1. SQUAMOUS CELL CARCINOMA OF MIDDLE EAR A CASE REPORT DR.ALEENA REHMAN(JR 1) DR.SUSHIL GAUR(AP) DR.O N SINHA (HOD) SANTOSH MEDICAL COLLEGE

2. CASE REPORT A 50 years old male patient presented in ENT OPD of Santosh Medical college and Hospital, Ghaziabad. CHIEF COMPLAINTS  Right ear discharge which was on and off since childhood.  Severe headache on and off since 6 months.  There was associated Vertigo, Hearing loss and facial paralysis from last 15 days.

3.  On examination, Subtotal perforation with discharge in the Right external auditory canal was seen.  Right sided facial palsy was present.  Post aural examination was normal.  Pure Tone Audiometry suggested of profound hearing loss in the right ear.  Rest ENT examination was normal.  No palpable lymph nodes. EXAMINATION

4. CT SCAN OF TEMPORAL BONE AND BRAIN  Soft tissue density lesion involving mastoid air cell  Attic extending to middle cranial fossa, sphenoid sinus, along with destruction of dural plate and sinus plate.

5. PROCEDURE Mastoid exploration was done under General Anaesthesia. It revealed a mass extending to Attic and Antrum, Middle cranial fossa with erosion of dural plate and sinus.

6. BIOPSY Biopsy for Histopathology Examination Report :- Moderately differentiated squamous cell carcinoma. Patient was treated with Palliative Radiotherapy

7. DISCUSSION  Temporal bone malignancy was first reported histologically in 1883 by politzer.  First extirpation of a temporal bone malignancy was described by heyer in 1899.  First successful single-stage temporal bone resection with preservation of petrous apex was done in 1954.  reported incidence is approx 1to 6 cases per 1,000,000.  The vast majority arise from the auricle followed by EAC, Middle ear and mastoid.  Histologically temporal bone malignancies are divided into 1. those originating from the surface epithelium 2. those originating from the glands 3. sarcomas

8. The risk factors for temporal bone malignancy are not well understood however it is associated with the following 1.Chronic suppurative otitis media 2.Irradiation 3.Inverted papilloma of middle ear 4.Radium dial worker 5.HPV The diagnosis of SCCa is often delayed due to nonspecific nature of the common presenting symptoms. Cranial nerve involvement is usually late and is an ominous sign of tumour extension and need for further iinvestigations.

9. Treatment is mainly surgical to improve survival. For early – stage tumours, an en bloc resection can often be performed with limited morbidity, especially when tumour is confined to the EAC. For advanced tumours, piecemeal resection is done. For middle ear and mastoid malignancy- Sub total temporal bone resection, llateral temporal bone resection or radical mastoidectomy can be done. The controversy over these differing surgical approaches to temporal bone tumours remains unresolved. Given the rarity of the disease and the variety of techniques employed, a conclusive study is unlikely. Currently, intensity- modulated radiation therapy (IMRT) is being used with greater frequency. This modality allows an approriate dose to be delivered to regions specified while minimizing the dose to the more radiosensitive surrounding tissues such as the brain, contralateral parotid gland and the orbits.

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