Subtotal temporal bone resection

Komune Noritaka, Nakagawa Takashi

doi:10.11289/otoljpn.34.143

<p>Malignant tumors of the temporal bone such as squamous cell carcinoma of the external auditory canal are extremely rare. Reportedly, en bloc resection with negative margins is the most reliable treatment strategy for these lesions. Lateral temporal bone resection (LTBR) and subtotal temporal bone resection (STBR) represent en bloc resection methods for malignant tumors of the external auditory canal. Retrospective single-center observational studies have reported that treatment results tend to be better at facilities that perform en bloc resection. However, owing to technical difficulties associated with the surgical techniques, studies recommend piecemeal tumor resection in patients who require treatment beyond classical/conventional LTBR (cLTBR). En bloc resection facilitates objective evaluation of histologically negative margins, whereas the surgeon’s subjective judgment is highly likely to affect margin evaluation in cases of piecemeal resection, and definitive histopathological evaluation of postoperative resection margins becomes difficult. Several studies have reported that tumor control using postoperative adjuvant therapy is challenging in patients with positive resection margins. However, appropriate additional postoperative adjuvant therapy is essential to prevent recurrence in patients with positive resection margins. Histopathological evaluation of resection margins is important for prompt treatment decision-making regarding additional postoperative chemo(radio)therapy. From this perspective, en bloc resection without exposure of the malignant tumor is a preferred therapeutic option.</p><p>Various osteotomy lines are used based on tumor extension; therefore, methods of en bloc resection of the temporal bone are not merely categorized into LTBR and STBR but can be classified as follows: (a) cLTBR, (b) extended LTBR, (c) modified STBR, and (d) cSTBR. En bloc resection of the temporomandibular joint is a challenging surgical procedure; therefore, cSTBR and concomitant en bloc resection of the temporomandibular joint represents one of the most technically demanding procedures in temporal bone surgery. Although some information on cSTBR is available in textbooks and articles, it is unclear whether all surgical techniques for STBR are clearly described. In this report, we outline cSTBR performed at our hospital.</p>

Subtotal temporal bone resection

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