Resection and Anterior Petrosectomy of Temporal Bone Tumor with
Combined Subtemporal and Endaural Approach
Yunia Chairunnisa1, Masyita Gaffar1,2*, Andi Ikhwan 1
1
Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of
Medicine, Hasanuddin University.
2
Akademis Jaury Jusuf Putera Hospital, Makassar
*Corresponding authors : Address : Jl. Racing Centre 1/2, Makassar
Email : sita_gaffar@[Link]
ABSTRACT
Background: Ceruminous adenoma is a tumor originating from the external
acoustic canal (EAC). The incidence of these cases is very rare (<1%) in
external ear tumors. Tumor characteristic slow growth. This mass appears on
the posterior wall of the outer 1/3 of the ear canal. Surgical management
resection of the tumor with endaural approach. Aim: To share knowledge
regarding to surgical management of the temporal bone tumor. Case report:
56 year old female, referred to ENT Department of Akademis Hospital from
Neurosugery Department, with chief complaint was hearing impairment with
appearance lump in ear canal that growing up for a year together with
frequent earache. On otoscopy : found mass covering the anterior superior
external acoustic meatus (EAM). Computed tomography (CT) scan showed
extension the tumor that eroded the anterior petrous. The management was (a
collaboration with neurosurgeon) resection and anterior petrosectomy of the
temporal bone ceruminous adenoma with combined subtemporal and endaural
approach. The results histopathology examination was ceruminous adenoma.
Three months follow up after operation, there was no sign of mass in right
ear canal
Methods: : Using literature review taken from Medeni med, Indian
journal of otology , head and neck oncology with the PICO format with
question “what is the management of temporal bone tumor? Results: Based on
the inclusion and exclusion criteria, 5 literature related to this case was
obtained Conclusion : Ceruminous adenoma is benign tumor but could be
extended to the petrous bone, surgery management is carried out with a
subtemporal approach because the exploration must reach to the petrous bone
Keywords :Temporal bone tumor, endaural approach.
Introduction Surgical management for
Ceruminous adenoma is a temporal bone ceruminous adenoma
benign tumor originate from the outer is resection with endural approach.
third of the lateral ear canal Small tumors are resected using an
cartilaginous part . Another name for endural approach because of better
ceruminous adenoma is ceruminoma access and visualization. The surgical
or apocrine adenoma is a benign scars caused no deformities and no
tumor of the ceruminous gland from complications were seen with the
endaural approach because the tumor
a skin gland but because it grows in
was completely excised. 3
the ear canal so it can give symptoms
of hearing loss, otalgia , otorrhea or Case Report
fullness in the ear. The diagnose
A 56-year-old woman was
based on clinical appearance, CT
referred to the ENT department by
scan and/or magnetic resonance
Neurosurgery department, with
imaging (MRI) and histopathology
extension of a petrous tumor into the
examination. CT scan can
ear canal. A lump in the ear that has
provideclues in the absence of signs
been complaining for more than 1
of invasion and erosion that are
year, accompanied by hearing loss
characteristic of benign tumors. MRI
and frequent earache.
with gadolinium diethylene triamine
pentaacetic acid (DTPA) contrast
used to differentiate between benign
and malignant gland tumors 1.2
Figure 1. Mass at right
EAM
Figure 3. Red arrow: eroded
On otoscopy found mass
tympanic part, petrous part,
covering the anterior superior EAM
squamous part , processus
with a superior base, on palpation
zygomaticum and eroded the
it was soft and attached to the skin
condylar process of the mandible.
(Figure 1).
Management:
Axial section of the temporal
bone CT scan: right EAM mass that Temporal bone tumor resection and
eroded the tympanic part, petrous anterior petrosectomy combined
part , and squamous part of temporal subtemporal and endaural approach
bone, zygomatic process, and eroded
the condylar process of the mandible.
(Fig. 2 and 3)
Figure 2. The red arrow shows a Figure 4. Mass in the anterior
mass in the petrous anterior superior petrous
to EAC
Intraoperative findings:
An ear canal mass of superior origin Method
was seen with a consistency similar Using the PICO system literature
to mass of anterior petrous, the with the question “what is the
tympanic membrane was intac management of temporal bone
tumor?”
Histopathology result : Ceruminous
adenoma
Obtained from Medeni med, Indian
Journal of Otology, Otolaryngology
and reconstructive surgery, Head
and neck surgery.
Inclusion criteria : 1) The method
uses literature with the keywords 2)
Published in the last 10 years 3)
Figure 5. The tumor tissue is lined Full text available. Exclusion
by the epidermis, under the tumor Criteria : 1) Review Article
tissue there is a fairly dense
proliferation of apocrine glands with
the lumen filled with eosinophilic
masses
Figure 6. Follow up 3 months post
operation: ear canal was adequate
and there was no sign of tumor growth
Identification of literature
from PubMed sources
Identificati
(n = 25)
Exclusion
Writing > 10 years (n = 12)
Records after writing
exclusion > 10 years
(n = 13)
Screenin
Records are screened
(n = 13)
- Fulltext not available (n=5)
- Lack of relevance (n=3)
The full article is assessed
Eligibilit
for eligibility
(n = 5)
Include
Studies are included in
qualitative synthesis
(n = 5)
Figure 7. Search terms and publication selection process (PRISMA Flowchart)
RESULTS
No Journal Population/Patient Intervention/ Co Results
Writer /Problem Index/ mpa
Indicator rato
r
1 George et A 87-year-old woman Excision with - Follow up 2
al, 2015 with complaints of transmeatal years
otalgia, hearing loss, approach no there is
otorrhea, itching, recurrence
otoscopy, redness,
tenderness, rounded,
tender mass in the outer
third of the left inferior
wall of the left EAC. .
CT scan : lesion cystic
on part EAC inferior
cartilage but no there is
lysis temporal bone .
Histopathology :
Ceruminous adenoma
2 Khabti et A 45-year-old woman Postaural - Not there is
al, 2016 with complaints of approach recurrence
hearing loss in the right up to 7
ear which has worsened [Link]
since 2 years, surgery
occasional otalgia.
Otoscopy showed a
soft mass in the
posterior
inferior half of the
EAC.
CT scan: soft mass
filling the EAC without
signs of bone eroded,
the tympanic cavity
and the mastoid cleft
are normal
Histopathology:
Ceruminous adenoma
3 Himanshu a 38-year-old female Endaural post surgery
et al, 2014 patient who presented approach follow up
with recurrent foul
8 months no
smelling blood-stained
complaints
discharge from the
right ear along with
hearing impairment ,
pinna was mildly
tender with excoriation
of inferior canal wall.
EAM was almost
blocked by shiny pea-
size swelling over
posterior canal wall. On
palpation mass was
tense, firm and
indurated with intact
overlying skin.
CT scan: right EAM
obliteration. tympanic
cavity and mastoid cleft
within normal limits.
Histopathology :
Ceruminous adenoma
4 Wan et al, 78 male with a history Transmeatal Follow-up, 27
2012 of recurrent otorrhoea approach months after the
for 6 months in the with total surgery, there
right ear, otoscopy removal was no evidence
showed pink and soft of recurrence.
0.5 × 0.7 cm mass on
the outside of the right
EAC, no pain
CT scan :showed a soft
lesion 0.5 × 0.5 cm in
the right EAC with no
sign of bone eroded
Histopathology :
Ceruminous adenoma
5 Siti et al, A 34-year-old woman Resection Not there is
2021 progressively tumor with recurrence
worsening hearing in postaural 1 year follow-
the right ear for two approach up
years. Her hearing loss
was accompanied by
tinnitus persistent non-
pulsatile otoscopic
examination of the
right ear revealed a
mass arising from the
superior wall of the
EAC. The mass was
lobulated, non-pulsatile
without blood.
CT scan : mass EAC
software measuring 1.2
x 0.5 x 0.7 cm. EAC
wall a little eroded . the
skutum sharp , and no
there is involvement
middle ear and inner
ear
Histopathology:
Ceruminous adenoma
The case of ceruminous
DISCUSSION
adenoma we found based on CT scan
Ceruminous adenoma is a rare of the tumor until eroded the pars
case, according to Aleksandra et al, petrous , whereas in the cases
the incidence of ceruminous adenoma reported by Siti et al, Wan et al,
is <1% in the age group of 50-60 Khabti et al, Himanshu et al, George
years. This is consistent with our et al based on CT examination is not
case, a 56 year old woman. Uzdan et there is eroded pars petrous bone. 5-10
al stated that there was no gender and Our patients undergo surgery
ethnic predilection for ceruminous management resection and anterior
2,4
adenomas. petrosectomy combine subtemporal
Our patient complained of a and endaural approach because the
lump in the right ear canal that was tumor eroded the petrous part . Based
getting bigger with hearing loss on research George et al, Khabti et al,
otalgia. According to George et al Himanshu et al, Wan et al and Siti et
the most frequent symptoms of al did temporal bone tumor resection
ceruminous adenoma are hearing with various approaches like
loss, otalgia, otorrhoea and rarely endaural, postaural transmeatal
5
causes facial nerve paresis. however not included anterior
In our case based on petrosectomy with subtemporal
otoscopy found mass covers the approach because there was no
anterior EAM on palpation was soft extension of the tumor to petrous
and adheres to the skin. George et al bone .5-9
reported in his case mass in the outer
third of the left inferior wall EAC,
Khabti et al reported in his case a soft
mass of skin that filled the postero-
inferior half of EAC.5,6
In conclusion ceruminous any residue, in order to prevent
adenoma is a rare skin gland tumor, recurrence.
affecting the age of 50-60 years, The
Ceruminous Adenomais
clinical presentation varies so it is
benign tumor but could be extended
difficult to diagnose, these tumors are
to the petrous bone. For this reason,
easy to recur and to distinguish
surgery management is carried out
benign and malignant tumors only
with a subtemporal approach because
based on histopathological
the exploration must reach to the
examination. The treatment is
petrous bone.
complete surgery without leaving
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