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Temporal Bone
Carcinoma
1
Introduction
Ishak LN, Goh SB, Saim L, 2014; Beyea AJ, Moberly CA, 2015
2
Lecture Goals
Malignant tumors
SCC and other primary
tumors
Metastatic tumors
Surgical technic
3
Temporal Bone Anatomy : identifying
pathways
of the spread of cancer
4
5 6
1 2 3
3
7 1 5
6 4 2
7 9
Axial Coronal
Hirsch EB, Chang JY, Antonio
4
MS, 2009
Cancer can spread :
1. Anteriorly : cartilaginous ear canal parotid
gland
2. Concha postauricular sulcus
3. Tympanic membrane middle ear
4. Posteriorly mastoid
5. Anterior mesotympanum carotid artery &
eustachian tube
6. Inner ear round window or otic capsule
7. Along the facial nerve infratemporal fossa
8. Through the mastoid, posterior fossa dura, &
sigmoid sinus
Hirsch EB, Chang JY, Antonio
9. Beneath the skull base jugular fossa, carotid
MS, 2009
artery & lower cranial nerves 5
PRIMARY MALIGNANCIES OF THE
TEMPORAL BONE
6
Metastasis to Temporal Bone:
Breast carcinoma
Prostatic carcinoma
Renal cell
carcinoma
Bronchogenic
carcinoma
Lymphoma
Histiocytosis X
Marsh M, Jenkins A, 2010; Beyea AJ, Moberly
ColonCA, carcinoma
2015
7
SIGNS AND SYMPTOMS
OF TEMPORAL BONE MALIGNANCIES
Most common
No sex prevalence
Most patients have H/O chronic
inflammation of some kind
S/S are otorrhea, HL and deep seated
otalgia. 40% have a ME mass.
Direct labyrinthine invasion is rare
due to otic capsule
Gustafson LM, Pensak LM, 2003; Noorizan Y, Asma A, 2010; Beyea AJ,
Moberly CA, 2015
10
Extensive
recurrence of a
tragal SCC of the
left ear
Marsh M, Jenkins A, 16
2010
Surgical Technic
Therapeutic guidelines by stage
T1 : LTBR or primary radiation, consider SP
T2 : LTBR plus postoperative radiation, consider SP
T3 : STBR or TTBR plus postoperative radiation,
consider SP
T4 : STBR or TTBR plus postoperative radiation,
consider SP
N+ : Add radical parotidectomy and SND to the
above
M1: Palliation
Hirsch EB, Chang JY, Antonio MS, 2009; Beyea AJ,
Moberly CA, 2015
17
Margins of resection
3.TT
BR
3.TTB
R
1.LTB 2.STBR
R
2.STBR
1.LTBR
Axial
2.STBR 3.TTB
R
1.LTB
R Hirsch EB, Chang JY, Antonio MS,
2009;
Beyea AJ, Moberly CA, 2015
Coronal 18
Carotid Management
Postauricular and
meatal incisions for
resection of the
temporal bone.
This illustration
demonstrates
inclusion of the
tragus with the
specimen
Hirsch EB, Chang JY, Antonio MS,
2009 22
Lateral T Bone Resection
Closure of the EAC
Complete
mastoidectomy
Hypotympanic Extended facial
dissection
recess (sacrifice the
chorda)
Disarticulate the IS
joint
Fracture the anterior
Specimen fractured
with osteotome
Specimen
separated EAC just lateral to the
from soft tissue
Eustachian tube
Marsh with
M, Jenkins A,
2010
osteotome 23
The anteriorly
based skin flap
containing the
pinna is separated
from the core of
the external
auditory meatus.
The meatus has
been oversewn to
prevent tumor
Hirsch EB, Chang JY, Antonio MS,
spillage. 2009
24
Subtotal T Bone Resection
26
C-shaped incision or Y-shaped incision
Incisions include a central
external auditory canal core,
which is sutured closed
Tragus can be preserved for
better cosmesis
Temporal craniotomy for
subtotal temporal bone
resection is smaller than for a
total temporal bone resection
Parotid gland with main trunk
of facial nerve has been
elevated from masseter
muscle.
Marsh M, Jenkins A,
2010 27
Subtotal T Bone Resection
Neck dissection
preformed for
vascular control of IJ
and ICA
Involvement of jugular
foramen necessitates
IJ sacrifice and ligation
of the sigmoid
Avoid injury to vein of
Labbe drainage of
the temporal lobe and
can result in venous
infarction of temporal
lobeBad!!
28
Marsh M, Jenkins A,
Subtotal T Bone Resection
Marsh M, Jenkins A,
2010 30
Total T Bone Resection
Marsh M, Jenkins A,
32
2010
N. VII through XI have
been transected
The underlying dura
incised as the posterior
border of the en bloc
resection of the petrous
bone
Vascular
Cerebrospinal fluid leak
Infection
Intracranial hemmorrhage and
hypertension
Wound
Hirsch EB, Chang JY, Antonio MS,
2009
35
Outcomes
Tumors limited to the EAC have 50-80%
cure rate after LTBR
Tumor extending beyond the ME 0-15%
survival >2yrs
Survival increases with dual modality
therapy
University of Pittsburg staging system
Increasing T stage is inversely proportional to
survival
T1 and T2 have reported 100% 2 yr survival
T3 lesions have 2 yr of 56%
2 yr survival of T4 tumorsHirsch
at 17%EB, Chang JY, Antonio MS,
2009 36
37