Surgical Procedures for External Auditory Canal Carcinoma and the Preservation of Postoperative Hearing

Abstract

Carcinoma of the external auditory canal (EAC) is an unusual head and neck malignancy. The pathophysiology of these tumors is different from other skin lesions because of their anatomical and functional characteristics. Early-stage carcinoma of the EAC can be generally cured by surgical treatment, and reconstruction of the EAC with a tympanoplasty can help to retain hearing, thus improving the patients' quality of life. In this study, we present two cases of early-stage carcinoma of the EAC treated by canal reconstruction using skin grafts after lateral temporal bone resection. A rolled-up skin graft with a temporal muscle flap was useful for keeping the form and maintaining the postoperative hearing. An adequate size of the skin graft and blood supply to the graft bed are important for achieving a successful operation.

Head and Neck Cancer Patients’ Quality of Life

“…Hearing loss in adults is related to HNC and different operative techniques can be used. Hoshikawa et al used a rolled--up skin graft with temporal muscle flap to maintain hearing [52].…”

Hearing Preservation after Lateral Temporal Bone Resection for Early-Stage External Auditory Canal Carcinoma

“…As early-stage carcinoma of the EAC can be generally cured by LTBR without postoperative radiotherapy, preservation of hearing ability and improvement in the QOL should be considered in selecting the treatment process [Hoshikawa et al, 2012;Iida et al, 2013;Koshima et al, 2004;Zhang et al, 2013]. In the absence of tumor invasion of the middle ear, it is possible to carefully separate the incus from the incudostapedial joint and preserve the stapes.…”

“…Reconstruction of the EAC involves various techniques such as the creation of local-pedicled flaps, free flaps and skin grafts [Bell, 1988;Hoshikawa et al, 2012;Iida et al, 2013;Koshima et al, 2004]. As local flaps are limited in terms of size and mobility, it is difficult to reconstruct the entire EAC and cover a circumferential defect with a single local flap, necessitating dual local flaps or the concomitant use of skin grafting [Bell, 1988].…”

“…Considering the good survival rates for early-stage EAC carcinoma, reconstruction of the EAC with tympanoplasty after tumor resection has been performed to preserve hearing ability and improve patient quality of life (QOL) [Hoshikawa et al, 2012;Iida et al, 2013;Koshima et al, 2004;Zhang et al, 2013]. However, conductive hearing loss may worsen after lateral temporal bone resection (LTBR) due to postoperative complications such as chronic infection, bone exposure, stenosis and closure of the EAC [Iida et al, 2013;Zhang et al, 2013].…”

“…However, conductive hearing loss may worsen after lateral temporal bone resection (LTBR) due to postoperative complications such as chronic infection, bone exposure, stenosis and closure of the EAC [Iida et al, 2013;Zhang et al, 2013]. To prevent these adverse events, several methods, such as the use of a local flap, free flap or skin graft, have been reported [Bell, 1988;Hoshikawa et al, 2012;Iida et al, 2013;Koshima et al, 2004]. Meanwhile, the details of postoperative hearing ability for patients with EAC carcinoma have not been well described in the literature.…”