 |
TEMPORAL BONE |
|
The temporal bone is the bone that houses the hearing mechanism and separates the ear from the brain. Cancer of this area is particularly rare, and as few as 200 new cases per year are diagnosed in the United States.
Tumors can occur both on the external ear (Pinna), the ear canal, and the deep ear structures (temporal bone). |
 |
|
Most often cancer of the temporal bone is caused by a tumor that has spread from the skin of the pinna (the external part of the ear). This is because the skin of the pinna undergoes years of sun exposure, which can lead to basal cell cancer or squamous call cancer development. Thus, fair skin and genetic predisposition to skin cancer are risk factors. (Also, temporal bone cancer can arise as a metastasis - a tumor that has spread from a cancer elsewhere in the body). Longstanding chronic infection of the skin of the ear canal is also a factor.
Basal Cell Carcinoma is the most common and the least aggressive type of skin cancer. It often appears as a pearly white lesion that grows very slowly. (Fig 2) It can show up as a painless lump on the skin that does not cause any discomfort, at times however it can ulcerate, become painful, and bleed. This tumor has a very slow growth rate and a very low potential for spread to other parts; due to these special characteristics we are able to treat it with a much less radical surgical treatment (meaning the tumor does not need to be removed with a large rim of normal tissue to assure cure). Although it can be treated with radiation therapy, radiation is reserved for more difficult cases that are in locations that are unusually difficult to reconstruct, or in very advanced cases.
Squamous Cell Cancers tend to be more aggressive than basal cell tumors and as such require a larger surgical excision (the tumor needs to be removed with a larger rim of normal tissue as compared to a basal cell cancer). The tumor is more destructive, tends to grow deeper, and has a much higher potential to spread. These tumors need to be treated immediately. At the time of operation, immediate pathologic examination (looking at the tissue under the microscope) of the skin at the periphery of the surgical defect is done to assure there has been no tumor left behind. The depth of the defect is often more. Reconstruction of these defects is often more challenging, and requires expertise. Our team carefully assesses the defect and plans the most appropriate reconstructive surgery. |
On the external ear (Pinna), most often a scaly area of the skin appears that does not seem to resolve with any treatment/moisturization. This is usually the first sign of a skin cancer, followed by development of a mass, which appears as a bump.
Tumors that grow inside the ear canal cause hearing loss, chronic discharge and at times bleeding.
Tumors that extend into the temporal bone cause more severe pain, hearing loss, and vertigo and in advanced cases, Facial paralysis. The diagnosis is made by getting a small sample of the mass for microscopic examination (Biopsy), which is fortunately easily done in this area of the body with little or no discomfort. |
|
|
|
Pinna - Small lesions should be monitored by a physician on a regular basis; if the lesions remain persistent or grows, a biopsy is done. If the biopsy indicates a cancer, then it must be removed. The extent of excision is dependent on the size, location and pathology of the tumor. It may be as simple as a small excision under local anesthesia in the office, to as large as removing a large portion and reconstructing the ear. These reconstructions are often very simple with great outcomes. Diagnosis must be made early and treatment undertaken immediately before spread of tumor.
Ear Canal/Temporal Bone - Again, the size, pathology and location of the tumor dictates the extent of treatment. These tumors are often treated by surgery and at times followed by radiation. Radiation is usually not considered the primary mode of treatment because the bone of the skull cannot be radiated to an adequate degree without causing severe complications. In the postoperative setting, the required dose is much less.
Surgical treatment is divided into three categories; each category is more extensive and treats more advanced tumors. |
 |
The earlier the diagnosis, the less extensive the treatment will be. Larger tumors that require large excisions also require a complex reconstructive effort. If the tumor invades into the cranial cavity/brain the removal is accomplished with a two team approach, involving both head & neck surgeons as well as neurosurgeons.
Close follow up of patients on a regular basis is imperative for a variety of reasons:
1. The treatments are often rigorous and the effects are profound both physically and psychologically; a close relationship between the patient and the head & neck surgeon assures all the early and late side effects of therapy are dealt with appropriately, and some even avoided.
2. Close monitoring and appropriate surveillance allows early detection of a cancer if it recurs, thus allowing us to have an opportunity to successfully treat the tumor, and also detect it early enough so that the treatment may be minimal. |
| |
|
| |
|
|
