En bloc temporal bone resections in squamous cell carcinoma of the ear. Technique, principles, and limits

En bloc resection should always be primarily considered in ear carcinoma, also in advanced tumors growing beyond the walls of the external auditory canal, because it achieves a full specimen for histopathological evaluation and allows a correlation between clinical, pathological features, and outcomes.

Dismal outcome of surgical and radiotherapic therapies for advanced ear carcinoma required a critical discussion of the oncological principles of treatment. Our analysis involved preliminarily a detailed description of surgical technique including the contribution of modern skull base microsurgery.

Evident limits in diagnostic protocols, surgical treatment and outcome evaluation modalities pointed to the need of a new approach towards an accurate definition of pre-operative tumor location, size, and behavior. En bloc resection achieved a specimen for a final pathological evaluation and an adjunctive piecemeal excision was necessary only whenever resection was not felt falling in safe, tumor-free tissue. Chemotherapy and radiotherapy should be considered in selected cases for adjuvant treatment.