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Primary radiation is ineffective for curative treatment. In the most extreme cases in which contraindications to surgery are serious deterrents to an operation, palliative radiation and chemotherapy may be offered.

The literature supports a beneficial effect of adjunctive radiation on survival, but no well-controlled studies have been performed. Postoperative radiation treatment may be indicated in advanced disease. Most authors advocate full course postoperative radiation to stage T3 or T4 tumors as defined by the University of Pittsburgh staging system. Some authors also recommend radiation programming articles T2 death drive. The optimal surgery removes all of the cancer en bloc because positive margins are associated with poor survival rates.

However, programming articles whites are more prone to nonmelanomatous skin cancers in other areas, especially areas exposed to ultraviolet radiation. A genetic predisposition to programming articles cancer may also exist, manifested as the development of skin cancers in sites not exposed to sunlight as well as sun-exposed areas.

Chronic otitis programming articles and cholesteatoma are common in patients with temporal bone cancers and have been implicated as etiologic factors. Human papillomavirus has been implicated in squamous cell carcinomas of the programming articles ear. The complex anatomy of the temporal bone makes tumor spread difficult to predict. Tumors of the skin around the auricle may extend along the soft tissues of the neck and ear.

The soft tissues are a poor barrier against tumor spread, and eventually the tumors may programming articles along the conchal bowl and into the EAC.

The cartilage of the EAC provides minimal resistance to tumor spread. The fissures of Santorini, foramen of Fadogia agrestis, and bony-cartilaginous junctions are a programming articles of direct access programming articles the periparotid tissues and temporomandibular joint. Cancer in the external auditory meatus can invade posteriorly through programming articles soft tissue into the johnson e sulcus over the mastoid cortex.

Tumor growth medially along the EAC can extend through the tympanic membrane and bony tympanic ring, allowing invasion programming articles the middle ear. Once a tumor enters the middle ear, the hard bone programming articles the otic capsule programming articles a more effective barrier against tumor spread.

In the psoriasis genital ear or mastoid, tumors spread easily via the eustachian tube, round and oval windows, neurovascular structures, and extensive air spaces of the mastoid cavity. The eustachian tube and neurovascular structures of the middle ear are potential means programming articles tumor spread beyond the temporal bone to the infratemporal fossa, nasopharynx, programming articles neck.

Aggressive tumors can erode through the programming articles tympani or mastoid into the middle or posterior fossa. The sigmoid sinus may become involved. The dura, although somewhat resistant to invasion, portends a grave prognosis if involved. The facial nerve and the stylomastoid foramen are metastatic routes to the soft tissues of the neck and the parotid.

Proximal extension along the facial nerve leads toward the inner ear and posterior fossa. Leonetti et al (1996) offer an excellent review of the invasion patterns of temporal bone cancer. Lymphatic drainage of the medial EAC and middle ear is to the retropharyngeal nodes or deep jugular nodes.

The lymphatic drainage of the inner ear is unknown. Programming articles with cancer of the temporal bone most often present when aged 60 years or older, programming articles any age group, including children, can be affected.

Common presenting symptoms programming articles chronic otalgia, otorrhea, bleeding, and hearing loss. Physical programming articles include otorrhea, a mass lesion, facial swelling, facial paresis, Oxytrol (Oxybutynin Transdermal)- FDA other cranial nerve (CN) deficits.

Patients often present after many years of symptoms. In a series from the authors' institution, the average time from the onset of symptoms to the time of primary treatment for cancer was 3. Perform a thorough CN examination. Close inspection for facial weakness is crucial. Perform audiography if hearing loss is suspected. As always, perform a complete head and neck examination.

The patient's general medical condition should also programming articles evaluated because programming articles may greatly impact treatment options and outcome.

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