No abstract

A review of all publications dealing with surgical treatment for squamous cell carcinomas of the temporal bone was performed. No randomized or nonrandomized control studies were identified. All studies were case series without control subjects. Twenty-six of 96 publications, which contained information on 144 patients, were analyzed. Several inferences are suggested by the available evidence; however, these areas should be investigated by properly designed randomized clinical trials: (1) patients with carcinoma that is confined to the external auditory canal have similar survival, regardless of whether mastoidectomy, lateral temporal bone resection (TBR), or subtotal TBR is performed: the addition of radiation therapy to lateral TBR does not appear to improve survival; (2) when disease extends into the middle ear, survival of patients treated with subtotal TBR appeared to be improved over those treated with lateral TBR or mastoidectomy: it remains uncertain if the addition of radiation therapy to mastoidectomy improves survival; (3) the value of surgical resection when carcinoma extends to involve the petrous apex remains unclear; (4) resection of involved dura mater does not appear to improve survival; however, incomplete data regarding margins of resection were reported; and (5) determination of the value of resection of involved brain parenchyma or internal carotid artery will require further study.

Eighty percent of all asymptomatic parotid masses are benign neoplasms. Pleomorphic adenoma, Warthin's tumor, oncocytoma, monomorphic adenoma, and the benign lymphoepitheliallesion are the most common tumors. Sebaceous adenoma, sebaceous lymphadenoma, and the papillary ductal adenoma are encountered infrequently. A facial nerve neurilemmoma manifesting as a parotid mass is a rare occurrence. CASE REPORTA 39-year-old man manifested a 6-month history of a painless mass in the region of the right parotid that he stated fluctuated in size throughout the day. There was no history of facial weakness and the physical examination revealed a 1 x 2 em firm mass in the tail of the parotid gland. Facial nerve function was normal. A computed tomography scan, performed at the referring institution, confirmed a 2 cm mass in the tail of the parotid gland (Fig. 1). Fine-needle aspiration biopsy was not performed.A superficial parotidectomy with facial nerve dissection was planned. After the skin flaps were raised and the usual landmarks were identified, it was apparent that the mass was deep to the main trunk of the facial nerve. On closer examination, fascicles of the facial nerve could be seen splayed out over the lateral surface ofthe mass. Proximally the lesion extended into the temporal bone, and distally 1 em of normal facial nerve trunk was seen. A mastoidectomy revealed fusiform swelling of the facial nerve from the distal vertical segment to the stylomastoid foramen (Fig. 2). The lesion was resected with the facial nerve and the frozen section revealed a neurilemmoma. The margins were clear and a graft using the greater auricular nerve was placed in the fallopian canal. 8-0 nylon suture was used for the distal anastomosis. The next day a gold weight From the Departments of Otolaryngology (Drs. Prasad, Myers, and Kamerer) and Pathology (Dr.

Revision stapedectomy operations performed over a 13-year period (1977 to 1990) for a conductive hearing loss are reviewed in terms of intraoperative findings and hearing results. All operations were performed in a conventional manner without use of laser techniques. A management algorithm based on intraoperative findings is described. Results are compared with previously reported series. The 66 cases include 20 males and 46 females, ranging in age from 8 to 73 years. Mean time between original and revision stapedectomy was 12.5 years. Prostheses encountered at time of revision included wireloop (29), Robinson (18), polyethylene (14), other (3), and two were not found. The most common cause of failure was displacement of the prosthesis. Incus erosion was found in 48% of wireloops, 35% of polyethylene, and only 11% of the Robinson prostheses. Revision resulted in closure of the pure-tone average (PTA) air-bone gap to within 10 dB in 46% and to within 15 dB in 76%. Sensorineural hearing loss (> 10 dB) occurred in 5 cases (7.6%), and a decline in speech discrimination (> 10%) occurred in 17%. Three of four cases requiring drillout had gap closure to within 10 dB. Findings suggest that our management technique produces results comparable to other large reported series. Drillout at the time of revision can be recommended.