LATERAL TEMPORAL BONE RESECTION FOR EXTENSIVE PINNAL MALIGNANCY - HASANYTHING CHANGED IN 40 YEARS

This paper offers an account of the contemporary surgical approach to advanced tumours of the external ear based on a series of 11 patients. There were eight squamous, two basal cell carcinomas and one mucoepid ermoid tumour. The traditional method of excision was slightly modifie d by performing microsurgical dissection of the lateral part of the te mporal bone rather than chisel osteotomies, and the a including it en bloc with the involved soft tissues. The defect was then closed using a scalp or myocutaneous flap and this combination of otological and re constructive expertise has proved satisfactory. Four patients are aliv e with no evidence of disease a mean of 4.2 (range 1.0-7.0) years from surgery: two patients who remained free of disease have subsequently died of unrelated conditions 12 and 24 months post-operatively, and in three cases death from recurrent disease occurred a mean of 1.4 (rang e 0.9-2.1) years after our surgery. There were two post-operative deat hs. Based on the actuarial survival of 36 per cent and a successful di sease clearance rate of 54 per cent, our conclusion is that the outloo k of this condition has not dramatically improved since the original d escriptions of the management of this problem first appeared, although intervention remains justifiable because of the potential curability and relief of symptoms.