Prosthetic rehabilitation after cancer resection in the head and neck.
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Denture Design↗
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Ear reconstruction.
The ear is one of the most difficult areas to reconstruct. Experience with and knowledge of various methods are tantamount to a successful outcome.
Ear Neoplasms↗
Micrographic surgery for the microscopically controlled excision of carcinoma of the external ear.
Micrographic surgery is particularly valuable for treating carcinomas of the external ear because the total microscopic control of excision afforded by this method permits selective removal of the clinically unpredictable cancerous outgrowths. The maximum conservation of normal tissues, including the cartilaginous framework that gives shape to the ear, is a benefit next in importance to the unusually high 5-year cure rates (97.1% in a series of 1213 cases of basal cell carcinoma and 92.3% in a series of 871 cases of squamous cell carcinoma). The fresh-tissue technique for removing most auricular carcinomas usually permits the excision of the successive layers in 1 day, and repair, if needed, can be done immediately. The fixed-tissue technique is still used by the authors for some extensive, bone-invading carcinomas.
Basal Cell Carcinoma↗
Carcinoma of the external auditory canal and middle ear.
PURPOSE: To evaluate therapeutic modalities used at our institutions regarding local control, disease-free survival and actuarial survival in carcinoma of the external auditory canal and middle ear, in an attempt to provide guidelines for therapy. METHODS AND MATERIALS: A series of 27 patients with carcinoma of the external auditory canal and middle ear treated between 1978 and 1997 in our institutions were analyzed with particular reference to tumor size and its relation to surrounding tissues, patterns of neck node involvement, surgical procedures, and radiation techniques employed. Clinical endpoints were freedom from local failure, overall survival, and disease-free survival. The median follow-up was 2.7 years (range 0.1-17.9 years). RESULTS: Treatment by surgery and radiotherapy resulted in an overall 5-year survival rate of 61%. According to the Pittsburgh classification, the actuarial 5-year survival rate for early disease (T1 and T2 tumors) was 86%, for T3 tumors 50%, and T4 stages 41%. Patients with tumors limited to the external auditory canal had a 5-year survival rate of 100%, patients with tumor invasion of the temporal bone 63%, and patients with tumor infiltration beyond the temporal bone 38%. The rate of freedom from local recurrence was 50% at 5 years. Unresectability by dural and cerebral infiltration, and treatment factors such as complete resection or resection with tumor beyond surgical margins are of prognostic relevance. All patients with dural invasion died within 2.2 years. The actuarial 5-year survival rate of patients with complete tumor resection was 100%, but 66% in patients with tumor beyond surgical margins. 192Iridium high-dose-rate (HDR) afterloading brachytherapy based on three-dimensional computed tomography (3D CT)-treatment planning was an effective tool in management of local recurrences following surgery and a full course of external beam radiotherapy. CONCLUSION: Surgical resection followed by radiotherapy adapted to stage of disease and grade of resection is the preferred treatment of cancer of the external auditory canal and middle ear.
Adult↗
Merkel-cell carcinoma of the pinna.
Merkel-Cell carcinoma is a rare malignant skin tumour. It was first described as 'Trabecular Carcinoma' by Toker in 1972. Since then many reports have appeared in the literature, mainly in the dermatology, pathology and to a lesser extent, in the plastic surgery journals. Surprisingly, the topic is rarely discussed in the otolaryngology literature, though nearly fifty per cent of these tumours arise in the head and neck.
Adenocarcinoma↗
Auro-nasopharyngeal polyp and cholesteatoma.
We report the association of an auronasopharyngeal polyp arising in a congenitally abnormal middle ear and Eustachian tube. Subsequently, ten years after removal of the polyp and insertion of a ventilation tube, there was recurrence of the polyp in association with cholesteatoma of the middle ear.
Adult↗
Glomus tympanicum chemodectoma: unusual radiological findings.
A 64-year-old Qatari female, with a one-year history of right otorrhoea and deafness, had a reddish-white mass projecting into the right ear canal, through the tympanic membrane, that proved histopathologically to be a paraganglioma. Computerized tomography (CT) of the temporal bones showed extensive destruction of the right mastoid bone, the posterior ear canal wall, and the sinus plate, with total disruption of the ossicles, simulating a malignant tumour, which is unusual for a middle ear paraganglioma.
Ear Neoplasms↗
Rapidly invading sebaceous carcinoma of the external auditory canal.
A very rare case of a sebaceous carcinoma of the external auditory canal with basal cell differentiation is presented. Fewer than 400 cases affecting any part of the body have so far been reported and of that only seven cases have been known to involve the external auditory canal. The clinical features, pathology and treatment are described and the relevant literature has been reviewed.
Adenocarcinoma, Sebaceous↗
Pseudovascular squamous cell carcinoma of the skin.
The presence of acantholysis in squamous cell carcinomas (SCC) may rarely be so extreme that, histologically, it mimics a vascular tumour. However, careful histological examination and immunohistochemical study usually lead to the correct diagnosis. We describe such a case to highlight the clinico-pathological features of this rare form of cutaneous malignancy and to emphasize the difficulties in establishing the correct diagnosis. We also review similar cases reported in the literature. Pseudovascular SCC shows a higher degree of recurrence and metastasis than other variants of SCC. Acantholytic foci in these tumours may demonstrate changes in keratinocyte differentiation markers, and this may explain the more aggresive biological behaviour in the pseudovascular variant of SCC.
Acantholysis↗
[99mTc marking of gel foam for catheter embolisation (author's transl)].
A simple method is described for marking gel foam particles with 99mTc after reduction of the pertechnetate. This is carried out in the Luer lock syringe to be used for the injection. After embolisation and control angiography, the patient is placed under a scintillation camera. The position of the embolising material can then be demonstrated scintigraphically. In six patients marked emboli were found to be correctly placed. In another patient undergoing a second embolisation for a renal tumour, particles were found in the peripheral circulation.
Angiography↗
[Histopathological studies of intratemporal growth behavior of middle ear carcinoma].
BACKGROUND: Otological hemorrhage otorrhea, and pain are amongst the first clinical signs of the middle ear carcinoma, which is usually diagnosed in advanced stages. Sudden deafness, facial nerve paralysis, and other symptoms of inner ear damage may be observed in the final stage. However, middle ear carcinoma is diagnosed extremely seldom in its early stages. The clinical management of this pathology is based on the knowledge of the tumor's pathways and its anatomic behavior. METHODS: Our study investigated 20 cases of middle ear carcinomas from the Wittmaack temporal bone bank (14 squamous cell carcinomas, 5 adenocarcinomas, and 1 adenoidcystic carcinoma) to analyze the behavior of the tumor growth and its influence on clinical symptoms. The aim was to determine criteria for early clinical diagnosis. RESULTS: The tumor arises in different regions of the temporal bone, and varying symptoms will subsequently reflect its pathway. When the tumor is confined to the middle ear area, its main location is the hypotympanum from which tumor spreads into the eustachian tube and, via infiltration of the adjacent bone structures (anterior wall of the middle ear), into the tensor tympani muscle and the sympathetic plexus of the internal carotid artery. Destruction of the ossicles was observed in the mid-tympanic cavity, and often only a thin layer of fibrous tissue from the Fallopian canal separated the tumor from the facial nerve (this nerve was rarely affected directly). The medial wall (labyrinthine wall) of the tympanic cavity remained intact in the majority of examined cases. The tympanic sinus, the round window niche, and the oval window niche did not show tumor infiltration. In the epitympanum, the tumor grew and infiltrated the adjacent mastoid. Larger tumors affected the internal auditory canal and infiltrated the acoustic nerve and the labyrinth. CONCLUSION: Improving the poor prognosis of middle ear carcinoma requires early diagnosis based on axial computed tomography (CT). Important factors in patient selection include age (50-70 years), sex (mostly women), and especially clinical symptoms (otorrhea, pain, hearing loss).
Adenocarcinoma↗
[Carcinoma of the external auditory canal and middle ear: therapeutic strategy and follow up].
BACKGROUND: Carcinomas of the external auditory canal (EAC) and the middle ear are rare and considered to have a poor prognosis. The recommended therapeutic strategy consists of surgical excision and postoperative radiotherapy. However, there are different opinions about the extend of the primary operation. PATIENTS AND METHODS: A series of 21 patients with carcinoma of the EAC and middle ear were treated at the ENT-Department of the Hospital Fulda from 1985 to 2003. Their records and radiologic findings were reviewed retrospectively with particular reference to tumor type and size, its relation to surrounding tissues, surgical procedures and radiation techniques. The tumors were staged according to the modified Pittburgh staging system for temporal bone carcinomas. The average follow-up time was 6.2 years (range 0.2 - 18.75). RESULTS: 17 patients suffered from carcinoma of the EAC, 4 carcinomas were primarily located in the middle ear. There were 15 squamous cell carcinomas, 3 adenoidcystic carcinomas, 2 adenocarcinomas and one mucoepidermoid carcinoma. 12 patients came primarily to our institution and were staged as follows: pT1 (n = 2), pT3 (n = 2), pT4 (n = 8). 8 patients showed up with recurrent or residual tumors (all of T3 or T4 stage). One patient could not be classified. In 5 cases the tumor was inoperable. These patients underwent combined chemoradiation therapy. All other 16 patients were operated and most of them received adjuvant radiation therapy. In the group of patients who were primarily operated overall 5-year survival rate was 100 %. In contrast, patients who's recurrent or residual tumors were resected had a 5-year survival rate of only 33 %. Patients who received combined chemoradiation therapy showed a 2-year survival rate of 75 %. CONCLUSION: Carcinoma of the EAC and middle ear should be treated primarily by a lateral or subtotal temporal bone resection stage dependent combined with a parotidectomy as well as a neck dissection. Local resection of the EAC is not sufficient, not even in T1 tumors. As from stage T2, in cases of recurrent tumor removal and questionable free margins as well as in cases with lymph node metastases an adjuvant radiation therapy should be added. The most important survival factor is removal of the primary tumor with histologically clear margins.
Adenocarcinoma↗
[Implantation metastasis of adenocarcinoma of the paranasal sinuses in the middle ear].
Carcinoma of the middle ear is a rare disease. We report about a 65-year-old man in which case it is assumed that a transtubal implantation metastasis of an adenocarcinoma had settled in the middle ear. Regular irrigation of the operated nose and unnoticed carcinoma recurrence were main assumptions for intracanicular metastasis. With experiments on dead and alive we could show that irrigation fluid intrudes through the tube into the middle ear. Finally the problem of growth of carcinoma cells on intact epithelial surfaces is critically discussed.
Adenocarcinoma↗
A radiation-shielding device for craniofacial implant placement.
The use of radiation shields in the head and neck cancer patient receiving adjuvant radiation therapy is a treatment alternative for protecting anticipated prosthetic implant sites. Shields can be fabricated easily as part of an interdisciplinary treatment protocol. In this article, the methods used to fabricate an extraoral radiation shield are described, and a patient treatment that illustrates possible uses of the shield for both extraoral and intraoral sites is presented.
Aged↗
Primary extracranial meningioma in the vicinity of the temporal bone: a benign lesion which is rarely recognized clinically.
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Diagnosis, Differential↗
Malignant tumors of the external ear.
Although only a few of the malignant tumors of the skin develop in the external ear, they are more frequent than one would expect. These tumors recur and develop metastases more often than tumors in other sites. Because of this and because of surrounding vital structures, these tumors have a poor prognosis. Surgical therapy, that is, wide excision, is better than radiotherapy. Many methods for reconstruction of the external ear have been published, and sometimes plastic protheses are acceptable. From 1982 to 1986, 17 patients with malignant tumors of the external ear were treated in our center. There were 15 men and 2 women. The mean age was 73 years. There were 4 basal cell and 12 squamous cell carcinomas, and 1 patient had malignant melanoma of the external ear. Nine of these tumors were on the helix. During the follow-up period, 6 patients had local recurrent disease. In 7 patients, reexcision had to be performed several times after incomplete excision. Six patients are alive without any sign of the disease, and 3 patients died.
Adult↗
Squamous cell carcinoma of the auricle arising from keloid after radium needle therapy.
The squamous cell carcinoma (SCC) of the auricle was one of the common tumors of not only skin but also ear. SCC of the auricle was described to be the carcinoma of old age with some predisposing factors and keloid was known to be one of the predisposing factors for malignant tumors. Keloid and radium needle therapy were risk factors, latter the major, independently from each other and were reported to conclude in SCC depending on the duration for the keloid and the dose for the radium needle therapy. The increased age with the long duration of these predisposing factors should have to be kept in mind in every situation when these treatment modalities had been planned to. Surgical interventions should always be the first choice in the treatment of not only the carcinomas but also in keloids in selected cases.
Aged, 80 and over↗
Basal cell carcinoma of the external auditory meatus.
Five of a personal series of 47 patients with carcinoma of the middle and external ear had basal cell carcinoma. Two patients had extensive disease, one having petrosectomy and the other refusing. All treated patients did well.
Adult↗