Optimizing indications and techniques for lateral temporal bone resection in early-stage external auditory canal carcinoma

Abstract

Early-stage external auditory canal carcinomas, classified as T1 and T2 under the modified Pittsburgh classification, are typically managed through lateral temporal bone resection (LTBR). LTBR involves the en bloc removal of both the cartilaginous and bony portions of the external auditory canal, including the tympanic membrane and malleus. This procedure integrates essential middle ear techniques, such as mastoidectomy, access to epitympanic and protympanic spaces, posterior tympanotomy, incudostapedial joint separation, and facial nerve identification. For T1 and T2 cases, LTBR alone can achieve a cure without adjunct radiotherapy or chemotherapy, offering substantial patient benefits when conducted by experienced otological surgeons. Although certain elements can be handled by less experienced surgeons, aspects like managing the mandibular fossa and the deep anterior-inferior ear canal require advanced expertise. Various approaches for defect obliteration post-resection have also been documented. This study discusses the indications and technical recommendations for performing LTBR.