Surgical Management of Temporal Bone Malignancy: A Decision without Regret

Objective: The authors report 23 cases of advanced malignant tumors of the temporal bone with invasion of the adjacent regions. The average age of the patients was 48 years (18–69 years). The final pathologic diagnosis obtained reveals 7 cases squamous cell carcinoma, 3 cases basal cell carcinoma, 4 adenocarcinomas, 1 case adenoid cystic carcinoma, 5 cases endolymphatic sac tumors and 3 cases rare tumors: multiple myeloma, Langerhans cell histiocytosis and Chondroid tenosynovial giant cell tumor. The preoperative evaluation included clinical examination, CT, MRI, and if needed MRA, MRV and PET scan. In 12 cases the tumors had not involved the meninges; however, in the remaining 10 cases, tumors had reached the internal carotid artery and involved the surrounding dura.

Methods and Results: Wide surgical excision is the corner stone treatment and the prognosis remains linked to local recurrences. Subtotal or total enlarged petrosectomy associated with parotidectomy with preservation of the FN if intact function, and perform neck dissection according to the lymph nodes involvement. A few cases underwent excision of the ear pinna as well as the peri-auricular region and the temporomandibular joint. The extent of the excision must be planned before the intervention and corrected during the intervention based on frozen section histological examinations. The patient should be counseled and consented about the possibility of FN and hearing sacrifice in case of inadvertent identification of tumor extension.

Results: Twelve patients with preoperative FN palsy (grades 3–6) had their nerve sacrificed. The transition from subtotal to total petrosectomy and dura excision was always valid options. Fourteen cases had gross total excision, while 8 patients had less than total excision: 5 patients had subtotal excision while 3 patients had partial palliative excision. Postoperative radio-chemotherapy was systematically planned according to the nature of the tumor. The average follow-up was 4 years (1–15 years). Half of the patients in whom the tumor had been completely resected are now living without recurrence. Five patients died: three due to tumor recurrence in the brain, one due to distant metastases, and one patient due to a massive cerebral infarction 4 months postoperative. Nine patients underwent free flap reconstruction which provided better tolerance in the event of postoperative radiotherapy. Therapeutic and prognostic particularities are analyzed in this work.

Conclusion: Treatment of advanced cancers requires a combination of therapeutic methods (surgery, radiotherapy, chemotherapy). Patients with advanced stages cancer require multidisciplinary approach leading to improvement of oncological, functional, morphological and aesthetic results thus better quality of life.

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Artikel online veröffentlicht:
07. Februar 2025