Significance of tubal resection in surgical treatment of middle ear carcinoma

We successfully carried out total en bloc resection of squamous cell carcinoma of the middle ear in two patients. Both patients have been free of the disease for 32–39 months. In one of the cases, the eustachian tube was resected totally with the temporal bone. Postoperative histopathological examination proved tumor invasion into the cartilaginous part of the tube. We would like to emphasize the significance of total resection of the eustachian tube when neoplastic invasion into the tube is highly suspected. Axial computed tomography is of great value for preoperative evaluation of such invasion. Anterior mobilization of the carotid artery from the carotid canal facilitates resection of the petrous apex and should be done after management of the eustachian tube. The carotid canal is best exposed ventrally, since lateral exposure is at high risk for injuring the bony part of the eustachian tube and may possibly disseminate tumor cells.