Squamous cell carcinoma of the temporal bone: A current review

Abstract

Objectives: The rarity of temporal bone squamous cell carcinoma (TBSCC) precludes a clear understanding of the disease and approach to its management. This review provides general background on the disease and discusses the current and emerging oncologic and rehabilitative management options.

Data sources: PubMed literature review.

Methods: A review of the current literature was conducted to assess and collate up-to-date information regarding TBSCC management.

Results: TBSCC is a rare and aggressive disease arising in the ear canal, temporal bone, or extratemporal sites. Prior radiation, chronic ear disease, or habitual ear picking may contribute to primary disease development. Because the symptoms of TBSCC and benign otologic disease are similar, TBSCC diagnosis may be delayed, allowing the tumor time to spread throughout the anatomically intricate temporal bone. The extent of the disease is determined based on imaging and is usually staged with the Pittsburgh Staging System. Temporal bone resection with parotidectomy and neck dissection is the current standard of care. Survival is generally good for early disease and poor for advanced disease, but chemotherapy is emerging as a promising treatment option. Auditory rehabilitation with osseointegrated hearing aids is recommended at initial oncologic resection.

Conclusions: The knowledge of and outcomes for TBSCC have improved with time, but because of the aggressive nature of the disease and the anatomic intricacy of the temporal bone, TBSCC treatment is complex and should be delivered by a multidisciplinary team. Inter-institutional collaboration may accelerate research for this rare disease.

Level of evidence: 5.

Keywords: biomarkers; ear canal cancer; osseointegrated hearing aids; squamous cell carcinoma; temporal bone.

Figure 1

This 59‐year‐old woman presented with a one‐year history of left ear blockage. A, Otoendoscopic view of left ear canal shows squamous cell carcinoma completely obstructing the canal. B, Axial computed tomography scan shows the tumor confined to the external ear canal without any bony destruction (arrow). No parotid invasion or cervical lymphadenopathy was present. The tumor was clinically staged in the Pittsburgh staging system as T1N0, but the final pathologic examination showed invasion into the bone of the ear canal. Thus, the patient's tumor was staged as pT2N0, and she received postoperative radiotherapy. At the time this review was written, she had survived 3 years after treatment with no evidence of recurrence

Figure 2

This 82‐year‐old man presented with a 4‐month history of left facial paralysis, hearing loss, otorrhea, hoarseness, and weight loss. A, Otoendoscopic view of the left ear canal shows squamous cell carcinoma involving the middle ear. B, Axial computed tomography scan shows destruction of the posterior temporal bone and obstruction of the sigmoid sinus (arrow). The scan also revealed that the tumor was destroying the bony ear canal (arrowhead). C, Coronal computed tomography scan shows the extent of disease in the upper neck and paraspinous muscles (arrow). The patient was given palliative treatment and died 2 months later