Unusual spread of sinonasal carcinoma via the eustachian tube into the middle and external ear.
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Management of melanoma of the external ear is controversial. Thirty-one patients treated for this disease were identified at our institution between January 1, 1974 and December 31, 1989. Follow-up was an average of 7.12 years (range 1-15). Local therapy performed included 16 wedge resections, 3 split thickness skin grafts after excision to the perichondrium, 10 partial and 2 total amputations. There were two local recurrences, four metachronous cervical metastases, and four distant metastases. Three elective and five therapeutic neck dissections were performed. Survivors at 1, 5, and 10 years were 93, 77, and 47%, respectively. There was no relationship between DNA ploidy, local surgical therapy, and eventual recurrence. Clinical stage and tumor thickness demonstrated a statistically significant correlation with likelihood of recurrence (P = .02 and .05). There is no evidence that melanoma of the ear has a poorer prognosis or different prognostic factors than melanoma at other cutaneous sites. In selected cases, local disease can be controlled by excision and skin graft rather than the more aggressive current procedures.
One minor anomaly of the external ear is a "third crus", which is an addition to the normal upper and lower crura at the anterior end of the anthelix. Another minor deformity is an extension of the crus of the helix, wherein it runs as a crest across the concha. An operation to correct the latter deformity is described.
Cholesteatoma arising in the external ear canal is uncommon. A variety of etiologic factors have been attributed to the development of cholesteatoma in the external ear canal. The various disease processes that cause excessive desquamation and cholesteatoma formation are reviewed and their management is presented.
The sensory supply of the middle and external ear is complicated by multiple neural communications. The anatomy of these communications and their clinical significance will be described in this paper.
External ear manifestations of sarcoidosis are rare. We review six cases in the literature and also report a case. The otolaryngologist plays an important role in making the diagnosis because of the ease of biopsy in all cases of sarcoidosis of the external ear.