Carcinoma of the external auditory canal.

Successful management of carcinoma of the external auditory canal depends upon four factors: 1. early diagnosis is imperative if a high cure rate is to be expected; 2. correct evaluation of the extent of the malignancy; 3. adequate surgery based upon correct evaluation; and 4. postoperative radiation in certain selected cases. In this review of 35 cases, two factors were used to determine whether the disease was localized or extensive. When extension occurs inot the mastoid as deep as the middle ear cleft or into the facial nerve, it should be designated as extensive tumor. Tumors which do no go as deep as the facial nerve or involve the mucosa of the middle ear should be designated as localized tumors. In localized tumors, it is possible to perform a wide en bloc resection of the bony and cartilaginous external auditory canal including the tympanic membrane and malleus, and if necessary, including the superficial lobe of the parotid. Postoperative radiation is indicated when the pathological specimen shows unclear margins in the surgical dissection. With localized tumors, en bloc resection of the external auditory canal offers a high cure rate. In extensive lesions, an en bloc dissection removing the bulk of the tumor mass, followed by irradiation, seems to offer at least as good a prognosis as more radical surgery.