En bloc resection of the temporal bone was performed by the lateral approach on two patients with carcinoma of the middle ear, which was associated with destruction in the temporal bone and tumor infiltration of the cranial base. Tumours of the external ear and temporal bone the lancet. May be sole treatment for tumors with low metastatic potential. The resulting posterior defect is reliably covered with a splitthickness skin graft. Lateral temporal bone resection in advanced cutaneous. Nov 09, 2017 lateral temporal bone resection using otomicrosurgical microsurgical technique duration.
The lower island trapezius flap is another rotational flap frequently used for reconstruction after lateral temporal bone resection. Lateral temporal bone resection using otomicrosurgical microsurgical technique duration. Lateral temporal bone resection surgical technique rajeev mathew, tashneem harris, parag patel lateral temporal bone resection refers to en bloc resection of the external auditory canal eac with the tympanic membrane tm. However, there are few reports on the detailed anatomy involved in the resection. Pre op photograph of proliferative growth seen in the bony part of the external auditory canal. The specific procedures and nomenclature vary among surgeons.
Lateral temporal bone resection for malignancy of external auditory meatus. The course seeks to improve the surgical skill of participants through a series of dissection exercises and. This surgery is performed to remove the ear canal in its entirety in one piece for cancers of the ear canal. Management outcomes following lateral temporal bone. May be suited to lateral temporal bone resection with sacrifice of facial nerve t4. Mar 15, 2019 surgical management included 49 lateral temporal bone resections and 18 subtotal temporal bone resections. Lateral temporal bone resection was the primary and most aggressive procedure performed. Pdf lateral temporal bone resection for malignancy of. In a finished bone, the tegmen should be exposed from the zygmatic root to the sinodural angle citellis angle. Axial a and coronal b contrastenhanced t1weighted mr imaging of the temporal bone in a patient with acute onset of left facial paralysis and a clinical diagnosis of bells palsy. Primarily for removal of tumors of external ear canal and temporal bone.
Management outcomes following lateral temporal bone resection for ear and temporal bone malignancies. Dec 12, 2012 lateral temporal bone resection was defined as removal of the structures lateral to the facial nerve and otic capsule, and this was performed in an en bloc fashion. As previously described, a mastoidectomy is performed and the specimen is removed lateral to the facial nerve, jugular vein, and internal carotid artery. Malignant tumors of the temporal bone our experience. Abnormal enhancement of the facial nerve is apparent in the labyrinthine small arrow, geniculate open arrow, and tympanic double arrow portions of the. Malignancies involving the temporal bone are increasingly common and require specialized multidisciplinary care.
Consistently based on a descending branch off the transverse cervical vessels, this flap similarly allows for effective soft tissue and skin coverage in a single stage. In this article, we shall look at the different parts of the temporal bone, their articulations, and any. The mean age of patients at the time of surgery was 62 years old range, 33. This will provide a comfortable access to the inferobasal neocortical region and temporal pole during the resection. Temporal bone anatomy cadaveric dissection iowa head and. This surgery has to be performed when cancers of the ear involve. Introduction temporal bone carcinoma is a rare disease very aggressive course if diagnosis is delayed bad prognosis rapid progression and limited therapeutic success squamous cell carcinoma scc. Parotid metastatic disease from cutaneous squamous cell. Although lateral temporal bone resection falls on the conservative side of this continuum, it is the most extensive surgical procedure involving malignant lesions of the temporal bone that reliably achieves en. Occasionally, this is not possible due to a low tegmen or. Increased local recurrence in advanced parotid malignancy. Data set for the reporting of ear and temporal bone tumors. Middleear adenocarcinomas are slowgrowing tumours and distant metastases can develop, but rarely. Post operative photograph of lateral temporal bone resection done.
If the tumor is in the inner twothirds of the ear canal or in the bony parts of the canal, a lateral temporal bone resection may be needed. The temporal bone can be affected by primary or secondary malignancies. The first is the mastoid process, an inferior projection of bone, palpable just behind the ear. The mean age of patients at the time of surgery was 62 years old range, 33 to 88 years, with 8 males 67% and 4 females 33%. Pdf management outcomes following lateral temporal bone. Not amenable to lateral temporal bone resection surgical anatomy the lateral of the eac is composed of fibroelastic cartilage and contains the fissures of santorini these communicate with the parotid anteriorly and the soft tissue overlying the. Soft tissue removal from the facia recess and sinus tympani. Severe complications would occur if the bone of the skull received the large dose of radiation needed to destroy the cancer.
Recognized prognostic indicators for metastatic cutaneous squamous cell carcinoma scc of the head and neck include facial nerve involvement, immune status, and parotid staging system pstage. Subtotal temporal bone resection stbr has been utilized for half a century to remove temporal bone malignancies. A type of surgery called sleeve resection is an option if the tumor is located in the third of the ear canal closest to the ears opening. Temporal bone resection for lateral skullbase malignancies. Objectiveto evaluate clinical outcomes following lateral temporal bone resection ltbr for management of malignancies involving the ear or temporal bone. It is generally performed for malignancies involving the eac, the most common being primary squamous cell carcinoma. Osteoradionecrosis orn of the temporal bone is a common complication estimated to affect 8. To our knowledge, this represents the only study of. The lateral temporal bone resection usually includes the cartilaginous and bony parts of the eac, the tympanic membrane, and the contents of the middle ear. Extent of spread determines specific degree of temporal bone resection. These cancers tend to occur in patients with chronic ear canal infections, those with significant sun exposure, or previous radiation therapy. Among subtypes of temporal bone resection, lateral temporal bone resection is by far the most commonly indicated.
A video of a lateral temporal bone resection can be seen below. Please note this is a surgical video and may not be suitable for all viewers. Such resection is appropriate for many sccas of the external auditory canal and adjacent sites, as these tumors are similar in disease progression and prognosis. Illustrations of skull base surgery and neurotology. May require adjuvant chemo or radiation therapy preoperative preparation. Temporal bone resection susan posted mon 10th of february, 2014 18. Microsurgical anatomy of subtotal temporal bone resection en. It is generally accepted that the prognosis and overall survival vary considerably depending on the stage of the disease, the treatment protocols, and the aggressiveness of the surgical resection. It contains the middle and inner portions of the ear, and is crossed by the majority of the cranial nerves. Temporal bone tumors uci head and neck surgery uci ent. The study included 12 patients who underwent lateral temporal bone resection ltbr for parotid cancer between 1994 and 2010 with median followup duration of 30. Temporal bone resection otolaryngology coding ask an. Lateral temporal bone resection was defined as removal of the structures lateral to the facial nerve and otic capsule, and this was performed in an en bloc fashion.
This is a surgery showing a left lateral temporal bone resection. We sought to examine the impact of lateral temporal bone resection ltbr on prognosis. Surgical management included 49 lateral temporal bone resections and 18 subtotal temporal bone resections. Tympanic membrane and ossicularsparing modified lateral. A study on post operative outcome of lateral temporal bone. A minimally invasive partial condylectomy and temporal bone resection for the treatment of a suspected chronic synovial sepsis of the temporomandibular joint in a 3. The complex anatomy of this region requires a thorough understanding in order to manage these lesions safely. Temporal bone resection is classified as lateral, extended lateral, subtotal, extended subtotal or, total in order of increasing surgical scope and invasiveness see table 1. The middle fossa plate mfp should be first identified in the squama of the temporal bone from the zygmatic root to the lateral sinus. Pure tone audiogram confirmed left conductive hearing loss moderate to severe, right moderate hearing loss. Surgery on the ear canal and temporal bone is divided into three types. On a lateral view of the temporal bone, such as figure 1. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. Temporal bone anatomy cadaveric dissection iowa head.
The specimen usually includes the conchal bowl and the cartilaginous part of the ear canal lateral to the tympanic membrane. A minimally invasive partial condylectomy and temporal. Herein we present a brief description of the techniques used to resect malignant temporal bone lesions. This extensive fiveday course is designed as a complete temporal bone dissection course for the resident or fellow in training or as an update. Lateral temporal bone resection iowa head and neck protocols. This is a surgery performed to remove cancers of the ear canal. The mfp is then followed medially to expose the tegmen. Hill tmtton, mo, oklahoma city, oklahoma eighteen consecutive patients underwent a lateral temporal bone resection for the treatment of tu mors originating in the auricle, the external audito ry canal, the periauricular skin, or the parotid and were retrospectively analyzed. D, for lateral temporal bone resection defects, the occipital flap can be inset over an abdominal fat graft to provide better contour and soft tissue coverage. Do not report code 69424 in conjunction with 69205, 69210, 69420, 69421, 6943369676, 6971069745, 6980169930 altlabel.
This portion of the temporal bone is located posteriorly. The occipital flap for reconstruction after lateral. Conclusion lateral temporal bone resection provides comparable disease free survival rates to more radical surgical therapy. Treatment of middleear adenocarcinomas parallels that of middleear squamous carcinomas, with attempts at surgical excision including lateral or subtotal temporalbone resection coupled with postoperative radiotherapy. Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. A case report blood investigations showed normal total white count and fasting sugar. Temporal bone squamous cell carcinoma penang experience. Current procedural terminology resection temporal bone. Objectives lateral temporal bone resection ltbr has traditionally been performed en bloc in accordance with oncologic principles. The temporal bone contributes to the lower lateral walls of the skull. A modified lateral temporal bone resection mltbr is a unique technique that spares the tympanic membrane tm and ossicles in select patients with squamous cell carcinoma scca. It is important to preserve the deep temporal branches of the maxillary artery that supply the temporalis muscle.
This procedure is used for small tumors located along the lateral aspect of the eac. Management outcomes following lateral temporal bone resection. In one of the patients, the petrous apex was resected along with the temporal bone. To evaluate clinical outcomes following lateral temporal bone resection ltbr for management of malignancies involving the ear or temporal bone. Evaluation of bone of skull base for tumor extension. The lower portion of the bone articulates with the mandible, forming the temporomandibular joint of the jaw. Objective to evaluate lateral temporal bone resection ltbr in the management of advanced cutaneous squamous cell carcinoma scc with temporal bone invasion and patterns of failure methods this is a retrospective study of 35 patients undergoing lateral temporal bone resection for advanced cutaneous scc at a tertiary care center between 1995.
If radiation is used after surgery the required dose is much less. Jul 12, 2018 the resection procedures that can be performed for the temporal bone include a modified lateral temporal bone resection, lateral temporal bone resection, subtotal temporal bone resection, and total temporal bone resection. Temporal bone ear area tumors uc irvine medical center. Squamous cell carcinoma involving the temporal bone. Debridement antibiotics topical steroids hyperbaric oxygen surgical resection and reconstruction. Although lateral temporal bone resection falls on the conservative side of this continuum, it is the most extensive surgical procedure involving malignant lesions of the temporal bone that reliably achieves en bloc tumor resection.
The occipital flap for reconstruction after lateral temporal. Dissected along the tegmen,to the cells, then did a reconstruction and meatoplasty. Outcomes of temporal bone resection for locally advanced. A a a a a preauricular incision extending into the temporal hairline and down into the neck and incorporating the ear canal. Temporal bone, squamous cell carcinoma, case series, lateral temporal bone resection introduction temporal bone carcinoma is rare accounting for less than 0. Further bone removal is needed along the oor of the temporal fossa down to the. Results the overall disease free survival for this series when considering both external auditory canal and adjacent site sccas was 70%. This procedure is used for tumors that extend into the middle ear space and include the entire eac figure 4, the contents of the middle ear. Jul 24, 2010 this is a surgery showing a left lateral temporal bone resection. Pus from the left eac cultured streptococcus milleri. In a finished bone, the tegmen should be exposed from.
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