[Diagnosis and treatment on osteoradionecrosis of temporal bone in cases with nasopharyngeal carcinoma after radiotherapy].
OBJECTIVE
To discuss the diagnosis and treatment on osteoradionecrosis of temporal bone in case with nasopharyngeal carcinoma (NPC) after radiotherapy.


METHODS
The clinical data of 21 cases (22 ears) diagnosed as osteoradionecrosis of temporal bone with NPC were studied, including 17 ears of localized type and 5 ears of diffuse type. Minimally surgical debridement with otoscope was performed on 17 ears of localized type and 1 ear of diffuse type. Four ears of diffuse type underwent the modified radical mastoidectomy and obliteration with vascularized fascia flaps.


RESULTS
The common clinical features were foul-smelling otorrhea and otalgia. Otoscopy revealed the exposed bone and bony sequestration in the external auditory canal with impacted keratotic debris, granulation tissue and cholesteatoma accumulation. It was with erosion or/and orifice to the mastoid. CT scan demonstrated the presentations: osteomyelitis, bone destruction as the islet-appearance and soft tissue mass. Among the 17 ears of localized type, 12 ears (70.6%) showed complete epithelization of the raw surface, 4 ears (23.5%) not fully epithelized were followed up without sequestration, and 1 ear (5.9%) was developing progressively. As for the 5 ears of diffuse type, 1 ear received the minimally surgical debridement and another 3 ears treated with mastoidectomy and obliteration were healed. Only 1 ear needed secondary surgery because of re-sequestration.


CONCLUSIONS
Both otoscopy and CT scan can offer the diagnostic value with different characteristics. The minimally surgical debridement of the sequestration by otoscopy can obtain good effects on localized type. It should be careful to select the surgery recipient on the diffuse type, and mastoid obliteration with vascularized flaps from regional tissue may be warranted after mastoidectomy. Regular follow up is needed because of possibility of the progressive development of the disease.
Ou
Yongkang
Y
Department of Otolaryngology, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China.
Zheng
Yiqing
Y
Chen
Suijun
S
Liu
Xiang
X
Xu
Yaodong
Y
Huang
Xiaoming
X
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013701:Temporal Bone / Q000473:pathology*