Update on Surgical Outcomes of Lateral Temporal Bone Resection for Ear and Temporal Bone Malignancies

摘要

Malignancies of the temporal bone are rare, accounting for less than 1% of head and neck tumors with an annual yearly incidence of six in one million people.12 Presenting symptoms of temporal bone malignancies are often nonspecific, including hearing loss, otalgia, external otitis, otorrhea or bleeding, necrosis, or ulceration in the area, and rarely facial nerve palsy.34 Because the presentation is both rare and often nonspecific, diagnosis may be delayed and neoplasms may already be advanced at the time of eventual diagnosis.3 Due to the aggressive nature of many of these tumors, multimodality therapy with surgery and radiation remains the standard of care.Surgical intervention for advanced temporal bone malignancies can be exceedingly challenging due to the complex anatomy of this region, and surgical approaches have been refined over time. Previously, temporal bone malignancies were treated with radical mastoidectomy alone.4 In 1954, Parsons and Lewis detailed a method for en bloc subtotal temporal bone resection which then became the standard of care for temporal bone malignancies.5 Lateral temporal bone resection (LTBR) was later introduced in 1960 by Conley and Novack, and remains the workhorse approach for many temporal bone lesions.6Despite advances in the management of temporal bone malignancies, staging and prognostic predictors for tumors remain elusive. The Pittsburgh Staging Criteria proposed by Arriaga et al7 in 1990 is widely utilized, and has been shown to correlate with prognosis in several retrospective studies,891011 although no significant correlation was observed in others.11 In previous studies, obtaining negative margins as well as lymph node status have been shown to be important predictors of survival.We previously retrospectively evaluated the outcomes of LTBR for malignancy at the Massachusetts Eye & Ear Infirmary (MEEI) from 1990 to 2007, and demonstrated that upfront surgical resection followed by postoperative radiation was an effective management strategy, and the presence of positive margins was a poor prognostic sign. Here, we provide an update to this work by reviewing the outcomes of LTBR at MEEI from 2008 to 2015.