SLEEVE//LATERAL//SUBTOTAL//TOTAL TEMPORAL BONE RESECTION скачать в хорошем качестве

SLEEVE//LATERAL//SUBTOTAL//TOTAL TEMPORAL BONE RESECTION

Today, let’s dive into the intricate world of temporal bone resections. We’ll cover the indications, contraindications, surgical techniques, and staging of squamous cell carcinoma of the external auditory canal. This is a critical topic for understanding how to approach cases requiring lateral, subtotal, or total temporal bone resections. Let’s discuss this step-by-step.” Staging of External Auditory Canal Squamous Cell Carcinoma: “Before we explore the surgical approaches, it’s essential to review the staging of squamous cell carcinoma of the external auditory canal, as it heavily guides the surgical decision-making process. The modified Pittsburgh staging system is the most commonly used: • T1: Tumor limited to the external auditory canal without bony erosion or involvement of the soft tissues. • T2: Tumor with limited bony erosion in the external auditory canal but no involvement of the middle ear or soft tissues. • T3: Tumor eroding the bony external auditory canal with extension into the middle ear or mastoid but without invasion of critical structures like the facial nerve, carotid artery, or dura. • T4: Advanced tumors with invasion into the deep soft tissues, such as the facial nerve, carotid artery, dura, brain, or other critical neurovascular structures. The surgical approach depends on the tumor stage: T1 and T2 are often treated with lateral temporal bone resection, T3 typically requires subtotal temporal bone resection, and T4 may necessitate total temporal bone resection if the tumor remains resectable.” Lateral Temporal Bone Resection: “Now that we’ve covered staging, let’s move to lateral temporal bone resection, which is suitable for T1 and select T2 tumors. This procedure involves removing the external auditory canal while preserving deeper structures like the middle ear, inner ear, and facial nerve. The contraindications for this surgery include disease extension beyond the external auditory canal or involvement of structures requiring a more extensive approach. The technique involves an en bloc removal of the ear canal and soft tissues, ensuring clean surgical margins. Reconstruction is done using soft tissue flaps to maintain the structural integrity and aesthetics of the area.” Subtotal Temporal Bone Resection: “Subtotal temporal bone resection is indicated for T3 tumors with invasion into the middle ear and mastoid. It’s an excellent option for managing tumors that haven’t reached the petrous apex or critical neurovascular structures. Contraindications include unresectable tumors or patient factors like poor general health. The procedure involves removing the external auditory canal, middle ear, mastoid, and sometimes portions of the facial nerve if involved. Reconstruction may require free flaps or vascularized tissue grafts, with possible facial nerve grafting if necessary.” Total Temporal Bone Resection: “For T4 tumors that are resectable, total temporal bone resection is the procedure of choice. These are advanced malignancies that invade critical areas, such as the petrous apex or dura, but have not yet crossed into unresectable territory. The contraindications include extension into areas like the cavernous sinus or brainstem, where surgery would be too high-risk or technically unfeasible. This surgery involves the en bloc removal of the entire temporal bone, including the external auditory canal, middle ear, mastoid, inner ear, and sometimes dura or intracranial components. Reconstruction is complex, requiring free flaps and prosthetics to restore form and function. Collaboration with a multidisciplinary team is essential for this procedure.” Postoperative Considerations: “Regardless of the extent of resection, postoperative care is critical. Patients often experience hearing loss and may face facial nerve dysfunction, particularly with subtotal or total temporal bone resections. Infection prevention and monitoring for complications like cerebrospinal fluid leaks are vital for optimal outcomes.” Closing Discussion: “As we’ve seen, temporal bone resections are intricate surgeries with specific indications based on tumor stage and patient factors. The Pittsburgh staging system is a cornerstone in guiding the surgical plan and ensuring that the extent of resection is tailored to the disease. Now, let’s open up the discussion. How would you manage a borderline T3-T4 tumor that appears resectable on imaging but involves significant soft tissue? Would you attempt subtotal resection with adjuvant therapy, or go straight for total temporal bone resection? Let’s discuss your approach.” #nose #ear #science #throathealth #ent #otolaryngology #nosebleed #biology #tonsils #anatomy