Patient Survival after Temporal Bone Resection for Malignancy

Objective Analyze factors which contributed to overall and disease-free survival in patients who underwent temporal bone resection for malignancy.

Methods We performed a retrospective chart review with patient data collection for all patients who underwent temporal bone resection at the LSU Medical Center, including two hospitals: Our Lady of the Lake Regional Medical Center and University Medical Center; from 2007 to present.

Results A total of 38 temporal bone resections were performed on 36 patients. The most common pathology was squamous cell carcinoma (55.26%), and 52.6% of patients presented with recurrent disease. Average age at the time of resection was 68.8 years and the most common primary tumor site was pre-auricular skin. 34 patients underwent lateral temporal bone resection and 4 patients underwent subtotal temporal bone resection. 76.3% of patients had a neck dissection, 84.2% of patients had a parotidectomy, and 18.4% of patients had a condylectomy. Nine patients had previously been treated with radiation and 20 patients received postoperative adjuvant radiation.

Two-year overall survival (OS) for patients with T2 staging was 37.5%, T3 was 60%, and T4 was 38.5%. When excluding palliative resections, T4 2-year OS was 50%. 2-year disease-free survival (DFS) for T2 staging was 33.3%, T3 was 60%, and T4 was 15.4%. 25 patients (67.6%) had perineural invasion, 19 patients (51.3%) were found to have facial nerve involvement, and 32.4% of patients had nodal disease at presentation. 2-year OS for temporal bone primary was 62.5% and DFS was 50%. For skin primary, 2-year OS was 43.8% and DFS was 27.5%. For parotid primary, 2-year OS and DFS was 0%. Kaplan–Meier graphs were calculated for all variables and multivariate analysis was performed.

All defects were reconstructed. The most common flap used was the anterior lateral thigh free flap (39.4%) followed by the temporalis flap (28.9%). There was one local flap failure, and all free tissue flaps survived. The most common complication was wound infection (13.1%), followed by CSF leak (5.2%).

Conclusion Patient survival after temporal bone resection has improved over the last half century, and can be related to certain positive and negative prognostic factors. Overall survival and disease-free survival rates were comparable to those previously described in the literature. Patients with primaries of nontemporal bone origin tended toward worse overall and disease-free survival rates.

No conflict of interest has been declared by the author(s).