J Neurol Surg B Skull Base 2014; 75 - A140
DOI: 10.1055/s-0034-1370546

External Auditory Canal and Temporal Bone Carcinoma with Parotid Gland and Facial Nerve Involvement

Samuel A. Spear 1, Rahul Mehta 1, Yu-Lan Mary Ying 1, Daniel W. Nuss 1, Moises A. Arriaga 1
  • 1Geismar, USA

Background: Surgical treatment of carcinoma of the external auditory canal (EAC) and temporal bone involves a lateral temporal bone resection (LTBR) or more extensive sub-total or total temporal bone resection with some degree of parotidectomy or parotid margins. Involvement of the parotid gland or parotid nodes results in a higher pathologic staging and likely worse outcomes. In this study, we review all temporal bone carcinoma specimens at our institution over the past three years for parotid gland or parotid node involvement.

Methods: All cases of external auditory canal (EAC) and temporal bone carcinomas who received surgical management over the past three years at our institution were retrospectively reviewed. Data on patient demographics, clinical staging, type and location of primary cancer, involvement of the parotid gland and parotid nodes, outcomes of surgery and post-operative complications were collected and recorded.

Results: 11 patients underwent LTBR for carcinoma of the EAC or temporal bone for squamous cell carcinoma except for one patient with adenoid cystic carcinoma of the EAC and one patient with salivary duct carcinoma. Of these cases, 100% underwent parotid margin sampling, 4 out of 11 received superficial parotidectomy and the remaining 7 also included the deep lobe of the parotid. 2 patients were stage T2 according to the modified Pittsburgh tumor staging of EAC carcinoma and 3 of 11 patients were stage t3, while the remaining 6 patients were T4. Parotid involvement was found in 6/11 patients and facial nerve involvement was found in 4/11 patients. 3/11 patients also had positive lymph node involvement.

Conclusion: Temporal bone resection with parotidectomy or sampling of the parotid margin is necessary to rule out parotid gland or parotid node involvement which would result in higher pathologic staging and potentially worse outcomes without adjuvant therapy. In cases of perineural invasion, facial nerve involvement is also a poorer prognosis.