Function of the great auricular nerve following surgery for benign parotid disorders

Great auricular nerve preservation in parotid surgery: rationale and long-term results insights

“…In spite of that, we reported that sen-232 sitivity in the pre-auricular region (area 1) recovered 233 almost to the normal level in each group between 6 months 234 and 1-year, postoperatively. In fact, as reported in Table 1, 235 this is probably due to the presence of collateral 236 innervation from the mandibular branch of the trigeminal 237 nerve and to the presence of an accessory anterior branch 238 that splits up before going into the parotid gland [2,3]. 239 We obtained excellent results in every group also for the 240 superior auricle area (area 2).…”

“…From this 98 cohort, 20 patients from each group were randomly 99 selected by generation of random numbers in Microsoft 100 Excel software (version 2007) with use of the RAND 101 function. The total number of subjects in each group was 102 decided on the basis of the current English Literature in 103 which a sample size of 10-33 patients in each group is 104 considered representative [1][2][3].…”

“…40 During superficial or total parotidectomy great care is 41 taken to preserve the facial nerve, not the same attention is 42 used to preserve other structures such as the great auricular 43 nerve (GAN) [2], a sensory nerve that serves the skin of the 44 postero-inferior region of the auricle, the mastoid region 45 and the lower half of the parotid-masseteric region. GAN 46 originates from the anastomotic loop between the second 47 and third cervical nerves; after its origin, it passes around 48 the sternocleidomastoid muscle and it ascends along the 49 muscle until it divides into branches near the mandibular 50 angle [3]. GAN has three branches: the anterior branch 51 which leads to the parotid gland; the lobular branch which 52 goes to the auricular lobule; and the posterior branch which 53 goes to the posterior-auricular area.…”

Long‐term great auricular nerve morbidity after sacrifice during parotidectomy

“…This study did not divide follow‐up periods into categories nor provide a range of follow‐up times with any specific sensory dysfunction. Bigiloli et al9 found that, based on subjective reporting, 90% (9 of 10) patients who had undergone sacrifice of the GAN still had anesthesia at the angle of the mandible at a minimum of 8 years of follow‐up. In comparison, we found that 26% (5 of 19) of patients had anesthesia and 47% (9 of 19) of patients had paresthesia over their mandible body at 4 to 5 years (Tables III and IV).…”

“…Conventionally, surgeons have sacrificed the great auricular nerve (GAN) during parotidectomy to facilitate access to the parotid gland 1. Studies have shown that GAN sensory loss can lead to anesthesia, paresthesia, discomfort, functional deficits (e.g., difficulties wearing earrings and handling the telephone), an increased risk of traumatic injury, and an increase risk of neuromas 2–9. We published a study in 200610 that provided details of the degree of morbidity and recovery of the GAN in the first postoperative year after full sacrifice of anterior and posterior branches during parotidectomy.…”