Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana 70112, USA.
Otol Neurotol. 2012 Feb;33(2):239-43. doi: 10.1097/MAO.0b013e3182423191.
To present a case of mucosal melanoma of the Eustachian tube with a focus on surgical technique and to review the literature on treatment of mucosal melanoma of the head and neck, and review cases involving the middle ear and/or Eustachian tube.
A 67-year-old man was diagnosed with mucosal melanoma of the middle ear and Eustachian tube.
The patient underwent primary surgical resection including transtemporal/transpetrosal approach, endoscopic nasopharyngectomy, infratemporal fossa dissection, temporomandibular joint resection, ipsilateral neck dissection (levels II-IV), and superficial parotidectomy.
The patient was discharged on postoperative Day 7 with a very good functional status. He did have early dysphagia and dysarthria as a result of the VII to XII anastomosis for facial nerve reconstruction, which did require PEG tube placement. However, at 4 months after surgery, the patient was eating solid foods and returning to normal activities. He received radiation therapy postoperatively. There has been no evidence of tumor recurrence at 8 months after treatment.
The standard treatment of head and neck mucosal melanoma is primarily surgical. Surgical removal of mucosal melanoma in the Eustachian tube/middle ear can present challenges in achieving microscopically negative margins. However, gross tumor resection with postoperative radiotherapy has been shown to improve locoregional control.
报告 1 例咽鼓管黏膜黑色素瘤病例，重点介绍手术技术，并复习头颈部黏膜黑色素瘤的治疗文献，以及涉及中耳和/或咽鼓管的病例。
一名 67 岁男性，被诊断为中耳和咽鼓管黏膜黑色素瘤。
患者接受了包括颞骨/岩骨入路、内镜经鼻咽切除术、颞下窝解剖、颞颌关节切除术、同侧颈清扫术（II-IV 级）和腮腺浅叶切除术在内的原发性手术切除。
患者术后第 7 天出院，功能状态良好。他确实存在因面神经重建的 VII 至 XII 吻合术导致的早期吞咽困难和构音障碍，需要放置 PEG 管。然而，术后 4 个月，患者开始进食固体食物并恢复正常活动。他术后接受了放射治疗。治疗 8 个月后，未见肿瘤复发的证据。
头颈部黏膜黑色素瘤的标准治疗主要是手术。咽鼓管/中耳黏膜黑色素瘤的手术切除可能难以达到显微镜下阴性切缘。然而，大体肿瘤切除术后行放疗已被证明可改善局部区域控制。
