Anatomic Consideration of the Medial Cuts for Lateral Temporal Bone Resection: Cadaveric Study

Area of Science:

• Otolaryngology
• Surgical Oncology
• Anatomy

Background:

• External auditory canal malignancies require surgical resection.
• Lateral temporal bone resection (LTBR) and subtotal temporal bone resection (STBR) are primary surgical techniques.
• LTBR is often preferred as an otological procedure, while STBR necessitates a skull base team.

Purpose of the Study:

• To detail the osteotomy technique for the anterior deep portion of the external auditory canal during LTBR.
• To identify and address the most challenging site for separation in LTBR.
• To improve complete en bloc resection rates and achieve negative margins.

Main Methods:

• Analysis of 11 cadaveric specimens.
• Examination of the osteotomy technique for the anterior deep portion of the external auditory canal.
• Focus on the area anteroinferior to the tympanic membrane.

Main Results:

• A specific 3.8 mm bone segment anteroinferior to the tympanic membrane is frequently left disconnected.
• This area represents the most challenging site for separation during LTBR.
• Incomplete separation can compromise en bloc resection and margin status.

Conclusions:

• Complete en bloc resection in LTBR necessitates precise separation of the anterior deep external auditory canal.
• Understanding and addressing the specific anatomical variations of this region is crucial.
• Appropriate surgical technique in this area ensures negative margins for external auditory canal malignancies.