Partial Temporal Bone Resection Research Articles

PET-CT-based resection guide for treatment of auricular squamous cell carcinoma: an innovative clinical management of soft tissue tumors: a case report

PurposeTo describe the successful use of a PET-CT-based resection guide for the treatment of auricular squamous cell carcinoma.Case presentationA 69-year-old male presented with a painless growing mass in his left ear helix that had been unsuccessfully treated conservatively by another surgeon. An incisional biopsy revealed moderately differentiated squamous cell carcinoma, and the patient was referred to the department for further management. A PET/CT was performed, which showed uptake of FDG in the ear with a SUV max value and T3N0M0 status. The treatment plan was based on a multidisciplinary team discussion and a thorough evaluation of the PET/CT imaging findings. A decision was made to proceed with excision of the mass with a wide safety margin, using a PET/CT-based resection guide for ear resection. Additionally, partial temporal bone resection, selective neck dissection, and superficial parotidectomy were planned. The patient opted for reconstruction with a scalp rotational flap. The patient’s treatment plan was successful, and at follow-up visits, he remained disease-free. This case report highlights the importance of using a PET-CT-based resection guide for the treatment of soft tissue tumors, specifically auricular squamous cell carcinoma. It also demonstrates the importance of a multidisciplinary team approach and thorough evaluation of imaging findings in determining an effective treatment plan for patients.ConclusionsThe use of PET-CT-based resection guide can be an effective tool in the treatment of auricular squamous cell carcinoma. It can provide more precise and accurate information about the extent of the tumor, leading to a more effective treatment plan. Multidisciplinary team approach and thorough evaluation of imaging findings are crucial in determining the best course of treatment for patients.

Advantages and Complications of Fisch Partial Mastoidotympanectomy for Tumors of the Retromandibular Fossa and Poststyloid Space.

Objective This study aims to characterize a single surgeon's experience with resection of tumors of the retromandibular fossa and poststyloid space utilizing the Fisch partial mastoidotympanectomy (FPMT) technique of partial temporal bone resection. Design Retrospective review. Setting Academic medical center. Participants Seven patients who underwent tumor resection with FPMT. Main Outcome Measures Complications. Results Six males and one female underwent FPMT, with ages ranging from 44 to 79 years. The facial nerve was sacrificed in six cases, no cases were converted to more extensive temporal bone resection procedures, and no postoperative hearing loss occurred. The only intraoperative complication experienced was a violation of the external auditory canal in four cases, which resulted in postoperative wound healing issues in two cases. Conclusions FPMT allows for the release of tumors of the poststyloid space and retromandibular fossa without compromise of hearing status. Preservation of external auditory canal soft tissues is challenging, and the violation is experienced relatively frequently due to shearing forces during soft tissue retraction. When encountered, robust repair of defects is encouraged to prevent further wound healing complications.

Surgical Resection of a Small Cell Carcinoma Primary Tumor of the Parotid Gland with Perineural and Skull Base Involvement

Background: One of the rarest tumors of the parotid gland is a Small Cell Carcinoma (SmCC) of neuroendocrine or ductal origin. These lesions tend to be aggressive, often invading bone and nerve and carry a grave prognosis for the patient. Presently there is no standardized treatment protocol and no consensus to tumor management. Case Report: This case report is of a 70 year-old male with a right-sided facial mass, facial pain, severe otalgia, weight loss, and right-sided facial paralysis. Subsequent imaging and Fine Needle Aspiration (FNA) revealed T4aN2bM0 SmCC of the parotid gland with facial nerve enhancement and skull base erosion. The patient underwent major extirpative surgery including radical neck dissection, total parotidectomy with facial nerve resection and cable graft, and partial temporal bone resection as the initial step in a combined modality therapy The patient has done very well post-operatively. Conclusion: This case report describes the successful, aggressive surgical management of locally and regionally advanced SmCC of the parotid gland. Although the prognosis for patients with SmCC of the parotid gland is typically grave, the absence of distant metastatic disease in the presented case provided the rationale for an aggressive surgical approach with a curative, rather than palliative, focus.

Leczenie nowotworów złośliwych przewodu słuchowego zewnętrznego i kości skroniowej w materiale Kliniki Otolaryngologii i Onkologii Laryngologicznej CM UMK w Bydgoszczy

Introduction, material and methods, aim of the studyEvaluation of the methods and results of treatment of 19 cases of malignant tumors of the external auditory meatus and/or temporal bone was performed. ResultsIn 10 cases planoepithelial carcinoma was diagnosed; in 7 cases basocellulare carcinoma; in 1 case rhabdomyosarcoma; and in 1 case malignant peripheral nerve sheath tumor were histopathologically established. In stage T1 were 8 cases, in T2 – 7, in T3 – 1 and in T4 3 patients were stated based upon clinical and radiological (HRCT and MRI) examination. Three patients in T4 stage were qualified to palliative therapy. In 2 cases radical mastoidectomy was performed, 8 patients underwent partial temporal bone resection. In 6 cases removal of cartilaginous and osseous external auditory meatus was done. In 9 cases local recurrence of tumor was observed during 2 years after surgery. The last 7 cases are under oncological observation. ConclusionsIn conclusion we stressed that patients with malignant tumors of this region are treated in late stages of the disease; it is a main cause of poor diagnosis.

Active Middle Ear Implants in Patients Undergoing Subtotal Petrosectomy

The functional outcome of ossiculoplasties in chronic ear and lateral cranium base surgery depends on the presence of a ventilated middle ear space and is guided by the existence or absence of ossicular remnants. In patients with poorly ventilated middle ears, after multiple previous operations, missing stapes suprastructure, or after partial temporal bone resection for tumor removal, restoration of conductive hearing is not possible. The direct placement of a vibrating floating mass transducer (FMT) onto the round window membrane with obliteration of the surgical cavity is a new option. Starting in January 2006, five patients underwent a subtotal petrosectomy to control their chronically discharging ear, to remove residual cholesteatoma, or to revise previous incompletely exenterated cavities. Four patients underwent a simultaneous placement of a Vibrant Soundbridge (VSB) onto the round window membrane; one patient had a staged reconstruction after initial Bone-Anchored Hearing Aid rehabilitation. In all operations, the external ear canal and the eustachian tube were closed, and the cavity was obliterated using abdominal fat. Preoperative and postoperative pure tone audiograms were analyzed in respect to deterioration of inner ear function, aided and unaided (hearing aid, VSB, and Bone-Anchored Hearing Aid) speech audiograms were compared to verify improvements in communication skills, functional gains were calculated at comfortable level settings, and postoperative computed tomographic scans were used to exclude recurrent disease and to confirm the position of the FMT onto the round window membrane. Patient's satisfaction was measured using a standardized questionnaire. All patients were very satisfied daily users of their middle ear implant and had complete eradication of their middle ear pathology. Bone conduction worsened at 2 kHz, with preservation of inner ear function in the other frequencies. Whereas none of the patients had any unaided speech discrimination before the surgery at conversational levels, all patients obtained 95 to 100% correct monosyllabic scores at 70 to 80 dB using the VSB. The functional gain was highest at higher frequencies. Patients with combined hearing loss undergoing subtotal petrosectomy with complete fat obliteration of the middle ear and mastoid area can be safely rehabilitated, placing the FMT of a VSB onto the round window membrane, either at the time of primary surgery, or as a staged secondary procedure.

A case of ceruminous adenocarcinoma of the external auditory canal presenting as an aural polyp

Ceruminous adenocarcinoma is a rare malignant tumor arising from the ceruminous gland of the external auditory canal ceruminous gland. Usually it displays no specific clinical symptoms or signs, so most reported cases have involved an advanced tumor and the treatment results have been disappointing. It is important to make an early diagnosis to improve the treatment's outcome. We present the case of a 54-year-old female patient with a 1-year history of feeling blockage in her left ear. Otoscopic examination revealed an aural polyp arising from the cartilaginous ear canal's anterosuperior wall. A wide local excisional biopsy was performed, and the pathologic result was a ceruminous adenocarcinoma. We were able to detect the tumor early, and en bloc resection was possible in the form of a partial temporal bone resection.

Skull base surgery for removal of temporal bone tumors

Conclusion. When selecting the appropriate surgical approach the pathological type of tumor, the physiological status as well as the functional aspects should be considered. Understanding the strengths and weaknesses of each surgical technique and knowledge of the particular tumor biology facilitates selection of the most appropriate surgical approach and a successful outcome. Objectives. The purpose of this study was to review cases that underwent skull base surgery for a variety of tumors that involved the temporal bone. We reviewed a single center's 25-year experience for epidemiologic characteristics, symptoms, treatment type and outcomes. Patients and Methods. The medical records and radiological images of 91 patients, who underwent skull base surgery, were retrospectively reviewed. Results. Among the 91 patients, 61 cases had benign disease and 30 had malignancies. A facial nerve schwannoma was the most common benign intratemporal tumor and a squamous cell carcinoma was the most common malignant tumor. With the facial nerve schwannoma, facial nerve paralysis and hearing loss were the most common presenting complaints; otalgia was the most common presenting symptom for temporal bone cancer. For patients with a glomus tumor, there was a characteristic pulsating tinnitus. A majority of the facial nerve schwannomas were resectable through the transmastoid approach. The infratemporal fossa approach type A was usually required for lower cranial nerve schwannomas and glomus jugulare tumors. However, the fallopian bridge technique with hypotympanectomy was another surgical option. Partial temporal bone resection and subtotal temporal bone resections were performed in cases with temporal bone cancer. The disease free 5-year survival of the temporal bone cancers was 42% and for the squamous cell carcinomas, it was 44%.

Extended temporal bone resection for squamous cell carcinoma.

The aim of this study was to assess the surgical results of a series of patients from this unit who underwent extended temporal bone resection for recurrent squamous cell carcinoma as a salvage procedure. The surgical records of 15 patients were analyzed in detail. Each patient had salvage surgery in the form of an extended temporal bone resection with supraomohyoid block dissection, dural grafting, and free microvascular forearm or scalp rotation flap repair for recurrent squamous cell carcinoma in a radical mastoid cavity. Radical surgery yielded a 47% 5-year survival. Twenty-nine percent of the survivors had temporal lobe involvement that necessitated a partial excision of the temporal lobe of the brain. Histologic evidence of local lymph node involvement in the supraomohyoid neck dissection was present in 13% of cases. Those who died did so in the first postoperative year. All those with poorly differentiated tumors died. The survivors had well or moderately differentiated tumors. Radiotherapy alone or partial temporal bone resection, most commonly a radical mastoidectomy with or without preoperative or postoperative radiotherapy is used by the majority of otolaryngologists in treating squamous cell carcinoma of the temporal bone. The 5-year survival rate after this treatment remains depressingly low and the prognosis gloomy, particularly for advanced tumors. The findings in this series of extended temporal bone resections as salvage surgery in recurrent disease is encouraging, and radical surgery combined with radiotherapy from the outset may give much better 5-year survival figures in the future than the conventional partial temporal bone resection and radiotherapy.

A case of pleomorphic adenoma recurred in temporal bone

A rare case of recurrent pleomorphic adenoma of temporal bone in a 67-year-old woman is described. The primary tumor originated in the superficial lobe of the right parotid gland, and was treated with surgery 10 times over 30 years, followed by radiotherapy of 50 Gy. The secondary tumor appeared 32 months after radiotherapy in the right temporal bone, extending to the posterior cranial f ossa and foramen magnum. Right partial temporal bone resection and lateral suboccipital craniotomy were performed on this metastasizing pleomorphic adenoma. Metastasizing pleomorphic adenoma is a very unusual tumor, which appears more likely in cases after incomplete resection. While some of recurred pleomorphic adenoma are pathologically benign, their behavior may become metastatic or clinically malignant in the long run as in the case descrebed here.

Extended temporal bone resection for squamous cell carcinoma

OBJECTIVE: The aim of this study was to assess the surgical results of a series of patients from this unit who underwent extended temporal bone resection for recurrent squamous cell carcinoma as a salvage procedure. DESIGN: The surgical records of 15 patients were analyzed in detail. Each patient had salvage surgery in the form of an extended temporal bone resection with supraomohyoid block dissection, dural grafting, and free microvascular forearm or scalp rotation flap repair for recurrent squamous cell carcinoma in a radical mastoid cavity. RESULTS: Radical surgery yielded a 47% 5-year survival. Twenty-nine percent of the survivors had temporal lobe involvement that necessitated a partial excision of the temporal lobe of the brain. Histologic evidence of local lymph node involvement in the supraomohyoid neck dissection was present in 13% of cases. Those who died did so in the first postoperative year. All those with poorly differentiated tumors died. The survivors had well or moderately differentiated tumors. CONCLUSIONS: Radiotherapy alone or partial temporal bone resection, most commonly a radical mastoidectomy with or without preoperative or postoperative radiotherapy is used by the majority of otolaryngologists in treating squamous cell carcinoma of the temporal bone. The 5-year survival rate after this treatment remains depressingly low and the prognosis gloomy, particularly for advanced tumors. The findings in this series of extended temporal bone resections as salvage surgery in recurrent disease is encouraging, and radical surgery combined with radiotherapy from the outset may give much better 5-year survival figures in the future than the conventional partial temporal bone resection and radiotherapy. (Otolaryngol Head Neck Surg 1997;116:617-23.)

Partial temporal bone resection for basal cell carcinoma of the external auditory canal with preservation of facial nerve and hearing

AbstractA 44‐year‐old retired naval airman with recurrent basal cell carcinoma of the external auditory canal underwent a partial temporal bone resection with preservation of the facial nerve and reconstruction of his hearing mechanism. The morbidity associated with radical temporal bone resection was avoided. Useful hearing was obtained by myringostapediopexy with staged split thickness skin grafting. The patient's postoperative appearance is enhanced by wearing of a prosthesis.

A New Technique Employing Partial Temporal Bone Resection in Parotid Gland Surgery for Cancer

A New Technique Employing Partial Temporal Bone Resection in Parotid Gland Surgery for Cancer