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Published on: May 26, 2023
Surgical Approaches to Pre-Auricular Cutaneous Squamous Cell Carcinomas Extending to the Temporal Bone
Michael Schachtel1,2, Mitesh Gandhi3,4, James Bowman1
1Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Queensland Skull Base Unit, Brisbane, Queensland, Australia.
Background:
Standardized surgical approaches to advanced pre-auricular cutaneous squamous cell carcinomas (cSCC) are lacking.
Methods:
Fifty-four patients who underwent lateral temporal bone resection (LTBR) for pre-auricular cSCC were grouped into "Levels" of increasing disease spread. Surgical approaches to achieve negative-margin resection were designed for each Level and replicated on cadaveric specimens.
Results:
Level 1 extended to the external auditory canal, requiring LTBR ± superficial parotidectomy. Level 2 involved the retromandibular space ± temporomandibular joint, necessitating partial mandibulectomy, in addition to the above. Level 3 and 4 involved the deep parotid, being situated either away from (> 5 mm) or close (≤ 5 mm) to the anterior carotid sheath (ACS), respectively. These tumors require radical parotidectomy, with incorporation of the ACS for Level 4. Level 5 involved the ACS at the skull base and should be treated non-surgically.
Conclusion:
This Level-based system will hopefully lead to further prospective studies and improvements in outcomes for advanced pre-auricular cSCC.
