Objective: To introduce the en bloc resection of the external auditory canal. To improve early diagnosis and the effective surgical management of external auditory canal carcinoma.
Method: Twelve cases of the early stage external auditory canal carcinoma were reviewed retrospectively. All cases were undergone surgical treatment by en bloc external auditory canal resection plus lateral temporal bone resection and superficial parotidectomy. All the patients were followed up from 1 to 3 years.
Result: There were 7 males and 5 females, age ranged from 28 to 75 years. According to T stage, there were 4 T1, 8 T2. Eight cases complaint of otalgia or ear pain and 6 cases present with otorrhea. Among 6 otorrhea cases, 3 cases had bloody secretions. Mass with variable sizes in the external auditory canal could be identified by physical examination. Six cases were diagnosed by biopsy preoperatively, another 6 cases were diagnosed by mass resection pathologically. Postoperative pathological diagnosis revealed that 6 cases with adenoid cystic carcinomas, 5 cases of squamous cell carcinomas, 1 case of cerumenal adenocarcinoma. No lesion involved in parotid gland and lymphoid of parotid surface. Safety lateral incision margin was obtained and no lesion penetrated tympanic membrane in all cases. Five cases of squamous cell carcinomas, 1 case of cerumenal adenocarcinoma and 3 cases of adenoid cystic carcinomas received radiotherapy postoperatively. All patients were alive free of carcinoma during the follow-up. Operation side in 6 cases present with incomplete facial paralysis immediately postoperatively and graded III to IV by House-Brackmann Facial Nerve Grading System, which all fully recovered within 1-3 months. All cases showed conductive hearing loss after surgery. The preoperative average hearing threshold was 38dB (500, 1000, 2000 Hz) while postoperative average hearing threshold of all cases was 65 dB (500, 1000, 2000 Hz). One patient had parotid fistula after surgery and recovered by pressure pocketing.
Conclusion: Timely and accurate biopsy is the key point to diagnose the early stage external auditory canal carcinoma. The complete resection with safety margin of external auditory canal carcinoma can improve the effect of surgery.