Squamous Cell Carcinoma of the Temporal Bone Presenting With Facial Nerve Paralysis: A 25-Year Experience.

Carcinoma of the temporal bone is a rare disease entity accounting for about 0.2% of malignancies in the head and neck. The objectives of the present study are to report outcomes after surgical resection with adjuvant radiotherapy for patients with advanced temporal bone carcinoma with facial paralysis at presentation. The current study was conducted as a retrospective chart review and included patients with biopsy-proven squamous cell carcinoma of the temporal bone with complete facial paralysis at presentation (T4 by definition). All included patients underwent temporal bone resection and facial nerve sacrifice just lateral to the geniculate ganglion with simultaneous free flap coverage from January 1997 to December 2022. There was one mortality in the study population (0.9%). One patient suffered a stroke during their perioperative course (0.9%); 3 patients had myocardial infarctions (2.9%); 2 patients developed cerebrospinal fluid leaks (1.9%); 3 patients developed encephaloceles perioperatively (2.9%). Nine patients had complaints of malocclusion (8.8%). There was one flap failure in the study group. Disease-free survival at 24 months was 81.3% and overall survival at 24 months was 74.5%. The results of the current study suggest that aggressive surgical resection with high facial nerve sacrifice, simultaneous free tissue transfer, and adjuvant radiotherapy of at least 65 Gy may provide a survival benefit over other options for management in this patient population. Level of Evidence: Level III.