective chart review was conducted among 252 patients who underwent LTBR at single tertiary care center from 2010 to 2020. We evaluated changes in ipsilateral bone conduction (BC) hearing thresholds after LTBR ± adjuvant therapy, including head and neck radiation, chemotherapy, and immunotherapy. Patients who completed at least 1 preoperative and 1 postoperative audiogram within 2 years of surgery were included. Patients who had preoperative chemotherapy, immunotherapy, or temporal bone radiation were excluded. Of 252 patients reviewed, 94 met the eligibility criteria. Audiometric data included pure tone average (PTA) for BC thresholds. A significant decline in hearing was defined as an increase in PTA ≥ 10 decibels (American Academy of Otolaryngology-Head and Neck Surgery). Three treatment subgroups were analyzed, including LTBR only, LTBR and radiation therapy, and LTBR with radiation and systemic therapy. Results: Among all patients, BC PTA increased on average by 7dB after treatment (p<0.001); 30% of patients had ≥ 10dB shift. Patients undergoing LTBR with adjuvant therapy had a higher rate of hearing loss compared to patients undergoing LTBR alone (22/69, 32% vs. 5/25, 20%, respectively). Conclusions: LTBR can cause significant long-term decline in BC hearing that is worsened with the addition of adjuvant therapy. Therefore, it is critical to systematically obtain preoperative and post-treatment audiologic testing to monitor and rehabilitate hearing loss over time. The findings of this study may help patients understand realistic expectations of long-term treatment outcomes related to hearing loss, as an initial step to help improve quality of life with hearing rehabilitation such as osseointegrated bone conduction devices.

＜Editors' Choice＞ Long-term outcomes of lateral skull base reconstruction with a free omental flap and facial nerve reconstruction.

In lateral skull base reconstruction, it is necessary to seal the defect in the lateral skull base, fill the dead space, and, sometimes, reconstruct the facial nerve. However, this procedure is difficult to perform with a standard musculocutaneous flap. Therefore, for such cases, an omental flap is used in our hospital because of its flexibility. In this study, we report our experience with the procedure (lateral skull base reconstruction with a free omental flap) and its long-term outcome and facial nerve reconstruction, with special focus on facial nerve recovery. This study is a technical note and a retrospective review. It was conducted in Nagoya University Hospital. Overall, 16 patients (12 women and 4 men; mean age: 55.1 years) underwent lateral skull base reconstruction with a free omental flap after subtotal temporal bone resection or lateral temporal bone resection during 2005-2017. The main outcome measures were postoperative complications and facial nerve recovery: Yanagihara score and House-Brackmann grading system. Complications included partial necrosis and minor cerebrospinal fluid leakage in 2 patients. Facial nerve recovery could be observed more than 12 months after surgery, with a mean Yanagihara score of 19.6 and House-Brackmann grade of 3.60. The free omental flap is a reliable method for lateral skull base reconstruction, especially in cases where facial nerve reconstruction is needed. To the best of our knowledge, this is the first report on facial nerve recovery after lateral skull base reconstruction.

The Study on Prognosis in Patients with Adenoid Cystic Carcinoma of the External Auditory Canal.

Adenoid cystic carcinoma of the external auditory canal is a rare primary malignancy, and surgery is the primary management strategy. This study aims to optimize management strategies and improve prognosis of adenoid cystic carcinoma of the external auditory canal. Seventeen patients with adenoid cystic carcinoma of external auditory canal who had been admitted to a single institution from January 2008 to March 2019 were recruited and retrospectively reviewed. Among patients with T1 tumors, 2 underwent local external auditory canal resection, 1 received lateral temporal bone resection+superficial parotidectomy. Among patients with T2 tumors, all 5 patients underwent lateral temporal bone resection+superficial parotidectomy. Among patients with T3 tumors, 3 underwent subtotal temporal bone resection+superficial parotidectomy, 2 underwent subtotal temporal bone resection+superficial parotidectomy+radiotherapy, and 1 underwent extended temporal bone resection+superficial parotidectomy+radiotherapy. Among patients with T4 tumors, 2 underwent subtotal temporal bone resection+superficial parotidectomy and 1 underwent extended temporal bone resection+total parotidectomy+radiotherapy. The common manifestations included otalgia (82.4%), hearing loss (23.5%), external auditory canal mass (23.5%), otorrhea (17.6%), and aural fullness (5.9%). In the study, 5/17 (29.4%) patients had been misdiagnosed preoperatively, 5/17 (29.4%) patients revealed local recurrence, and 3/17 patients (17.6%) were identified with distant metastasis postoperatively. The 3- and 5-year overall survival rates were 88.2% and 82.3%, respectively. There was no significant difference in overall survival (P=.746) and disease-free survival (P=.933) between patients receiving different surgical approaches. Three out of 17 patients (17.6%) died of T2, T3, and T4 diseases, respectively. Otalgia is the most common manifestation of adenoid cystic carcinoma of the external auditory canal, and misdiagnosis is frequently encountered. Surgery is the preferred therapy, and local resection is associated with relapse, lateral temporal bone resection is strongly recommended in patients with early-stage tumor. Regular follow-up should be routinely conducted postoperatively to early identify local recurrence.

A Rare Case of Adenoid Cystic Carcinoma of the External Auditory Canal

Malignancy of the external auditory canal (EAC) is rare, and adenoid cystic carcinoma (ACC) of EAC is even rarer. It is generally managed by radical resection with a clear oncological margin, followed by radiotherapy. However, local recurrence and distant metastasis are still the major concerns during follow-up. The authors present a case in a 32-year-old female, presenting with a mass in the EAC which was endoscopically removed. Histopathological examination revealed an ACC. Further imaging confirmed absence of distant metastasis and parotid gland involvement. The patient was treated with right modified lateral temporal bone resection and achieved clear surgical margins and thus planned for a long-term follow-up.

Primary Lymphoepithelial Carcinoma of Parotid Gland: Inadequate Preoperative Assessment Resulting in Extensive Surgery

Parotid lymphoepithelial carcinoma is extremely rare, and makes up only 0.4% of cases among the anaplastic variant of salivary gland carcinoma. We present a 63-year-old man who had progressive enlarging right neck swelling for one year. He sought treatment in another centre and underwent superficial parotidectomy, following an ultrasound assessment of the mass that was suggestive of a benign parotid tumour. There was no fine needle aspiration cytology or other radiological imaging performed prior to the surgery. However, the surgeon encountered difficulty intraoperatively and abandoned the surgery. The incisional biopsy of the tumour was reported as lymphoepithelial carcinoma. He then presented to us with the progression of the residual parotid malignant tumour. CT and MRI showed a locally aggressive parotid tumour that had infiltrated the subcutaneous tissue, external auditory canal, facial nerve, and multiple ipsilateral metastatic cervical lymph nodes. Subsequently, the patient underwent total parotidectomy with facial nerve resection, lateral temporal bone resection and ipsilateral modified radical neck dissection. The surgical site defect was reconstructed with anterolateral thigh myocutaneous free flap. Concurrent static facial reanimation with fascia lata sling was performed. The patient received adjuvant chemoradiation following the surgery. The extent of the local infiltration by the tumour and the resulting surgery could have been reduced if the tumour had been properly assessed and excised at the initial stage. A complete preoperative assessment of a parotid mass is essential to avoid misdiagnosis, unexpected intraoperative finding and delay in definitive treatment.

High-grade transformation of adenoid cystic carcinoma of parotid gland with isolated intratemporal facial nerve involvement: a case report and literature review

BackgroundHigh-grade transformation Adenoid cystic carcinoma (HGT-AdCC) of the parotid gland is a rare transformation noted in slow growing low grade AdCC. Perineural invasion and spread is an important feature of this tumor. Temporal bone involvement is rare. A total of only 10 cases of HGT-AdCC in parotid gland has been reported in literature so far predominantly in the elderly with peak incidence in 5th–6th decade.Case presentationWe present a young lady of HGT-AdCC of right parotid gland with temporal bone involvement in the form of isolated perineural invasion (PNI) of facial nerve till the tympanic segment. She underwent right radical parotidectomy with modified radical neck dissection with modified lateral temporal bone resection and pectoralis major myocutaneous flap reconstruction. Histopathological examination revealed both low- and high-grade areas. Sections from facial nerve showed tumor invasion.ConclusionThe radiological features of isolated perineural spread in intratympanic part of facial nerve can be easily missed if not specifically looked for. Every attempt should be made preoperatively and intraoperatively to determine the complete extent of the tumor for adequate disease clearance. A combined clinico-radiological approach aided by histopathology examination helps in early detection of this carcinoma and in better patient management.

Temporal Bone Resection for Squamous Cell Carcinoma of the Lateral Skull Base: Systematic Review and Meta-analysis.

Temporal bone squamous cell carcinoma (TBSCC) is rare and often confers a poor prognosis. The aim of this study was to synthesize survival and recurrence outcomes data reported in the literature for patients who underwent temporal bone resection (TBR) for curative management of TBSCC. We considered TBSCC listed as originating from multiple subsites, including the external ear, parotid, and external auditory canal (EAC), or nonspecifically from the temporal bone. PubMed, Cochrane Library, Embase, and manual search of bibliographies. A systematic literature review conducted in December 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Survival data were collected from 51 retrospective studies, resulting in a pooled cohort of 501 patients with TBSCC. Compared to patients undergoing lateral TBR (LTBR), patients undergoing subtotal (SBTR) or total (TTBR) TBR exhibited significantly higher rates of stage IV disease (P < .001), positive surgical margins (P < .001), facial nerve involvement (P < .001), and recurrent disease (P < .001). A meta-analysis of 15 studies revealed a statistically significant 97% increase in mortality in patients who underwent STBR or TTBR. On multivariate analysis, recurrent disease was independently associated with worse overall survival (P < .001). On univariate analysis, facial nerve involvement was also associated with decreased overall survival (P < .001). Recurrent disease was associated with risk of death in patients undergoing TBR. Larger prospective multi-institutional studies are needed to ascertain prognostic factors for a wider array of postoperative outcomes, including histology-specific survival and recurrence outcomes.

Ultrasound-Guided Placement of Percutaneous Abutments for Bone Conduction Hearing Devices.

To introduce a minimally invasive and image-guided technique for staged placement of a percutaneous abutment after osseointegrated implantation. Adults undergoing temporal bone resection at two academic medical centers. Ultrasound-guided percutaneous installation of a bone conduction hearing device abutment. All patients had lateral temporal bone resection with osseointegrated implantation. Abutment placement followed as a planned staged procedure 3 to 6 months later depending on the use of radiotherapy. Ability to use a bone conduction hearing device and occurrence of skin reactions or wound complications. Twelve patients successfully underwent abutment installation through a 5 mm skin biopsy punch incision, nine of which had minimal to no skin reaction surrounding the abutment. Two patients developed Holgers grade 1 skin reaction (redness with slight swelling). One patient experienced an osseointegration failure 152 days after abutment placement. Ultrasound is a widely available imaging modality that can be used to precisely localize subcutaneous osseointegrated implants, allowing for minimally invasive percutaneous placement of an abutment under local or general anesthesia.

Lateral temporal bone resections for peri-auricular cutaneous squamous cell carcinoma: prognostic indicators and radiological predictive values.

Lateral temporal bone resections are used in the management of locally advanced peri-auricular cutaneous squamous cell carcinomas, but there is still conflicting evidence regarding the staging, surgical and adjuvant treatment decisions. A retrospective analysis was performed on all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma between January 2015 and December 2019 at a dedicated tertiary oncology referral centre. Twenty-nine patients were included, with a median age of 77 years. Computed tomography, magnetic resonance imaging and positron emission tomography showed good diagnostic accuracy in identifying disease in the parotid gland, external auditory canal and mastoid bone, but had poor sensitivity in identifying cervical nodal metastasis. Six patients had recurrence at a median of 4.8 months post-operatively. Tumour differentiation (p = 0.0040) and post-operative radiotherapy (p = 0.0199) were associated with significantly better recurrence-free survival. Lateral temporal bone resection for peri-auricular cutaneous squamous cell carcinoma requires careful surgical planning using clinico-radiological correlation, particularly in patients with poorly differentiated tumours.

Application of a virtual and mixed reality-navigation system using commercially available devices to the lateral temporal bone resection

BackgroundLateral temporal bone resection (LTBR) is performed for stage T1-2 external ear malignant tumors and requires spatial anatomical knowledge of the rare surgical field. ObjectiveThis paper presents a novel virtual reality (VR) based surgical simulation and navigation system using only commercially available display device and an online software, to assist in the understanding of the anatomy pre and intraoperatively. Result and conclusionVR model created by 3D Slicer modules and visualized on head mounted display enabled users to simulate and learn surgical techniques of a rare surgical case. 3D hologram through HoloLens assisted the surgeon in comprehending the spatial relationship between crucial vital structures and the pathological lesion during the operation. This platform does not require the users to possess specific programming skill or knowledge, and is therefore applicable in daily clinical usage.

Clinical features and prognostic factors for early-stage external auditory canal carcinoma

Objective:To analyze the clinical features and the prognostic factors of early-stage external auditory canal carcinoma. Methods:Data from 36 patients with early-stage external auditory canal carcinoma（T1, T2） treated in Department of Otolaryngology, Xijing Hospital, Air Force Military Medical University from January 2008 to June 2020 were reviewed retrospectively, including clinical manifestations, surgical and treatment methods, pathological types and disease status. The relationship between survival rate and the prognostic factors was compared using Kaplan-Meier method, and the independent risk factors were analyzed by Cox proportional hazards model. Results:There were 36 patents with early-stage external auditory canal carcinoma. The common initial symptoms were otalgia（66.7%）, otorrhea（41.7%） and hearing loss（30.6%）. The most common histopathologic types were adenoid cystic carcinoma（50.0%） and squamous cell carcinoma（33.3%）. Among the patients, 21 patients（58.3%） were initially treated, 9 patients（25.0%） were treated with salvage therapy, and 6 patients（16.7%） were re-surgery after recurrence. The 5-year disease-specific survival（DSS）, disease-free survival（DFS） and relapse-free survival（RFS） were 82.3%, 64.0% and 73.0% respectively. Seven cases （19.4%） relapsed after surgery. For 5-year survival rate, the lateral temporal bone resection with superficial parotidectomy（DSS 91.7%, DFS 83.9%） is higher than the lateral temporal bone resection only（DSS 77.8%, DFS 55.6%） and sleeve resection（DSS 75.0%, DFS 56.0%）, but there was no significant difference（P>0.05）. In these patients, the postoperative radiotherapy and disease status had no significant impact on the survival rate. Additionally, there was no obvious correlation between recurrence and age, gender, stage, histopathologic types, operation methods and postoperative radiotherapy（P>0.05）. But there were significant differences between histopathologic types and DSS or DFS（P<0.05）. Multivariate regression analysis showed that histopathologic type was an independent prognostic factor for DFS. Conclusion:There are no specific clinical manifestations for early-stage external auditory canal carcinoma, such as otalgia and otorrhea. Histopathologic types have a direct impact on the patients'prognosis. Thus, individualized treatment should be applied based on pathologic findings to improve the survival rate.

Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region.

To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure. A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia. Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30). Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.