How Well Are Surgeons Doing?
A study presented at the recent meeting of the Triological Society showed that lateral temporal bone resections were effective for malignant tumors of the parotid gland, periauricular area, and the skin. The study was presented by Hung H. Dang, MD, a resident at the University of Oklahoma Health Sciences Center in Oklahoma City, OK.
“This type of surgery provides reasonable locoregional control and survival, and can be done with minimal morbidity to the patient,” stated Jesus Medina, MD, Professor and Chairman of the Department of Otolaryngology at the University of Oklahoma in Oklahoma City, and senior author of the study. Dr. Medina emphasized that good results are dependent on close collaboration between head and neck oncologic surgeons and otologists.
The retrospective study focused on 52 patients with malignant tumors adjacent to or invading the temporal bone who were treated with lateral temporal bone resection. The study included 43 males and nine females ranging from 30 to 91 years of age. Fifty percent of tumors were squamous cell, 25% were basal cell, and 23.1% were parotid carcinomas. There was one melanoma and one metastatic nasopharyngeal carcinoma.
In an interview, Dr. Medina said that these patients were treated with either subtotal resection to remove all of the temporal bone up to the internal carotid artery, or one of four variations of lateral temporal bone resections (Type I–IV). He noted that “total” is a misnomer, because not all of the temporal bone is removed with these procedures.
“We have been doing these procedures for quite some time at our institution. More often than not, tumors are attached to the temporal bone and may invade the mastoid. We found that we didn’t need to remove most of the bone, but could just remove areas of the bone adjacent to or actually invaded by tumor. The extent of surgery depends on involvement of the tumor,” Dr. Medina said.
Dr. Medina noted that results of the study should be viewed in the context of the patient population, which included mainly patients with advanced tumors. Sixty-nine percent of patients had previous treatment, including radiotherapy, and 28% already had facial paralysis when they underwent lateral temporal bone resection.
Local control was possible in 100% of 13 patients with basal cell carcinoma. Overall disease-free survival at two years was 46% for those with squamous cell carcinoma, 67% for basal carcinoma, and 50% for parotid carcinoma. At the last follow-up, 29 patients were alive and disease-free.