Temporal Bone Malignancies

Primary temporal bone tumors are rare. Suspicious lesions of the ear canal should be biopsied for diagnosis. Surgical resection to achieve negative margins is the mainstay of treatment. Small tumors can be treated with lateral temporal bone resection. Parotidectomy and neck dissection are added for disease extension and proper staging. Higher staged tumors generally require subtotal temporal bone resection or total temporal bone resection. Adjuvant postoperative radiotherapy has shown improved survival for some patients. Chemotherapy has an emerging role for advanced stage disease. Evaluation and management by a multidisciplinary team are the best approach for patients with these tumors.

Key points

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Squamous cell carcinoma accounts for 60% to 80% of the tumors that arise in the ear canal, middle ear, or mastoid cavity.
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Otorrhea, otalgia, and hearing loss are the most common symptoms of temporal bone tumors and can be confused with benign disease.
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Preoperative staging requires computed tomography, magnetic resonance imaging, or both. The University of Pittsburgh staging system is useful for treatment planning and prognostication.
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Lateral temporal bone resection is required to treat most tumors. Auriculectomy, parotidectomy, mandibulectomy, craniotomy, and neck dissection are performed based on staging and location of tumor. Temporalis muscle flap or microvascular free flap are reconstruction options.
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Adjuvant radiotherapy is recommended for temporal bone tumors staged T2 and higher. Adjuvant chemotherapy has an emerging role for T3 and T4 tumors.