Mediterr J Otol 2005:1(1):24-30.

Results of Surgery for Carcinoma Affecting Temporal Bone

Stankovic M.
ORL Clinic, Medical Faculty Nis,  Serbia. milan.orl@bankerinter.net

OBJECTIVES: The aim of this study was to analyze the clinical characteristics and surgical results of a series of patients who underwent surgery for primary or secondary temporal bone tumors.

PATIENTS AND METHODS: Twenty patients underwent surgical treatment for malignant tumors of the external auditory canal and the middle ear. There were 16 males and four females, with a mean age of 66 years (range 37 to 79 years). Eight patients had primary, 12 patients had secondary temporal bone tumors. Primary tumors involved the middle ear or the ear canal, while secondary tumors originated from the auricle, its neighborhood, or the parotid gland. Computed tomography was used to assess the extent of involvement. Tumor staging was made according to the system proposed by Arriaga et al. Partial (n=7) or total (n=2) temporal bone resections, or a subtotal resection (petrosectomy) (n=11) were performed. All the patients received postoperative irradiation at a total dose of 6,000 cGy in 30 fractions for six weeks. Clinical characteristics, types of operations, and survival were analyzed. Statistical analysis was made using the chi-square test.

RESULTS: Otalgia, otorrhea or bloody otorrhea were the main complaints. Primary tumors were at an advanced stage in most of the patients, with destruction of the surrounding bone in four, involvement of the endocranium in two, paralysis of the facial nerve in five, and total hearing loss in seven patients. The diagnosis was established before surgery in four patients. Surgery was planned for suspected chronic otitis in four patients. Histopathologic diagnosis of primary tumors was squamous cell carcinoma in all the cases. Significant differences
were found between primary and secondary temporal bone tumors with respect to symptoms and the type of operation (p<0.05). The overall five-year survival rates were 37.5% (3/8) and 58.3% (7/12) for primary and secondary temporal bone malignancies, respectively. Patients with free margins had a significantly better survival (9/11, 81.8%) than those with positive margins (1/9, 11.1%) (p<0.05). Patients with lymph node involvement had a very poor survival (19%). Local recurrence was the cause of death in all the cases with a mean of 4.1 months from recurrence to death. The extent of surgery did not have any significant influence on the survival (p>0.05).

CONCLUSION: The prognosis of carcinomas involving the temporal bone is directly related to the extent of tumoral propagation. Early diagnosis, appropriate selection of patients and the surgical technique, together with reconstruction, and postoperative radiotherapy may enable an improved survival and quality of life.