Temporal Bone Resection Research Articles

Long-term Follow-up of Secondary Reconstruction of Facial Paralysis and Depressive Deformities After Subtotal Temporal Bone Resection.

Subtotal temporal bone resection (STBR) frequently results in facial paralysis and depression, making reconstruction challenging due to significant tissue loss. This study aimed to evaluate the effectiveness of a procedure designed for simultaneous smile and soft tissue reconstruction after STBR. The authors included 3 patients who underwent latissimus dorsi (LD) neuromuscular flap combined with adipose flap transfer after STBR at the Tokyo Medical and Dental University Hospital between 2010 and 2016. Among these patients, 2 had facial vessels unsuitable for anastomosis due to prior neck dissection, and their masseteric nerves were unavailable for neurorrhaphy due to STBR. The thoracodorsal nerve was coaptated to the contralateral facial nerve in all patients and to the ipsilateral masseter nerve in one patient. Follow-up periods ranged from 7 to 13 years, with all patients achieving spontaneous smiles within 12 months post-surgery. Although depressive deformities improved, long-term follow-up revealed buccal muscle bulging due to unstable LD muscle fixation from a zygomatic arch defect caused by STBR. Revision surgeries, including muscle refixation with a tensor fasciae lata graft, muscle reduction, eyebrow lifting, blepharoplasty, and adipose tissue repositioning, were performed as needed. Ultimately, all patients achieved satisfactory facial contours and spontaneous smiles. This study demonstrates that free LD muscle with adipose flap transfer is effective for post-STBR reconstruction. However, detailed surgical planning and multistage reconstruction are often necessary due to the complexities involved.

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.

Risk Factors for Complications in Patients Undergoing Temporal Bone Resection and Neck Dissection: Insights From a National Database.

Temporal bone resection (TBR) with or without neck dissection (ND) is performed for otologic malignancies with occult or clinical cervical lymph node metastases. To date, characterization of post-operative complications in single institution case series may be non-representative of real-world outcomes. Here, we used data from the National Inpatient Sample (NIS) to comprehensively assess the complications encountered, their frequencies, and to identify underlying risk factors to improve future outcomes. The population was patients undergoing TBR and ND derived from the NIS between the years of 2017 and 2019. We utilized ICD-10 diagnosis codes to identify patients with post-operative complications, those discharged to non-home facilities (DNHF), and those with increased length of stay (LOS). Multivariable regression was performed to identify significant variables related to the above outcomes. Ninety of 277 patients that underwent LTBR with ND had postoperative complications. Wound complications were the most frequent complication, occurring in 11 (4%) of patients, followed by CSF leak (n = 6; 2.2%), with acute respiratory failure being the most common medical complication (n = 4; 1.4%). Sixteen percent (45/277) were discharged to a facility besides home. Dementia (OR = 7.96; CI95 3.62-17.48), anemia (OR = 2.39; CI95 1.15-4.99), congestive heart failure (OR = 5.31; CI95 1.82-15.45), COPD (OR = 3.70; CI95 1.35-10.16), and history of prior stroke (OR = 8.50; CI95 1.55-46.68) increased the odds of DNHF. When evaluating LOS (median = 5 days, IQR = 1, 9), anemia (OR = 5.49; CI95 2.86-10.52), and Medicaid insurance (OR = 3.07; CI95 1.06-10.52) were found to increase the LOS. The vast majority of patients undergoing LTBR with ND have no complications and are discharged within a week. Liver disease is a risk factor for medical complications and increased charges. Patients with dementia or a prior stroke are at risk for DNHF, and those with prior anemia are at risk for a wound complication. This study identified factors related to worse post-operative outcomes in patients undergoing temporal bone resection and neck dissection. Although safe for most patients, an existing diagnosis of liver disease, stroke, dementia, and anemia specifically are at risk for developing negative outcomes. 3.

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.

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.

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.

Patterns of spread and anatomical prognostic factors of pre-auricular cutaneous squamous cell carcinoma extending to the temporal bone.

Improvements can be made in the management and staging of advanced pre-auricular cutaneous squamous cell carcinoma (cSCC). We aimed to analyze radiological patterns of spread and clinico-anatomical prognostic factors. Retrospective review of 54 patients with pre-auricular cSCC (cutaneous/nodal) who underwent temporal bone resection with curative intent. Involvement of the cartilaginous external auditory canal (EAC) (79.6%) and retromandibular space (63.0%) was common. Styloid process/anterior carotid sheath (ACS) (11.1%) and bony EAC (7.4%) involvement were rare. ACS involvement resulted in high rates of involved surgical margins (100%) and poor outcomes on univariable analysis. Negative prognostic factors on multivariable analysis included salvage surgery and invasion of the bony EAC, mandible, pterygoid muscle(s), and dura. The bony EAC and ACS can form temporary barriers to tumor spread, with the latter representing a potential limit of resectability. Prognostic factors revealed can lead to the development of a more appropriate staging tool.

Total conservative parotidectomy combined with an extended lateral temporal bone resection

Total conservative parotidectomy combined with an extended lateral temporal bone resection

Impact of Positive-Margin Resection of External Auditory Canal Squamous Cell Carcinoma.

Positive-margin resection of external auditory canal squamous cell carcinoma (EAC-SCC) is still a major cause of recurrence. The aim of this study is to examine the clinical impact of positive-margin resection of EAC-SCCs. We retrospectively reviewed 40 surgical cases with en bloc temporal bone resection of EAC-SCC at a tertiary referral center from October 2016 to March 2022. Two-year disease-specific, overall, and disease-free survival rates for all 40 cases reviewed were 85.2%, 88.85%, and 76.96%, respectively. En bloc resection with a negative margin significantly improved patient prognosis (p < 0.001). Positive-margin resection was observed in 9/40 cases (22.5%). Insufficient assessment of preoperative images was the cause in two of these cases. Postoperative lymph node metastasis and distant metastasis were observed in cases in which vascular, lymphatic duct or perineural invasion was found on postoperative pathological examination. In addition, three cases in which no vascular, lymphatic duct, or perineural invasion was found exhibited local recurrence during the follow-up period. Of the nine positive-margin resection cases, only two showed no postoperative recurrence. Once positive-margin resections are confirmed, cases might have a high risk of tumor recurrence, even with the addition of postoperative adjuvant chemoradiotherapy.

A Combined Exoscopic and Endoscopic Approach for Radical Temporal Bone Resection and Usefulness of the Endoscopic Approach to the Medial Aspect of the Temporal Bone.

Radical temporal bone resection (TBR) for lateral skull base malignancies is technically challenging because of the vital anatomical structures located at the medial part of the temporal bone and their limited exposure. A possible solution is to adopt an additional endoscopic approach for medial osteotomy to reduce blind spots. The authors aimed to describe a combined exoscopic and endoscopic approach (CEEA) for cranial dissection in radical TBR and to determine the usefulness of the endoscopic approach to the medial aspect of the temporal bone. Having utilized the CEEA in for cranial dissection in radical TBR since 2021, the authors included 5 consecutive patients who underwent the procedure between 2021 and 2022. All surgeries were successful and resulted in no significant complications. The additional use of an endoscope improved visualization of the middle ear in 4 patients and that of the inner ear and carotid canal in 1 patient, enabling precise and safe cranial dissection. Furthermore, surgeons experienced reduced intraoperative postural stress with CEEA than with a microscopic approach. The main advantage of CEEA in radical TBR was the extension of the viewing angles of the endoscope, which allowed observation of the medial aspect of the temporal bone and limited tumor exposure and injury to vital structures. Given the other benefits of exoscopes and endoscopes, including compact size, ergonomics, and surgical field accessibility, CEEA proved to be an efficient treatment option for cranial dissection in radical TBR.

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&lt;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.

Intrapulmonary Metastasis from Adenoid Cystic Carcinoma of the External Auditory Canal: A Case Report.

External auditory canal adenoid cystic carcinoma (EAC) is rare and is associated with nonspecific clinical manifestations such as early ear pain. We report a patient with advanced lung metastases from adenoid cystic carcinoma (ACC) of the EAC, which is difficult to diagnose. Under general anesthesia, lengthened right temporal bone resection, parotidectomy, facial nerve resection, cervical lymph node dissection (I-III), partial mandibular resection, tumor resection in the inferior temporal fossa and lateral femoral flap repair were performed, followed by regular radiotherapy and chemotherapy. During 2years of postsurgical follow-up, there was no recurrence. The combination of early detection, resection, postoperative radiotherapy, and chemotherapy can result in a good therapeutic effect.

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.

Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone.

The objective of this study was to explore the pattern of lymph-node spread of SCCs involving the temporal bone. We retrospectively reviewed all cutaneous SCCs involving the temporal bone over a 20-year time-period. Forty-one patients were eligible. Mean age was 72.8 years. The diagnosis was cutaneous SCC in all cases.All patients underwent a temporal bone resection, 70.7% had a neck-dissection and 78.0% a parotidectomy.Level 2 was the most common area of neck metastasis, and occurred in 12.2%. The parotid had disease in 34.1%. 51.2% of patients underwent free-flap reconstruction.Mean overall survival of the cohort was 4.2 years. Overall, the rate of cervical nodal metastasis was 22.0% and 13.5% in the occult setting. The parotid was involved in 34.1% and 10.0% in the occult setting. Results from the present study support consideration for performing a parotidectomy at the time of temporal bone resection, while a neck dissection can be performed for adequate staging of the nodal basin. 3.