Great Auricular Nerve Preservation Improves Outcome of Superficial Parotidectomy

Abstract

Introduction:The present study aimed to evaluate the applicability and value of great auricular nerve (GAN) preservation on sensory recovery of supplied dermatomes after superficial parotidectomy. Patients and Methods: The study included 35 patients; 23 males and 12 females with mean age of 5110.2±; range: 2962-years. All patients presented by unilateral swelling in the parotid region and underwent superficial parotidectomy. The GAN was identified at the point just beneath the lobule (for branches identification) and at the point on the sternoclienomastoid muscle beside the external jugular vein (for trunk identification). The anterior branch is usually sacrificed while the posterior superficial and deep branches were preserved. Touch sensation of ear lobule and the infraauricular area was evaluated using a cotton swab and represented on 100-point visual analogue scale (VAS) with 0=no sensation of the pinna and 100= no difference in sensation compared to that of the other side. The quality of life (QOL) after parotidectomy was evaluated using a similar VAS with 0=a feeling of severe discomfort; while 100=no discomfort or difficulties. VAS scores were evaluated 2-weeks, 1, 2, 3 and 6-months after surgery. Results: Posterior branches of GAN could be preserved in 23 cases (65.7%) while the nerve was thin and could not be preserved in 8 cases and was adherent and could not be dissected in the remaining 4 cases, thus GAN was excised in 12 cases (34.3%). Mean VAS scores showed a significant increase at each time of examination compared to the previous records up to 3-months after surgery; but VAS scores recorded at 6-months after surgery were non-significantly higher compared to that recorded at 3-months. Recorded VAS scores at 2, 3 and 6 months after surgery were significantly higher in patients with preserved GAN compared to those with excised GAN. At 6-months after surgery, only 6 patients (26.5%) with preserved GAN had sensation score of <50, while the other 17 patients (73.5%) had sensation score of >50, whereas all patients with excised GAN had sensation score of <50. Number of patients with preserved GAN who had high sensation scores was significantly higher compared to those with excised GAN. Conclusion: It could be concluded that preservation of posterior branches of GAN is feasible and improves the outcome of superficial parotidectomy with significant preservation of sensation of earlobe and the infraauricular area and improved quality of life.