Subtotal Temporal Bone Resection Research Articles

＜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.

Variations of en Bloc Resection for Advanced External Auditory Canal Squamous Cell Carcinoma: Detailed Anatomical Considerations.

Simple SummaryFrom the viewpoint of surgical anatomy, surgical patterns of temporal bone cutting to achieve negative margin resection for advanced squamous cell carcinoma of the external auditory canal can be divided into four categories: conventional lateral temporal bone resection (LTBR), extended LTBR, conventional subtotal temporal bone resection (STBR), and modified STBR. Extended LTBR is divided into four types: superior, inferior, anterior, and posterior procedures. Several directional extension procedures can be combined based on the extension of the tumor to achieve negative margin resection. Furthermore, en bloc resection with the temporomandibular joint or glenoid fossa increases the technical difficulty of a surgical procedure because the exposure and manipulation of the petrous segment of the internal carotid artery are limited from the middle cranial fossa. Accurate preoperative evaluation of the tumor extension and preoperative consideration of the exact resection line are required to achieve negative margin resection.Currently, only lateral temporal bone resection (LTBR) and subtotal temporal bone resection (STBR) are widely utilized for the surgical treatment of advanced squamous cell carcinoma of the external auditory canal (EAC-SCC). However, there are few descriptions of variations on these surgical approaches. This study aimed to elucidate the variations of en bloc resection for advanced EAC-SCC. We dissected the four sides of cadaveric heads to reveal the anatomical structures related to temporal bone resection. From the viewpoint of surgical anatomy, surgical patterns of temporal bone cutting can be divided into four categories: conventional LTBR, extended LTBR, conventional STBR, and modified STBR. Extended LTBR is divided into four types: superior, inferior, anterior, and posterior extensions. Several extension procedures can be combined based on the extension of the tumor. Furthermore, en bloc resection with the temporomandibular joint or glenoid fossa increases the technical difficulty of a surgical procedure because the exposure and manipulation of the petrous segment of the internal carotid artery are limited from the middle cranial fossa. Surgical approaches for advanced SCC of the temporal bone are diverse. They require accurate preoperative evaluation of the tumor extension and preoperative consideration of the exact line of resection to achieve marginal negative resection.

Treatment Outcome of External Auditory Canal Carcinoma: The Utility of Lateral Temporal Bone Resection.

We examined the role of lateral temporal bone resection (LTBR) in the treatment of external ear canal (EAC) carcinoma between 2007 and 2018. The estimated 3-year disease-free survival (DFS) and disease-specific survival (DSS) according to the tumor stage and treatments were investigated in 36 patients with EAC squamous cell carcinoma. T stage classification according to the University of Pittsburgh staging system was as follows: 14 patients in T1, four patients in T2, nine patients in T3, and nine patients in T4. The 3-year DFS rate was 77.4% for T1 tumors, 100% for T2, 44.4% for T3 tumors, and 11.1% for T4 tumors (p < 001). The 3-year DSS rate was 100% for T1/T2 tumors, 87.5% for T3 tumors, and 11.1% for T4 tumors (p < 0.01). T1/T2 patients received mostly LTBR. Among nine T3 tumors, five patients (56%) received LTBR combined with preoperative chemotherapy and/or postoperative radiation (RT). Four of them had negative surgical margin and survived with no evidence of disease. The DFS of T3 patients who underwent concurrent chemoradiotherapy and LTBR was 0 and 80%, respectively (p = 0.048). For T1/T2 tumors, surgery achieved an excellent outcome. For T3 tumors, LTBR achieved negative surgical margin and showed good survival when combined with preoperative chemotherapy and/or postoperative RT. In contrast, the prognosis of T3 patients who could not undergo surgery was as poor as that of T4 patients. Therefore, in addition to subtotal temporal bone resection, LTBR-based treatment strategy may be a treatment option for limited cases of T3 patients.

Surgical treatment for squamous cell carcinoma of the temporal bone: predictors of survival.

SUMMARYObjectiveEvaluation of the management and survival in patients treated for temporal bone squamous cell carcinoma (TBSCC) in a tertiary referral centre.MethodsForty-nine patients underwent primary treatment for TBSCC. Thirty-six patients underwent a lateral temporal bone resection (LTBR) or subtotal temporal bone resection (STBR). Overall survival (OS) and disease-specific survival (DSS) analysis were assessed.ResultsFive-year OS of the 49 patients was 39%. Five-year OS of the 36 patients who underwent LTBR or STBR was 46%. Tumour-free margins were achieved in all patients with T1 and T2 disease, in 59% patients with T3 tumours and 0% patients with T4 disease. Five-year DSS was 85% for all T1/T2 tumours, 53% for T3 tumours and 0% for T4 tumours. Clear resection margins was the only significant predictor of DSS in our cohort.ConclusionsThe mainstay of treatment for TBSCC is temporal bone resection with tumour free resection margins, with or without adjuvant radiotherapy. Survival is negatively influenced by non-radical resection. T1 and T2 tumours can be managed safely with LTBR. More advanced disease requires a more extensive resection, with a higher likelihood of non-radical resections and decreased survival rates.

Management of the temporal bone defect after resection of external auditory canal cancer

ObjectiveTo evaluate the surgical procedures used to treat external auditory canal cancer with respect to avoiding postoperative infection of the temporal bone defect. MethodsEnrolled in the study were 52 patients with external auditory canal cancer surgically treated between July 2015 and October 2020 (38 lateral temporal bone resections, 12 subtotal temporal bone resections and 2 partial resections, accompanied by various combined procedures). Retrospective chart review was conducted taking into consideration postoperative infection, and univariate analysis of prognostic factors was performed. ResultsIn cases managed with subtotal temporal bone resection, no postoperative infections occurred. Cases managed with subtotal temporal bone resection demonstrated increased use of free-flap reconstruction, and longer antibiotic infusion period. On the other hand, analysis of cases managed with lateral temporal bone resection revealed 10 out of 38 patients with postoperative infection (26.3%). However, we couldn't find out any factors that contributed significantly to the prevention of postoperative infection, including the surgical procedures used to manage the defected space, which included free-flap implantation, obliteration with fat tissue, muscular flap rotation, and leaving the space empty without obliteration or reconstruction. ConclusionIn cases managed with lateral temporal bone resection, leaving the resected space empty did not increase the risk of infection. On the other hand, in cases with subtotal temporal bone resection, filling the surgical defect with an autologous bulk, including the free-flap reconstruction and fat obliteration, seems to prevent the infection. Moreover, prolonged antibiotic infusion may suppress postoperative infection of the temporal bone defect.

Clinical Analysis of En Bloc Resection for Advanced Temporal Bone Squamous Cell Carcinoma.

Objective En bloc and margin-negative surgical resection seems to offer the best prognosis for patients with temporal bone squamous cell carcinoma (TB-SCC). In this study, we summarize the outcomes of surgical cases of advanced TB-SCC (T3-T4) that were managed in two institutions, with an accompanying description of the surgical procedure that was utilized: modified subtotal temporal bone resection (STBR), which involves the en bloc removal of the temporal bone including or transecting the otic capsule. Design This is a case series study with chart review. Setting The study was conducted at two academic tertiary care medical centers. Participants Chart information was collected for all patients who underwent surgical resection of advanced TB-SCC between July 1998 and February 2019. The resulting dataset contained 43 patients with advanced TB-SCC who underwent en bloc resection during the review period. Tumor staging followed the modified Pittsburgh classification. Disease-specific survival (DSS) rates were calculated according to the Kaplan-Meier method. Main Outcome Measure This study shows disease-specific 5-year DSS rate. Results The 5-year DSS rate of the cases who underwent en bloc resection was 79.7%. En bloc lateral temporal bone resection was employed in a total of 25 cases (DSS: 79.0%). En bloc modified STBR was utilized in 18 cases (DSS: 81.7%). Conclusion En bloc margin-negative resection is a reliable treatment strategy for advanced TB-SCC. Modified STBR can be a treatment option for TB-SCC without marked posterior extension.

Management of squamous cell carcinoma of the temporal bone: long-term results and factors influencing outcomes.

Temporal bone squamous cell carcinoma (TBSCC) is a rare, aggressive tumor. Surgery, alone or combined with radiotherapy, represent the mainstay of treatment. To report our experience in the treatment of TBSCC and evaluate the disease-specific survival, identifying the factors influencing this outcome. A retrospective study was performed on 66 patients between 1993 and 2018. Patients were staged according to the University of Pittsburgh-modified TNM staging system. Nine cases (13.6%) were Stage I, 7 cases (10.6%) Stage II, 20 cases (30.3%) Stage III and 30 cases (45.5%) Stage IV. Twenty-four patients underwent lateral temporal bone resection (LTBR) and 42 patients underwent subtotal temporal bone resection (STBR). One hundred percent of Stage I and II patients showed no evidence of disease (NED) after a median follow-up of 101months (range 1-289months). NED resulted in 88.2% of Stage III (mean follow-up 80.3months; range 8-257) and 46.4% of stage IV (mean follow-up 50.6months; range 3-217). Pittsburgh Stage or involvement of mastoid, facial nerve, medial wall of the middle ear, temporomandibular joint and middle fossa dura emerged as negative prognostic factors. The highest mortality rate occurred in the first 2 years after treatment, due to local recurrence. Prognosis of TBSCC can be excellent in early stage tumors, employing a LTBR. In more advanced cases, prognosis is poor. STBR with adjuvant radiotherapy represents the treatment of choice, offering acceptable survival rates. Given the rarity of the pathology, many controversies still exist concerning optimal management.

Clinical experience of 23 cases of adenoid cystic carcinoma of the external auditory canal.

Adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is a rare tumor. The present study aimed to describe the clinical features and survival of patients with ACC of the EAC. The present retrospective study included 23 patients (mean age, 51.4±15.4 years; 12 males) diagnosed with ACC of the EAC between January 2010 and September 2017 at The First Affiliated Hospital of The Third Military Medical University (Chongqing, China). The median disease course was 24 months. The presenting features were earache in 16 patients, otorrhea in 7 patients, hearing loss in 5 patients, feeling of aural fullness in 2 patients and EAC mass in 4 patients. Tumor stage was T1 in 13 patients, T2 in 3 patients, T3 in 3 patients and T4 in 4 patients. Among patients with T1 tumors, 5 underwent en bloc external EAC resection; 3 underwent local EAC resection; 1 underwent en bloc EAC resection and superficial parotidectomy; 1 underwent subtotal temporal bone resection for postoperative recurrence; Among patients with T4 tumors, 1 underwent extended temporal bone resection, right parotidectomy, right resection of middle cranial fossa tumors and right resection of temporomandibular joint capsule. 1 underwent subtotal temporal bone resection. Among these 15 patients who underwent surgery, 2 received postoperative radiotherapy, 1 received postoperative chemotherapy, 5 received postoperative chemo-radiotherapy, and 7 did not receive postoperative chemo-radiotherapy. The 3- and 5-year cumulative survival rates of the 23 patients were 47.8% and 17.4%, respectively. Survival may have been improved in patients who received postoperative chemo-radiotherapy and early diagnosis may be the key to improving survival.

Parotidectomy in the management of squamous cell carcinoma of the external auditory canal.

To investigate optimal approaches for appropriate removal of the parotid gland in the management of squamous cell carcinoma (SCC) of the external auditory canal (EAC) at different tumor stages. In total, 39 patients with SCC of EAC treated at the Second Affiliated Hospital of Nanchang University between September 2003 and April 2019 were enrolled in this study. All patients underwent lateral temporal bone resection or subtotal temporal bone resection. Total parotidectomy was performed in patients with direct parotid invasion. Superficial parotidectomy was performed in patients with parotid node metastasis and patients with advanced stages without evidence of parotid involvement. The mean follow-up period was 68.7months. Local recurrences or distant metastases occurred in five patients (12.8%). The 5-year overall survival rate was 78.4%. The 5-year survival rate was 100% in early stage (T1 and T2) patients, and 58.9 and 50.0% in patients staged III and IV, respectively. Direct parotid invasion was observed in only advanced-stage patients, while parotid node metastasis was noted in both early and advanced-stage patients preoperatively. There were no significant differences (χ2 = 0.1026; p = 0.749) between different tumor primary locations. However, soft tissue or preauricular organs became vulnerable once the anterior wall was infiltrated or eroded. Parotid management is important for achieving safer and wider tumor-free margins. Total parotidectomy should be mandatory for all advanced-staged (T3 and T4) patients. An optimal decision for parotid management in early stages depends on the infiltration or erosion of the anterior wall of the EAC.

Grading system and surgical approaches for endolymphatic sac tumors.

Endolymphatic sac tumors (ELSTs) are rare, low-grade adenocarcinomas arising from the endolymphatic sac. This study aims to present a novel grading system for ELSTs to determine the optimal management strategy. We performed a retrospective analysis of 16 patients with 17 ELSTs. The tumor location and involved adjacent neurovascular structures on CT and MRI were selected to establish the grading system. Based on the novel grading system, grade III a tumors were most common (7/17), followed by grade I (4/17), grade II (3/17), and grade III b (3/17) tumors. Eight advanced ELSTs (grade III a and III b) received an infra-temporal fossa approach, while the other 6 early stage ELSTs (grade I and II) underwent either a retrolabyrinthine approach with posterior petrosectomy or a translabyrinthine approach combined with subtotal temporal bone resection. Hearing preservation was achieved in 2 grade I patients. Postoperative facial nerve function was HB II in 1 grade III a patient who underwent anterior facial nerve transposition and was HB III in 4 advanced patients who received facial nerve grafts with the great auricular nerve or facial-hypoglossal nerve anastomosis. The mean follow-up time was 35.1months. Two grade III patients and 1 grade II patient had tumor recurrence during follow-up, among whom 1 grade III b patient had two cases of recurrence. A correct initial diagnosis was established in all patients after meticulous imaging studies. Surgical resection is still the first choice to manage patients with ELSTs. The novel grading system enables surgeons to select tailored surgical approaches. Long-term follow-up is necessary following surgical intervention.

Temporal bone resection for lateral skull-base malignancies.

Malignancies involving the temporal bone are increasingly common and require specialized multi-disciplinary care. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. In this review we discuss general principles for temporal bone resection, as well as alternative and complementary surgical approaches that should be considered in the management of patients with temporal bone cancer. A comprehensive review on literature pertaining to temporal bone resection was performed. The primary surgical strategy for malignancies of the temporal bone is temporal bone resection. This may be limited to the ear canal and tympanic membrane (lateral temporal bone resection) or may include the otic capsule and its contents (subtotal temporal bone resection), and/or the petrous apex (total temporal bone resection). Management of adjacent neurovascular structures including the facial nerve, the carotid artery, and the jugular bulb/sigmoid sinus should be considered during surgical planning. Finally, adjunctive procedures such as parotidectomy and neck dissection may be required based on tumor stage. Temporal bone resection is an important technique in the treatment of lateral skull-base malignancies. This strategy should be incorporated into a multi-disciplinary approach to cancer.

Clinical analysis of missed diagnostic congenital cholesteatoma

Objective:The clinical symptoms, imaging features and surgical treatment of congenital cholesteatoma are reported. Method:The clinical data of 20 patients with congenital cholesteatoma diagnosed and treated in our hospital from January 2016 to May 2018 were retrospectively analyzed, including the age of onset, clinical symptoms, signs, audiology, HRCT of temporal bone, surgical methods and so on. Result:In 20 patients with congenital cholesteatoma, the clinical manifestations were hearing loss in the affected ears, including 5 cases with ear fullness and 4 cases with tinnitus. There were 13 cases of local yellow-white shadow of tympanic membrane, 5 cases of normal tympanic membrane and 2 cases of tympanic membrane bombe. Pure tone audiometry showed conductive deafness in 14 cases and mixed deafness in 6 cases. CT scan of temporal bone showed that 15 cases had pneumatic type of mastoid, 4 cases had diploectic type and 1 case had sclerostic type. There were 15 cases of interspersed flocculent shadow and 5 cases of mass shadow. Among the 20 cases of chronic otitis media with cholesteatoma, 6 have cholesteatoma in epitympanum, 4 in tympanic cavity, 3 in tympanic cavity and epitympanum, 2 in mastoid and tympanic antrum, 1 in mastoid, tympanic antrum and tympanic cavity, 1 in tympanic antrum, tympanic cavity and petrous apex, 1 in tympanic cavity, hypotympanum, posterior tympanum and ostium tympanicum tubae auditivae, 1 in aditus ad antrum, epitympanum and posterior tympanum, 1 in tympanic cavity, epitympanum and posterior tympanum. Intact canal wall mastoidectomy and tympanoplasty were performed in 7 cases, open mastoidectomy and tympanoplasty in 5 cases, middle ear exploration and tympanoplasty in 4 cases, atticotomy with reconstruction and tympanoplasty in 3 cases and subtotal temporal bone resection in 1 case. Conclusion:For patients with intact tympanic membrane presenting with hearing loss, the tympanic membranes should be carefully examined, and thin-section CT and MRI of temporal bone should be performed in time to avoid missed diagnosis of congenital cholesteatoma. Once diagnosed, surgery should be performed as soon as possible.

Temporal bone carcinoma: Treatment patterns and survival.

Carcinomas of the temporal bone are rare, and appropriate treatment, staging, and survival data are limited. This study evaluates clinical characteristics and survival rates for patients with temporal bone carcinoma treated with resection at a single tertiary-care institution, with a focus on the outcomes of patients with locally advanced disease including skull base and/or dural invasion. Retrospective chart review. Demographic, tumor-specific, and survival data were collected for patients with primary carcinomas of the external auditory canal with involvement of the temporal bone from 2003 to 2015. All patients were staged according to the modified Pittsburgh system. Kaplan-Meier and logistic regression analysis were used to calculate factor-specific survival outcomes. Sixty-seven patients met inclusion criteria; 85% were male. There were 43 squamous cell carcinomas (64%) and 24 basal cell carcinomas (BCCs) (36%). Tumor stage was 24 (36%) T2, 12 (18%) T3, and 31 (46%) T4 tumors; 53% had recurrent disease. Surgical management included 49 lateral temporal bone resections and 18 subtotal temporal bone resections. Kaplan-Meier analyses revealed more favorable 5-year survival rates associated with BCC histology (P = .01), lateral temporal bone resection compared to subtotal temporal bone resection (P < .01), lack of immunocompromise (P = .04), and absence of perineural/lymphovascular invasion (P = .01). Multivariate regression analysis did not yield statistically significant results. Factors predictive of more favorable survival include lack of immunocompromise, BCC histology, absence of perineural/lymphovascular invasion, and disease extent amenable to lateral temporal bone resection. Dural invasion is not an absolute contraindication to surgery, with a subset of patients surviving >5 years. 3 Laryngoscope, 130:E11-E20, 2020.

Evaluation and Management of Carcinoma in External Auditory Canal

A retrospectively reviews of 11 patients treated for carcinoma of EAC at our department between January 2000 and December 2018 was conducted to evaluate outcomes in treating carcinoma of external auditory canal (EAC) and to analysis factors which effect the prognosis of this disease. All patients underwent surgical treatment and the diagnosis confirmed by pathological examination. Results: There were adenoid cystic carcinoma (ACC) in 6 patients, squamous cell carcinoma (SCC) in 3 patients, adenocarcinoma (AC) in one patient, and verrucous carcinoma (VC) in I patient. The tumors were classified as Stage I in 5 cases, Stage II in 2 cases, Stage III in 3 cases, and Stage IV in 1 cases. Four patients underwent extensive tumor resection (ETR), 2 patients underwent lateral temporal bone resection (LTBR), 2 patients underwent modified LTBR, one patient underwent subtotal temporal bone resection (STBR), and 2 patients underwent only open biopsy. Besides, adjunctive procedures, including neck dissection, parotidectomy and pinna resection were performed when indicated. Ten patients received postoperative radiotherapy. By the end of follow up, two patients had died of their disease, 2 lost to follow up, 2 survived with the disease, and the rest survived disease-free. The median follow-up period was 24 months. Complete tumor resection appears to be an effective treatment for carcinoma of the EAC. Patients with SCC seem to have worse prognosis than those with ACC. Radiation therapy seems less effective for the disease than surgical treatment.

Outcomes of reconstruction after temporal bone resection for malignancy

Reconstruction after temporal bone resection (TBR) is challenging due to the lack of consensus on an optimal approach. Records of the Keck Hospital of USC were searched to identify, collect and group data on patients who underwent TBR for malignancy. Chi-square analysis was used for categorical variables, and ANOVA was used for continuous variables. Forty TBR including 27 lateral (LTBR), 8 total (TTBR), and 5 subtotal (STBR) temporal bone resections were performed at our institution over a ten year time period (2003–2013) and reconstructed with free, regional, and local flaps and tissue grafts. TTBR was associated with postoperative complications as was presence of a dural defect, though other traditionally poor prognostic factors such as age, comorbidity status, and history of irradiation were not. Patients who underwent auriculectomy or parotidectomy were more likely to require free flap reconstruction. We conclude that TBR and reconstruction can be performed successfully on many patients including those who are older or who have more aggressive disease. We recommend free tissue transfer for the large defects created by TTBR, parotidectomy and auriculectomy.

Prognostic Factors Affecting Surgical Outcomes in Squamous Cell Carcinoma of External Auditory Canal.

Objectives Carcinomas of the external auditory canal (EAC) are rare, and management remains challenging. Previous studies seeking prognostic factors for EAC cancers included cancers other than carcinomas. In this study, we analyzed the treatment outcomes of, prognostic factors for, and survival rates associated with specifically squamous cell carcinoma (SCC) of the EAC.Methods A retrospective review of 26 consecutive patients diagnosed with SCCs of the EAC in a 10-year period was performed in terms of clinical presentation, stage, choice of surgical procedure, and adjunct therapy. Overall survival (OS) and recurrence-free survival (RFS) were calculated and univariate analysis of prognostic factors was performed.Results The median age of the 26 patients with SCCs of the EAC was 63 years (range, 40 to 72 years), and 16 males and 10 females were included. According to the modified University of Pittsburgh staging system, the T stages were T1 in 11, T2 in six, T3 in four, and T4 in five cases. The surgical procedures employed were wide excision in three cases, lateral temporal bone resection (LTBR) in 17, and extended LTBR in four, and subtotal temporal bone resection in two. Two patients underwent neoadjuvant chemotherapy, and two underwent adjuvant chemotherapy. One patient received preoperative radiation therapy, and eleven received postoperative radiation therapy. Of the possibly prognostic factors examined, advanced preoperative T stage and advanced overall stage were significant predictors of RFS, but not of OS.Conclusion The advanced T stage and overall stage were associated with decreased survival after surgical treatment in patients with SCC of the EAC, highlighting the importance of clinical vigilance and early detection.

Squamous cell carcinoma of tympano-mastoid region: a series of six cases

&lt;p class="abstract"&gt;The malignancies of tympanomastoid region are very rare entity. These tumours are more common in elderly persons in 6th and 7th decade. Males are more commonly affected than females. Chronically discharging ears are considered as risk factor which may be due to metaplasia in the middle ear mucosa following prolonged chronic infection. The most common symptoms are long standing blood tinged ear discharge, severe nocturnal pain, rapidly growing polypoidal or granulomatous mass in EAC or middle ear, peripheral facial palsy and painless ulceration over pinna or EAC. CT scan for bony erosion and MRI for soft tissue involvement and neural invasion are investigations of choice. Tissue biopsy is must for histopathological examination and confirmation of diagnosis. Surgery and chemo-radiotherapy are the mainstay of treatment. Surgery includes wide local excision, lateral temporal bone resection, subtotal temporal bone resection and total temporal bone resection.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Abstract 22: Radiation induced and de novo squamous cell carcinoma of the temporal bone—a comparison

Abstract Introduction: Squamous cell carcinoma (SCC) temporal bone is a rare malignancy with incidence of around 1.2 per million population per year. Risk factors included chronic otitis media and chronic irritation of the skin and mucosal of the external and middle ear. A rare but important etiology is radiation to the external auditory canal from treatment of head and neck malignancies. The current study compares the presentation, treatment and prognosis of de novo temporal bone SCC and radiation induced temporal bone SCC. Materials and Methods: From 1995 to 2016, 30 patients were treated at our institution for squamous cell carcinoma of the temporal bone, of which 16 (53.3%) occurred after prior radiotherapy for nasopharyngeal carcinoma. Comparisons were made on the stage at presentation, disease free survival and overall survival. The modified Pittsburgh staging is used for staging. Kaplan Meier plot and log rank test are used for survival analysis. Results: All patients who had prior radiation had radiation treatment for undifferentiated carcinoma of the nasopharynx. There were 23 male and 6 female patients. One male patient who had prior radiation treatment for NPC suffered from sequential SCC of the left and right external auditory canal. Median age on presentation was 66.1 (range 46-84.5 years). There was no difference in the age of presentation between patients with de novo disease (mean 65.5 years) and radiation induced SCC (mean 65.3, p=0.97, t-test). There was also no difference in the gender distribution between de novo and radiation induced SCC of the temporal bone (p=0.63, chi-square). 27 cases were treated with surgery with 11 cases treated with radical mastoidectomy, 11 cases treated with lateral temporal bone resection and 5 cases underwent subtotal temporal bone resection. Postoperative radiotherapy was given to 14 cases. 2 patients received radiotherapy alone and 1 patient received chemo-radiation alone. The majority (85%) of the de novo cancers received postoperative radiotherapy but only 21% of the radiation-induced cancer had adjuvant radiotherapy. Radiation-induced cancer presented significantly earlier with lower T-stage (p=0.028, Mann-Whitney U test) and overall staging (p=0.019, Mann-Whitney U test). Cumulated 5-year survival was 35%. Estimated median overall survival (OS) and disease specific survival (DSS) of the whole cohort after treatment was 43 and 48 months respectively. There was no difference in the OS and DSS between the de novo cancers and radiation-induced cancers (p=0.99 and p=0.50 respectively, log-rank test). Conclusion: SCC of the temporal bone is a rare disease with poor prognosis despite treatment. Radiation-induced cancer of the temporal bone is a rare but important complication of radiation treatment to the head and neck region. Radiation-induced cancers presented earlier but prognosis is similar to de novo cancers. Inability to prescribe further radiation to the temporal bone after surgery may be a factor for poor prognosis in this group of patients. Citation Format: Raymond King-Yin Tsang, Nikie Sun. Radiation induced and de novo squamous cell carcinoma of the temporal bone—a comparison [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 22.

Treatment and Outcomes of Carcinoma of the External and Middle Ear: The Validity of En Bloc Resection for Advanced Tumor.

Carcinoma of the external and middle ear is a very rare disease. Despite the various treatment modalities available, its prognosis is still poor. We aimed to analyze the treatment modalities, outcomes, and validity of surgical approaches, especially in advanced tumors in the ear. Twenty-five patients with carcinoma of the external and middle ear were retrospectively analyzed. The modified Pittsburgh staging system was used for staging of the patients. Overall and disease-free survival was estimated using of Kaplan-Meier method. In our cohort of 25 patients, the majority (76%) had tumor located in external auditory meatus. The most common histologic subtype was squamous cell carcinoma (80%). More than half of patients (56%) had tumor stage IV. In the stage IV group, five patients underwent subtotal temporal bone resection and ipsilateral neck dissection. Seven patients underwent definitive radiotherapy. The remaining two patients underwent palliative chemotherapy. The 2-year overall and disease-free survival for patients with tumor stage IV was 67.7% and 57.8%, respectively. In patients with tumor stage IV, the 2-year overall survival for patients who underwent surgery was 80.0% versus 53.6% for those who underwent radiotherapy (P = 0.16). The 2-year disease-free survival for patients who underwent surgery was 80.0% versus 28.6% for those who underwent radiotherapy (P = 0.15). In the present study, the outcome of patients who received surgical treatment tended to be better than that of patients who received radiation therapy. Our results suggest that en bloc resection could be the first choice even in the advanced disease stage.