Great Auricular Nerve Morbidity After Nerve Sacrifice During Parotidectomy

Abstract

To clarify the extent, timing, and patient perspectives of great auricular nerve (GAN) morbidity and recovery after nerve sacrifice during parotidectomy during the first postoperative year.Design: Prospective series.Setting: Tertiary care academic medical center.Patients: Twenty-seven consecutive patients who underwent parotidectomy with GAN sacrifice.Main Outcome Measures: Preoperatively and at 3, 6, 9, and 12 months postoperatively, we performed light touch sensation tests on each patient to develop an ink map representing anesthesia and paresthesia in the GAN sensory territory; patients also completed an outcomes questionnaire.Results: Twenty-two (81%) of 27 patients completed follow-up. The prevalence and average area of anesthesia decreased continually during the first year according to sensory testing and patient scoring. Half of the patients had no anesthesia at 12 months. The prevalence and average area of paresthesia increased during the first year according to sensory testing; however, the contiguity and subjective scoring of paresthesia peaked at 6 months and decreased in subsequent follow-up points. Throughout the first year, patients had difficulty using the telephone, shaving, combing their hair, wearing earrings, and sleeping on the operative side because of both anesthesia and paresthesia. Conclusions:The impact of GAN sacrifice morbidity on patient quality of life is tolerable and improves during the first postoperative year. However, we feel that GAN morbidity may be bothersome enough to warrant efforts to preserve the posterior branch of the GAN when possible and appropriate.

The feasibility and significance of preservation of the lobular branch of the great auricular nerve in parotidectomy

“…In previous studies 1, 3,4,6,8,9,[11][12][13][14] , most authors compared sensory recovery within the GAN sacrifice group and the GAN preservation group. In the latter group, parotidectomy was performed with the posterior branch of GAN preserved.…”

Comparing Modified with Conventional Parotidectomy for Benign Parotid Tumors

“…In order to prevent ear lobule numbness, many surgeons have advocated that preservation of the posterior branch of the GAN during surgery could reduce the incidence of numbness [7,8]. In the present study, the anterior branch of the GAN was amputated; meanwhile, the posterior auricular branch was preserved.…”

“…The GAN and FN were identified and dissected. The branches of the GAN to the parotid gland were cut, while the posterior branch was preserved [7,8]. At the same time, the main trunk of the FN was identified, and the FN branches adjacent to the tumor were dissected and preserved without extensive dissection of the FN branches outside the tumor-bearing area.…”

“…With these favorable developments in reducing the incidence of recurrent disease and permanent FN paralysis, attention gradually shifted to other sequelae of parotid surgery, including ear lobule numbness, cosmetic problems, and Frey syndrome. Several modifications have been implemented to preserve the posterior branch of the great auricular nerve (GAN) [7,8], to develop a facelift incision, and to preserve the parotid gland fascia [6,9]. …”

Hidden scar or its absence: is it always safe?

“…In addition to that most patients accept superficial explanations that the numbness around the ear is an inevitable consequence of the operation, and a cheap price to pay for the results achieved. However, such injuries could be symptomatic [3].…”