Long‐term quality of life and sensory impact of great auricular nerve preservation in parotid surgery as measured with the Parotidectomy Outcome Inventory‐8

Abstract

Objectives: This study aimed to evaluate sensory dysfunction resulting from great auricular nerve (GAN) sacrifice versus preservation in parotid surgery for benign lesions and its imact on long-term health-related quality of life (QOL). Design: Retrospective.Setting/main outcome measures: Participants were divided into two groups (GAN and non-GAN), and both short-term (two postoperative weeks) and long-term (at least 5 years) QOL were assessed. The second item of the Parotidectomy Outcome Inventory-8 (POI-8) was used to analyse postoperative sensory loss. All items of the POI-8 questionnaire were used to determine health-related QOL.We used t test for dependent samples and Mann-Whitney U-test to compare patient groups Participants: A total of 137 patients (65 male and 72 female) enrolled in this study.Average age at the time of surgery was 53 years (±12.8).Results: The GAN preservation group had significantly better sensation than the GAN sacrifice in short term (2.8 vs 2.1; P = 0.017). Both groups experienced improved sensation in the long term, and there was a trend towards better QOL in the GAN-preservation group. However, the difference in sensation was not statistically significant (1.7 vs 1.3; P = 0.145). Health-related QOL also increased in the long term (compared to short term) for both groups (7.6 ± 6.2 to 12 ± 7.6; P < 0.0001) postoperatively. GAN preservation did not significantly improve sensation in long term, nor did it increase health-related QOL postoperatively. Conclusion:Although GAN preservation was easily feasible, it only improved sensation in short term. We report a negative result: GAN preservation did not significantly improve sensation in long-term, nor did it increase health-related QOL postoperatively when compared to GAN sacrifice.

Long-term Outcomes and Quality of Life Following Parotidectomy for Benign Disease: A Cohort Study

“…reported that GAN preservation did significantly improve sensation in short-but not in long-term, nor did it increase QOL in long term when compared to GAN sacrifice [13]. Based on the observation period of 12-16 years after parotidectomy, we could show that hypoesthesia significantly improved over the years (p < 0.001) but still remains without limiting patients in QoL, a clinically relevant finding here.…”

“…Consequently, patients should be preoperatively informed about the possible prolonged or permanent hypoesthesia. According to data of Bulut et al [13], we only found a positive association between intraoperative preservation of the GAN and improved hypoesthesia in the ST-cohort (p = 0.028), not in the LT-cohort. Finally, we can conclude that patients seem to adapt to the postoperative functional impairment over time and focus less on the reduced ability to feel temperature and pain on the facial skin over the parotid gland and auricle.…”

“…Thus, subjective perception of post-parotidectomy complications might be influenced by these mentioned factors unrelated to surgery [2] as disadvantage of self-reported measures. Besides, no objective testing method exists for accurate evaluation of QOL in the head and neck region [13]. Another limitation of our study is the different group size in the ST-, LT-and SLT-cohort.…”

“…Key goal in parotid surgical approaches for treatment of benign lesions is not only to remove the entire tumour and to minimize morbidity but also to maintain patients' quality of life. However, only few studies address patients' perspective on complications and the related QoL [5,[7][8][9][11][12][13], but predominantly in a short followup after parotidectomy -usually 6 months or 1-2 years -and by using different symptom-specific QoL assessments. Beutner et al [8] reported no changes in QoL in 34 patients one year after superficial parotidectomy for benign diseases compared with preoperative answers using the EORTC QLQ-C30…”

“…Nitzan et al utilized a modified version of the University of Washington Quality of Life Questionnaire and could detect subjective sequelae like altered sensation, change in appearance, Frey's syndrome and pain during at least 1-year follow-up period which did not significantly affect QoL [9]. New data of Bulut et al described for the first time a significant increase in QOL in the long term (100 months postoperatively) compared to short term (2 weeks postoperatively) by focusing on sensory dysfunction resulting from great auricular nerve (GAN) sacrifice versus preservation in parotid surgery [13]. Since most studies have only a short follow-up, it raises the question what impacted the patients the most on QOL more than 10 years after parotidectomy.…”