Reconstructive options after temporal bone resection for squamous cell carcinoma.
Squamous cell carcinoma (SCC) of the temporal bone is a rare, aggressive and highly malignant tumour that requires specialised, multidisciplinary surgery for its treatment. Reconstruction of the defect is as crucial as the tumour ablation in terms of mortality and postoperative morbidity.


METHODS
The experience of the East Anglian Skull Base Surgery Service from 1982 to 2004 in managing 42 consecutive patients (22 females; age range 37-80 years) undergoing extended and lateral temporal bone resection for SCC is presented.


RESULTS
The overall 5-year survival was 31.0% (median follow up: 97 months) when both curative and palliative procedures were included. On multivariate analysis, the favourable prognostic factors were male sex, well-differentiated tumours and stage N(0) neck. The reconstructions in 38 patients were analysed. The majority (24/38) had free tissue transfer reconstructions and most of these were radial forearm free flaps. Later in the series, other free flap types such as anterolateral thigh flaps and lateral arm flaps were employed. Pedicled myocutaneous flaps and local flaps were also used.


CONCLUSIONS
This paper analyses the outcomes of the various reconstructions and discusses the evolution of their care in our unit. The information obtained from the review of our data is extrapolated to offer guidance on the choice of reconstructive option in these patients.
Moncrieff
Marc D
MD
Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK. marc@moncrieff.net
Hamilton
Stuart A
SA
Lamberty
George H
GH
Malata
Charles M
CM
Hardy
David G
DG
Macfarlane
Robert
R
Moffat
David A
DA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002454:Cell Differentiation; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012737:Sex Factors; D013524:Surgical Flaps; D016019:Survival Analysis; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome