squamous cell carcinoma followed by adenoid cystic carcinoma and basal cell carcinoma is a more common type of eac malignancy , whereas mucoepidermoid carcinoma is extremely rare . only four cases of mucoepidermoid carcinoma arising from the eac have been reported in the english literature [ 1 - 4 ] . symptoms of eac malignancy are often nonspecific and are similar to those of external otitis . thus , definite diagnosis could be delayed , resulting in an advanced tumor stage at the time of diagnosis . we report on a case of mucoepidermoid carcinoma of the eac with a review of the literature , and suggest proper treatment of mucoepidermoid carcinoma in the eac . a 24-year - old male patient presented with bloody otorrhea , ear fullness , and foreign body sensation in the left eac . he first noticed the bloody otorrhea one year prior to visiting the otolaryngologist and felt a small mass in the eac while cleaning out the discharge using an ear pick . he denied hearing loss , tinnitus , and vertigo , but complained of intermittent ear fullness . on the otoscopic examination , a pinkish mass was observed in the bony - cartilaginous junction of the postero - superior portion of the eac ( fig . a punch biopsy was performed , and the mass was diagnosed as intermediate grade mucoepidermoid carcinoma ( fig . a high - resolution temporal bone computed tomography ( ct ) scan with contrast and fluorine-18 fluorodeoxyglucose ( f-18 fdg ) positron emission tomography ( pet)/ct scan were performed for evaluation of the extent of the mass and for detection of distant metastasis . a slightly enhanced protruding lesion measuring approximately 1.2 cm in size in the posterior aspect of the eac was observed on the ct scan . the lesion was confined to the eac and did not invade the parotid gland or adjacent bony structures . a faint fdg uptake was observed in the left eac with a peak standard uptake value of 1.12 , and no other abnormal absorption of the f-18 fdg was observed in distant organs ( fig . 2 ) . according to the university of pittsburgh staging system for eac carcinoma , the lesion was classified as t1n0m0 . a lateral temporal bone resection was performed through a retroauricular approach . in the operative view , the mass was firm and pink ; it was removed en bloc with the cartilaginous and bony eac and tympanic membrane . a part of the temporal muscle was rotated in order to obliterate the surgical defect . a small retroauricular lymph node was observed and confirmed as " reactive hyperplasia " by frozen biopsy . no pathologic lymph nodes were observed at the parotid area and the facial nerve was intact in the operative field . despite the risk of regional metastasis in intermediate - grade mucoepidermoid carcinoma , considering the early stage of disease and the patient 's young age , neck dissection and parotidectomy we obliterated the eac with the temporal muscle , resulting in destruction of the sound transmission system of the middle ear . the patient suffered post - operative unilateral conductive hearing loss ; however , the hearing level in the contralateral ear was normal . he did not want to use bone conduction hearing aids . in the four years of follow - up since surgery , there have been no signs of recurrence and no abnormal uptake of f-18 fdg has been observed on f-18 fdg pet / ct scans . mucoepidermoid carcinoma is a malignant tumor that frequently originates in the major and minor salivary glands and also occurs in other glandular structures in both normal anatomic and ectopic sites . thus , the ceruminous gland of the deep dermis in the eac is a possible site of growth . on otoscopy , mucoepidermoid carcinoma does not differ from other types of malignancy , and histologic confirmation is essential to diagnosis . under histologic examination , mucoepidermoid carcinomas appear to be composed of scattered , solid and cystic mucinous areas . due to the mixed components , classification is based on the proportion of the solid part that is present . in low - grade tumors therefore , with regard to its epithelial components , high - grade mucoepidermoid carcinoma is very similar to poorly differentiated squamous cell carcinoma . histologic grade plays a major role in treatment and prognosis of mucoepidermoid carcinoma . currently , there is no consensus regarding the appropriate staging and treatment of mucoepidermoid carcinoma in the eac . the university of pittsburgh staging system for the eac is widely used for squamous cell carcinoma ; however , its applicability to mucoepidermoid carcinoma of the eac remains uncertain . in the general treatment of eac cancers , a tumor confined to the cartilaginous eac may be managed sufficiently with sleeve resection of the eac . when a tumor invades the bony canal , a lateral temporal bone resection should be performed , and , in the case of middle ear involvement , subtotal temporal bone resection should be performed . mucoepidermoid carcinoma of the eac is extremely rare and its characteristics can differ significantly from those of squamous cell carcinoma ; therefore , precise guidelines for treatment and treatment strategies have not been established . .   reported on a case of t2 , intermediate - grade mucoepidermoid carcinoma arising from the bony - cartilage junction of the eac . the patient underwent lateral temporal bone dissection , total parotidectomy , and unilateral elective neck dissection without postoperative radiotherapy . the authors warned of hidden metastasis in intermediate and high - grade mucoepidermoid carcinoma and recommended an aggressive treatment strategy , including elective neck dissection . however , bared et al .   reported a step - by - step surgical approach for malignancies of the eac in order to minimize operative morbidity and postoperative dysfunction based on the histologic type and extent of disease . malignancies of the eac have a poor prognosis and a high rate of recurrence ; therefore , most authors advocate aggressive treatment at the time of diagnosis . on the other hand , an aggressive approach to treatment is associated with higher risk of postoperative morbidity , including hearing loss and facial nerve dysfunction . in treatment of mucoepidermoid carcinoma of the eac , both oncologic outcome and surgical morbidity must be considered . our case was a t1n0m0 intermediate - grade mucoepidermoid carcinoma limited to the eac , and was treated with lateral temporal bone dissection . we thought that elective neck dissection and postoperative radiotherapy were not necessary in the early stage of disease ; therefore , parotidectomy , elective neck dissection , and postoperative radiotherapy were deferred . so far , during the four years following surgery , no evidence of recurrence has been found on physical examination and f-18 fdg pet / ct scans . based on this case , we suggest that lateral temporal bone resection is an appropriate surgical method for treatment of early stage mucoepidermoid carcinoma arising from the eac . for establishment of a general treatment strategy , further study including a larger number of cases will be necessary .
mucoepidermoid carcinoma in the external auditory canal is extremely rare . 
 strategies used for treatment of mucoepidermoid carcinoma remain controversial . 
 we present a case of mucoepidermoid carcinoma of the external auditory canal . 
 the patient underwent lateral temporal bone resection and the surgical defect was obliterated with temporal muscle . 
 he is currently disease - free , four years after surgery . 
 proper diagnostic measures and strategy for treatment of mucoepidermoid carcinoma are discussed .