Komune Noritaka, Kuga Daisuke, Miki Koichi, Nakagawa Takashi
Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Cancers (Basel). 2021 Sep 10;13(18):4556. doi: 10.3390/cancers13184556.
Currently, only lateral temporal bone resection (LTBR) and subtotal temporal bone resection (STBR) are widely utilized for the surgical treatment of advanced squamous cell carcinoma of the external auditory canal (EAC-SCC). However, there are few descriptions of variations on these surgical approaches. This study aimed to elucidate the variations of en bloc resection for advanced EAC-SCC. We dissected the four sides of cadaveric heads to reveal the anatomical structures related to temporal bone resection. From the viewpoint of surgical anatomy, surgical patterns of temporal bone cutting can be divided into four categories: conventional LTBR, extended LTBR, conventional STBR, and modified STBR. Extended LTBR is divided into four types: superior, inferior, anterior, and posterior extensions. Several extension procedures can be combined based on the extension of the tumor. Furthermore, en bloc resection with the temporomandibular joint or glenoid fossa increases the technical difficulty of a surgical procedure because the exposure and manipulation of the petrous segment of the internal carotid artery are limited from the middle cranial fossa. Surgical approaches for advanced SCC of the temporal bone are diverse. They require accurate preoperative evaluation of the tumor extension and preoperative consideration of the exact line of resection to achieve marginal negative resection.
目前，仅外侧颞骨切除术（LTBR）和颞骨次全切除术（STBR）被广泛用于外耳道晚期鳞状细胞癌（EAC-SCC）的外科治疗。然而，关于这些手术方法的变体描述很少。本研究旨在阐明晚期EAC-SCC整块切除术的变体。我们解剖尸体头部的四个侧面以揭示与颞骨切除相关的解剖结构。从手术解剖学的角度来看，颞骨切割的手术模式可分为四类：传统LTBR、扩展LTBR、传统STBR和改良STBR。扩展LTBR分为四种类型：上、下、前和后扩展。可以根据肿瘤的扩展情况组合几种扩展手术。此外，整块切除颞下颌关节或关节盂会增加手术的技术难度，因为从中颅窝对颈内动脉岩骨段的暴露和操作受到限制。颞骨晚期鳞状细胞癌的手术方法多种多样。它们需要对肿瘤扩展进行准确的术前评估，并在术前考虑确切的切除线，以实现切缘阴性切除。
