Komune Noritaka, Kuga Daisuke, Hashimoto Kazuki, Fujiwara Yoshinori, Shimamoto Ryo, Nakagawa Takashi
Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Am J Otolaryngol. 2021 Jul-Aug;42(4):103081. doi: 10.1016/j.amjoto.2021.103081. Epub 2021 May 23.
Primary temporal bone squamous cell carcinoma is sporadic. According to previous studies, margin-negative resection provides the best prognosis (Nakagawa et al., 2006; Moody et al., 2000; Yin et al., 2006; Komune et al., 2021 [1-4]). When tumors extend behind the tympanic membrane, lateral temporal bone resection, which is a well-established procedure, is insufficient to achieve a tumor-free margin. For these cases, subtotal temporal bone resection (STBR) can achieve a complete en bloc resection with a tumor-free margin. Furthermore, STBR en bloc with surrounding structures, including the temporomandibular joint and parotid gland, complicates surgical techniques. We previously reported this surgical procedure in a stepwise manner using cadaveric dissection (Komune et al., 2014 [5]). The STBR en bloc with the parotid gland and temporomandibular joint is composed of three approaches according to our previous report: high cervical exposure (neck dissection), a subtemporal-infratemporal fossa approach, and a retromastoid-paracondylar approach. However, we currently lack demonstrative surgical videos. According to our previous report, this video first demonstrates STBR en bloc with the parotid gland and temporomandibular joint (Komune et al., 2014 [5]). The histopathological diagnosis of a 57-year-old woman suffering from a large tumor protruding from her auricle indicated squamous cell carcinoma; after the diagnosis she was referred to our hospital. Computed tomography revealed the full extent of the tumor, which was about 8 cm in diameter and had damaged the middle cranial base, mastoid bone, and middle ear cavity. Magnetic resonance imaging indicated invasion of the glenoid fossa and parotid gland, equivalent to a Pittsburg stage cT4 tumor. The patient underwent STBR en bloc with the parotid gland and temporomandibular joint. Lower cranial nerves (CN IX-XII) were preserved, and the patient achieved normal oral intake without additional procedures after surgery. At six months post-operation, no recurrence was noted. In this video, we first demonstrate the surgical procedure of the STBR en bloc with the parotid gland and temporomandibular joint for far-advanced temporal bone squamous cell carcinoma, and it can be one of the surgical options to achieve the complete resection without exposure of the tumor. Informed consent was obtained from the patient. The video was reproduced with the written informed consent of the patient. Primary temporal bone squamous cell carcinoma is sporadic. According to previous studies, margin-negative resection provides the best prognosis (Nakagawa et al., 2006; Moody et al., 2000; Yin et al., 2006; Komune et al., 2021 [1-4]). When tumors extend behind the tympanic membrane, lateral temporal bone resection, which is a well-established procedure, is insufficient to achieve a tumor-free margin. For these cases, subtotal temporal bone resection (STBR) can achieve a complete en bloc resection with a tumor-free margin. Furthermore, STBR en bloc with surrounding structures, including the temporomandibular joint and parotid gland, complicates surgical techniques. We previously reported this surgical procedure in a stepwise manner using cadaveric dissection (Komune et al., 2014 [5]). The STBR en bloc with the parotid gland and temporomandibular joint is composed of three approaches according to our previous report: high cervical exposure (neck dissection), a subtemporal-infratemporal fossa approach, and a retromastoid-paracondylar approach. However, we currently lack demonstrative surgical videos. According to our previous report, this video first demonstrates STBR en bloc with the parotid gland and temporomandibular joint (Komune et al., 2014 [5]). The histopathological diagnosis of a 57-year-old woman suffering from a large tumor protruding from her auricle indicated squamous cell carcinoma; after the diagnosis she was referred to our hospital. Computed tomography revealed the full extent of the tumor, which was about 8 cm in diameter and had damaged the middle cranial base, mastoid bone, and middle ear cavity. Magnetic resonance imaging indicated invasion of the glenoid fossa and parotid gland, equivalent to a Pittsburg stage cT4 tumor. The patient underwent STBR en bloc with the parotid gland and temporomandibular joint. Lower cranial nerves (CN IX-XII) were preserved, and the patient achieved normal oral intake without additional procedures after surgery. At six months post-operation, no recurrence was noted. In this video, we first demonstrate the surgical procedure of the STBR en bloc with the parotid gland and temporomandibular joint for far-advanced temporal bone squamous cell carcinoma, and it can be one of the surgical options to achieve the complete resection without exposure of the tumor. Informed consent was obtained from the patient. The video was reproduced with the written informed consent of the patient.
原发性颞骨鳞状细胞癌是散发性的。根据以往的研究，切缘阴性切除可提供最佳预后（中川等人，2006年；穆迪等人，2000年；尹等人，2006年；小宗等人，2021年[1-4]）。当肿瘤延伸至鼓膜后方时，已成熟的外侧颞骨切除术不足以实现无瘤切缘。对于这些病例，颞骨次全切除术（STBR）可实现完整的整块切除并获得无瘤切缘。此外，STBR整块切除周围结构，包括颞下颌关节和腮腺，会使手术技术变得复杂。我们之前曾通过尸体解剖逐步报告过该手术过程（小宗等人，2014年[5]）。根据我们之前的报告，STBR整块切除腮腺和颞下颌关节由三种入路组成：高位颈部暴露（颈部清扫）、颞下-颞下窝入路和乳突后-髁旁入路。然而，我们目前缺乏演示性手术视频。根据我们之前的报告，本视频首次展示了STBR整块切除腮腺和颞下颌关节（小宗等人，2014年[5]）。一名57岁女性，耳廓有一个大肿瘤突出，组织病理学诊断为鳞状细胞癌；诊断后转诊至我院。计算机断层扫描显示了肿瘤的全貌，直径约8厘米，已侵犯中颅底、乳突骨和中耳腔。磁共振成像显示关节窝和腮腺受侵，相当于匹兹堡cT4期肿瘤。该患者接受了STBR整块切除腮腺和颞下颌关节。保留了低位颅神经（IX-XII颅神经），患者术后无需额外手术即可正常经口进食。术后六个月，未发现复发。在本视频中，我们首次展示了STBR整块切除腮腺和颞下颌关节治疗晚期颞骨鳞状细胞癌的手术过程，它可以是实现完整切除且不暴露肿瘤的手术选择之一。已获得患者的知情同意。该视频经患者书面知情同意后复制。原发性颞骨鳞状细胞癌是散发性的。根据以往的研究，切缘阴性切除可提供最佳预后（中川等人，2006年；穆迪等人，2000年；尹等人，2006年；小宗等人，2021年[1-4]）。当肿瘤延伸至鼓膜后方时，已成熟的外侧颞骨切除术不足以实现无瘤切缘。对于这些病例，颞骨次全切除术（STBR）可实现完整的整块切除并获得无瘤切缘。此外，STBR整块切除周围结构，包括颞下颌关节和腮腺，会使手术技术变得复杂。我们之前曾通过尸体解剖逐步报告过该手术过程（小宗等人，2014年[5]）。根据我们之前的报告，STBR整块切除腮腺和颞下颌关节由三种入路组成：高位颈部暴露（颈部清扫）、颞下-颞下窝入路和乳突后-髁旁入路。然而，我们目前缺乏演示性手术视频。根据我们之前的报告，本视频首次展示了STBR整块切除腮腺和颞下颌关节（小宗等人，2014年[5]）。一名57岁女性，耳廓有一个大肿瘤突出，组织病理学诊断为鳞状细胞癌；诊断后转诊至我院。计算机断层扫描显示了肿瘤的全貌，直径约8厘米，已侵犯中颅底、乳突骨和中耳腔。磁共振成像显示关节窝和腮腺受侵，相当于匹兹堡cT4期肿瘤。该患者接受了STBR整块切除腮腺和颞下颌关节。保留了低位颅神经（IX-XII颅神经），患者术后无需额外手术即可正常经口进食。术后六个月，未发现复发。在本视频中，我们首次展示了STBR整块切除腮腺和颞下颌关节治疗晚期颞骨鳞状细胞癌的手术过程，它可以是实现完整切除且不暴露肿瘤的手术选择之一。已获得患者的知情同意。该视频经患者书面知情同意后复制。
