(下载)30 耳聋及其防治 耳肿瘤
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CT is most helpful in providing bony detail and is the most useful modality for early lesions as well as those causing bony changes.
MRI provides a much clearer delineation of tumorLeabharlann Baiduextent within soft tissue.
It is superior in differentiating tumor from normal tissue Involvement of cranial nerve, intracranial, infratemporal fossa, parotid
gland, and temporpmandibular joint
Patient live quite a long time even if not cured, Metastasis disease can present many years after
initial treatment.
Case management
Chunfu Dai M.D & Ph.D
Diagnostic studies
The most critical step in diagnosis is early biopsy Providing an adequate biopsy sample to the pathologist is critical
A significant risk of misdiagnosis with small tissue specimens. CT and MR determine tumor extent and aid the diagnosis
The nerve can be reconstructed using a cable nerve graft consisting of the greater auricular nerve or the sural nerve.
Interventions
Cervical metastasis
Intervention
Tumor management
T1 lateral temporal bone resection, superficial parotidectomy, XRT
T2 lateral temporal bone resection, superficial parotidectomy, XRT
Facial nerve management
The facial nerve can be preserved if it is clearly free of tumor,
If there is any tumor involvement, the facial nerve should be sacrificed, using frozen section evaluation to ensure tumor-free margins both proximally and distally.
Pain was not complaint.
Previous medical history
In 2004, he was undergone left EAC mass biopsy, it indicated atypic proliferation
In Nov. 2005, mass biopsy was performed again, SSC diagnosis was established
Intervention
Radiation therapy
Postoperative radiation therapy should be initiated within 6 weeks of the primary surgery
Radiation ports should include the local tumor bed and surrounding structures including the parotid gland, temporomandibular joint, and infratemporal fossa as well as the ispilateral neck.
Diagnosis
Clinical presentations Physical examination
Neoplasm in middle ear Hemorrhage
CT, MRI: to determine the extension of mass
Biopsy: to confirm histological diagnosis
This 5 year disease free survival is obviously not representative of cure
Recurrences can often present over 10 years after initial treatment,
The actual cure rate is most likely substantially lower.
Diagnosis
SCC in the left EAC (T1N0M0)
Surgery –lateral temporal bone resection + superiorfacial parotidectomy
Surgery –lateral temporal bone resection + superfacial parotidectomy
General examination: to exclude remote metastasis
Intervention
Comprehensive therapy
Radiotherapy+surgery+chemotherapy Surgery
Lateral temporal bone resection+ parotidectomy Subtotal temporal bone resection + parotidectomy Temporal bone resection + parotidectomy Basilar carcinoma: surgery, no extra radiotherapy Rhabdomone carcinoma: chemotherapy+radiotherapy+surgery
The risk of cervical metastasis at the time of presentation is quite low
Neck dissection should be considered are
Presence of enlarged neck nodes
radical or modified radical neck dissection.
Stage
T1 tumor limited to the EAC, no bone erosion or soft tissue extension
T2 tumor with limited bone erosion to EAC or less than 0.5 cm soft tissue involvement.
T3 subtotal temporal bone resection, superficial parotidectomy, ND, XRT
T4 total temporal bone resection, total parotidectomy, ND, XRT.
Interventions
Extensive nature of the primary tumor with invasion into the middle ear or mastoid
Presence of tumor spread into the parotid gland.
a modified radical neck dissection preserving as much function as possible and addressing at least zones II and III is recommended.
Primary complaint
A 57 years old man present with mass in the left EAC and discharge of left ear for one year
Mass was identified in superior anterior wall of the left EAC, it was 0.5 cm in diameter
Interventions
The locoregional recurrence rates is quite high, An aggressive approach is advocated. The best chance of cure is generally achieved with
T3 tumor with full thickness EAC bone erosion, less than 0.5 cm soft tissue involvement or tumor in middle ear, mastoid, or facial nerve。
T4 tumor eroding the cochlea, petrous apex, medial wall of the middle ear, carotid canal, jugular foramen, or dura, or more than 0.5cm soft tissue involvement.
Surgery –lateral temporal bone resection + superiorfacial parotidectomy
Surgery –lateral temporal bone resection + superfacial parotidectomy
Prognosis
complete surgical resection of the tumor followed by adjuvant radiation therapy to the primary site as well as regional lymph nodes and other areas at risk such as the skull base.
and otitis externa
Clinical presentations
Ear discharge with blood Otalgia and headache Hearing loss Facial paralysis Dysplagia Involvement of other cranial nerves Metastasis to associated lymphatic node
Carcinoma of temporal bone
Chunfu Dai M.D & Ph.D
Background
Most origin of EAC, then involve middle cavity, parotid gland or brain et al.
Predilection in 40-60 y Dominated by squamous carcinoma Followed by adenoid cystic carcinoma Associated with chronic otitis media
MRI provides a much clearer delineation of tumorLeabharlann Baiduextent within soft tissue.
It is superior in differentiating tumor from normal tissue Involvement of cranial nerve, intracranial, infratemporal fossa, parotid
gland, and temporpmandibular joint
Patient live quite a long time even if not cured, Metastasis disease can present many years after
initial treatment.
Case management
Chunfu Dai M.D & Ph.D
Diagnostic studies
The most critical step in diagnosis is early biopsy Providing an adequate biopsy sample to the pathologist is critical
A significant risk of misdiagnosis with small tissue specimens. CT and MR determine tumor extent and aid the diagnosis
The nerve can be reconstructed using a cable nerve graft consisting of the greater auricular nerve or the sural nerve.
Interventions
Cervical metastasis
Intervention
Tumor management
T1 lateral temporal bone resection, superficial parotidectomy, XRT
T2 lateral temporal bone resection, superficial parotidectomy, XRT
Facial nerve management
The facial nerve can be preserved if it is clearly free of tumor,
If there is any tumor involvement, the facial nerve should be sacrificed, using frozen section evaluation to ensure tumor-free margins both proximally and distally.
Pain was not complaint.
Previous medical history
In 2004, he was undergone left EAC mass biopsy, it indicated atypic proliferation
In Nov. 2005, mass biopsy was performed again, SSC diagnosis was established
Intervention
Radiation therapy
Postoperative radiation therapy should be initiated within 6 weeks of the primary surgery
Radiation ports should include the local tumor bed and surrounding structures including the parotid gland, temporomandibular joint, and infratemporal fossa as well as the ispilateral neck.
Diagnosis
Clinical presentations Physical examination
Neoplasm in middle ear Hemorrhage
CT, MRI: to determine the extension of mass
Biopsy: to confirm histological diagnosis
This 5 year disease free survival is obviously not representative of cure
Recurrences can often present over 10 years after initial treatment,
The actual cure rate is most likely substantially lower.
Diagnosis
SCC in the left EAC (T1N0M0)
Surgery –lateral temporal bone resection + superiorfacial parotidectomy
Surgery –lateral temporal bone resection + superfacial parotidectomy
General examination: to exclude remote metastasis
Intervention
Comprehensive therapy
Radiotherapy+surgery+chemotherapy Surgery
Lateral temporal bone resection+ parotidectomy Subtotal temporal bone resection + parotidectomy Temporal bone resection + parotidectomy Basilar carcinoma: surgery, no extra radiotherapy Rhabdomone carcinoma: chemotherapy+radiotherapy+surgery
The risk of cervical metastasis at the time of presentation is quite low
Neck dissection should be considered are
Presence of enlarged neck nodes
radical or modified radical neck dissection.
Stage
T1 tumor limited to the EAC, no bone erosion or soft tissue extension
T2 tumor with limited bone erosion to EAC or less than 0.5 cm soft tissue involvement.
T3 subtotal temporal bone resection, superficial parotidectomy, ND, XRT
T4 total temporal bone resection, total parotidectomy, ND, XRT.
Interventions
Extensive nature of the primary tumor with invasion into the middle ear or mastoid
Presence of tumor spread into the parotid gland.
a modified radical neck dissection preserving as much function as possible and addressing at least zones II and III is recommended.
Primary complaint
A 57 years old man present with mass in the left EAC and discharge of left ear for one year
Mass was identified in superior anterior wall of the left EAC, it was 0.5 cm in diameter
Interventions
The locoregional recurrence rates is quite high, An aggressive approach is advocated. The best chance of cure is generally achieved with
T3 tumor with full thickness EAC bone erosion, less than 0.5 cm soft tissue involvement or tumor in middle ear, mastoid, or facial nerve。
T4 tumor eroding the cochlea, petrous apex, medial wall of the middle ear, carotid canal, jugular foramen, or dura, or more than 0.5cm soft tissue involvement.
Surgery –lateral temporal bone resection + superiorfacial parotidectomy
Surgery –lateral temporal bone resection + superfacial parotidectomy
Prognosis
complete surgical resection of the tumor followed by adjuvant radiation therapy to the primary site as well as regional lymph nodes and other areas at risk such as the skull base.
and otitis externa
Clinical presentations
Ear discharge with blood Otalgia and headache Hearing loss Facial paralysis Dysplagia Involvement of other cranial nerves Metastasis to associated lymphatic node
Carcinoma of temporal bone
Chunfu Dai M.D & Ph.D
Background
Most origin of EAC, then involve middle cavity, parotid gland or brain et al.
Predilection in 40-60 y Dominated by squamous carcinoma Followed by adenoid cystic carcinoma Associated with chronic otitis media