Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2015
Radiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management.
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Phillips David J, Njoku Innocent U, Brown Kevin D, Selesnick Samuel H
Аннотация
OBJECTIVE: To document our experience with osteoradionecrosis (ORN) of the temporal bone.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary care medical center.
PATIENTS: Patients who developed exposed necrotic bone of the external auditory canal after radiation therapy to the head and neck.
INTERVENTIONS: Temporal bone ORN was managed conservatively in all patients with a combination of systemic antibiotics, antibiotic ear drops, and in-office debridement. Three patients required surgery, two of which were for a cholesteatoma.
MAIN OUTCOME MEASURE: The need for surgical intervention in the management of ORN.
RESULTS: Twenty-three patients with ORN of the temporal bone comprise the study group. The average age of patients at the time of diagnosis was 58 years (range, 34-75 yr). The parotid gland was the most common primary tumor site (n = 10). The mean lag time from completion of radiotherapy to diagnosis of ORN was 11 years (range, 2-48 yr). The most common presenting symptom was hearing loss (n = 18), followed by tinnitus (n = 13) and otorrhea (n = 13). All 23 patients were managed conservatively with antibiotic therapy and in-office debridement of necrotic bone. None of the patients required temporal bone resection and/or free-flap reconstruction.
CONCLUSION: ORN of the temporal bone is a rare adverse event that can occur after radiotherapy for a variety of neoplasms of the head, neck, and central nervous system. Conservative management, which includes directed antibiotic therapy and regular in-office debridement of necrotic bone, can adequately control the disease process and symptomatology, thus avoiding more invasive surgical interventions.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary care medical center.
PATIENTS: Patients who developed exposed necrotic bone of the external auditory canal after radiation therapy to the head and neck.
INTERVENTIONS: Temporal bone ORN was managed conservatively in all patients with a combination of systemic antibiotics, antibiotic ear drops, and in-office debridement. Three patients required surgery, two of which were for a cholesteatoma.
MAIN OUTCOME MEASURE: The need for surgical intervention in the management of ORN.
RESULTS: Twenty-three patients with ORN of the temporal bone comprise the study group. The average age of patients at the time of diagnosis was 58 years (range, 34-75 yr). The parotid gland was the most common primary tumor site (n = 10). The mean lag time from completion of radiotherapy to diagnosis of ORN was 11 years (range, 2-48 yr). The most common presenting symptom was hearing loss (n = 18), followed by tinnitus (n = 13) and otorrhea (n = 13). All 23 patients were managed conservatively with antibiotic therapy and in-office debridement of necrotic bone. None of the patients required temporal bone resection and/or free-flap reconstruction.
CONCLUSION: ORN of the temporal bone is a rare adverse event that can occur after radiotherapy for a variety of neoplasms of the head, neck, and central nervous system. Conservative management, which includes directed antibiotic therapy and regular in-office debridement of necrotic bone, can adequately control the disease process and symptomatology, thus avoiding more invasive surgical interventions.