Great Auricular Nerve Preservation Research Articles

Evaluation of The Results of Preservation of Great Auricular Nerve during Parotid Surgery

Evaluation of The Results of Preservation of Great Auricular Nerve during Parotid Surgery

Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors

Limited literature exists on surgical outcomes after selective deep lobe parotidectomy (SDLP) with preservation of superficial lobe for patients with benign deep lobe tumors. To compare the following factors for SDLP vs total parotidectomy for patients with benign tumors in the deep lobe: postoperative complications, including facial nerve paresis or paralysis, Frey syndrome, first bite syndrome, cosmetic defect, sialocele formation, and wound infection; and tumor control and recurrence. This case series included 273 adults who underwent SDLP (n = 177) or total parotidectomy (n = 96) at a single tertiary care institution for benign parotid tumors located in the deep lobe or deep lobe and parapharynx from January 1, 2000, to December 31, 2020. Selective deep lobe parotidectomy vs total parotidectomy. Incidence of postoperative complications and tumor recurrence. Among 273 patients (SDLP, 177 [65%]; 122 women [69%]; median age at surgery, 58 years [IQR, 46-67 years]; total parotidectomy, 96 [35%]; 57 women [59%]; median age at surgery, 59 years [IQR, 40-68 years]), the most common tumor was pleomorphic adenoma (SDLP, 128 of 177 [72%]; total parotidectomy, 62 of 96 [65%]). An abdominal dermal fat graft was less commonly performed for patients who underwent SDLP than those who underwent total parotidectomy (2 of 177 [1%] vs 20 of 96 [21%]; difference, -20% [95% CI, -28% to -11%]). The rate of great auricular nerve preservation was higher in the SDLP group than in the total parotidectomy group (84 of 102 [82%] vs 20 of 34 [59%]; difference, 24% [95% CI, 5%-42%]). No meaningful difference in length of hospital stay was found. The percentage of patients with House-Brackmann grade I immediately after surgery was 48% (85 of 177) in the SDLP group and 21% (20 of 96) in the total parotidectomy group (difference, 28% [95% CI, 16%-40%]). There were no clinically meaningful differences in rates of hematoma, sialocele, seroma, ear numbness, wound infection, or unplanned return to emergency department or operating room. The SDLP group reported a lower rate of Frey syndrome than the total parotidectomy group (1 of 137 [1%] vs 12 of 78 [15%]; difference, -15% [95% CI, -23% to -7%]), as well as a lower rate of facial contour defect (28 of 162 [17%] vs 25 of 84 [30%]; difference, -13% [95% CI, -24% to -1%]) and a higher rate of first bite syndrome (34 of 148 [23%] vs 7 of 78 [9%]; difference, 14% [95% CI, 5%-23%]). The percentage of patients with House-Brackmann grade I at their first follow-up visit was 67% (118 of 177) in the SDLP group compared with 49% (47 of 96) in the total parotidectomy group (difference, 17% [95% CI, 4%-30%]). There was no clinically meaningful difference in House-Brackmann grade after 1 year. Findings of this case series study suggest that SDLP can be considered an effective and even superior technique for management of benign tumors in the deep parotid lobe. Advantages associated with SDLP include reduction in need for reconstruction for facial contour defect and reduction in complications, such as immediate facial nerve weakness and Frey syndrome. The incidence of first bite syndrome was higher in the SDLP group. Tumor control was not compromised by SLDP.

Great auricular nerve conservation and parotidectomy for tumor

ObjectiveTo describe the key technical points for preserving the great auricular nerve during parotidectomy for tumor, and to discuss the literature regarding the benefits, limitations and indications for nerve-sparing surgery. Data suggested that great auricular nerve preservation should be discussed in the preoperative consultation, attempted intraoperatively and mentioned in the operative report once parotidectomy completed.

Impact of great auricular nerve sacrifice on sensory disturbance after parotidectomy

PurposeTo investigate the association between great auricular nerve (GAN) sacrifice during parotidectomy and postoperative sensory disturbance. Materials and methodsPatients who underwent parotidectomy between November 2016 and May 2020 at a single academic institution were included in this retrospective chart review. Operative notes were reviewed to determine incidence of GAN sacrifice. Prevalence of patient-reported sensory complaints in the GAN distribution and time to spontaneous resolution of symptoms were assessed. ResultsOf 305 parotidectomy patients, 111 (36.4%) endorsed complaints of postoperative sensory disturbances in the GAN distribution typically characterized by numbness or shooting pains. GAN sacrifice was present in 9 (8.1%) of 111 patients who experienced sensory disturbances compared to 9 (4.6%) who reported no sensory disturbances (p > 0.05). Twenty-five patients (32.5%) experienced spontaneous resolution of symptoms at their most recent follow-up at a mean of 6.2 months after onset of symptoms. Of those that experienced a sensory disturbance, GAN preservation was not significantly associated with likelihood of spontaneous recovery (p > 0.05). ConclusionsWe report the largest series to date of post-operative sensory disturbance in parotidectomy patients as it relates to intraoperative GAN sacrifice. Although the relationship between GAN sacrifice and the incidence of postoperative sensory disturbance and its subsequent resolution were not significant, we continue to advocate for GAN preservation to reduce incidence of postoperative sensory disturbances.

Superficial parotidectomy with or without great auricular nerve preservation. Is there a difference in postoperative sensory recovery rates and quality of life?

The clinical implications of great auricular nerve (GAN) preservation or sacrifice during parotid surgery have long been a topic of controversy. This study aimed to compare sensory recovery rates and quality of life (QoL) in patients who had undergone superficial parotidectomy and had their GAN preserved or sacrificed. Fifty patients were prospectively analysed, 28 with the GAN preserved, and 22 with it sacrificed. The primary outcomes were tactile sensitivity and QoL. The secondary outcomes were operating times and other complications. There was a gradual improvement in tactile sensitivity in both groups, which showed a statistically significant difference favouring the preserved group at 1, 3, 6, and 9 months postoperatively (p<0.05). There was no statistically significant difference in tactile sensation for both groups at 12 months postoperatively. The overall sensory recovery rates in the GAN preserved and sacrificed groups after 1, 3 ,6, 9 and 12 months were 42.8%, 42.8%, 57.1%, 57.1%, and 78.5%, and 0%, 0%, 13.6%, 27.3%, and 59.1%, respectively. According to the QoL assessment, there was a significant difference in mean (SD) loss of sensation scores (sacrificed group 0.86 (0.94) and preserved group 0.39 (0.62), p= 0.039). However, there were no statistical differences between the groups regarding other categories of the questionnaire. No significant difference was seen between groups regarding operating time and other complications. This study concluded that when evaluated objectively, sensory impairment ultimately lessened in severity in the second half of the first postoperative year. GAN preservation minimised sensation disturbance in long-term results, but overall QoL seemed to be unaffected following GAN preservation or sacrifice.

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

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). Retrospective. Participants were divided into two groups (GAN and non-GAN), and both short-term (two postoperative weeks) and long-term (at least 5years) 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 53years (±12.8). 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. 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.

Great auricular nerve preservation in parotid gland surgery: Long-term outcomes.

To assess sensory outcomes and quality of life (QoL) in two groups of patients with and without great auricular nerve (GAN) preservation during parotidectomy. Retrospective chart review. The posterior branch of the GAN was preserved in 42 patients (group A) and sacrificed in 13 (group B). Tactile, heat, and cold sensitivities were investigated by dividing GAN territory into seven areas. Comparisons between operated (OS) and nonoperated sides (NS) within each group, and between the OS of the two groups were made. The QoL questionnaire was administered. In group A, normal tactile, heat, and cold sensitivities ranged from 16.7% to 66.7%, 11.9% to 73.8%, and 21.4% to 81%, respectively, in different OS areas. Significant differences between OS and NS were found, except for the preauricular superior area. In group B, normal tactile, heat, and cold sensitivities ranged from 0% to 61.5%, 0% to 53.8%, and 7.7% to 76.9%, respectively, in different OS areas. Significant differences between OS and NS were found except for the preauricular superior (tactile sensitivity), and preauricular superior and helix/concha areas (cold sensitivity). Comparing the OS tactile and thermic sensitivities between the two groups, only the lobule area showed differences. The preauricular inferior area was different only for heat. The QoL questionnaire showed different hypoesthesia extension between the two groups. All other items were comparable. Sensory deficits are commonly reported despite GAN preservation. Lobule and preauricular inferior areas showed differences in terms of tactile and thermic sensitivities, with better outcomes in group A. QoL seems tolerable despite GAN sacrifice. 4

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

Great auricular nerve (GAN) is frequently sacrificed during parotid surgery. GAN preservation during parotidectomy is advised to avoid complications such as sensitive disorders, but debate still exists. In this study, our experience is reported on the matter. From a cohort of 173 parotidectomies carried out in the period 2005-2010, we studied 60 patients: 20 patients in which we preserved only the posterior branch of GAN (group A), 20 patients in which we preserved also the lobular branch (group B) and 20 patients in which the main trunk of GAN was sectioned (group C); we evaluated tactile sensitivity in all the skin supplied by GAN at 1 week, 1 month, 6 months and 1 year after surgery. Group B is the best in terms of loss and recovery of sensitivity after 1-year post-surgery, followed closely by group A, on the contrary group C confirmed to be the worst. Results suggest that saving as many branches of the GAN as possible during parotid surgery could be useful for reducing hypo-dysesthesia. Preserving posterior and lobular branches of the GAN, when possible, improves the sensitivity of the preauricular area with better quality of life for the patient.

Great Auricular Nerve Preservation During Parotidectomy for Benign Tumors

The great auricular nerve, the largest sensory branch of the cervical plexus, arises from the third cervical nerve (C3) with irregular contribution from the C2. The first part of its course is deep to the sternocleidomastoid muscle. In few years, many experiences by different authors concerning the issue of great auricular nerve integrity during parotidectomy were published in the literature. The aims of our article were to report our experience with 78 consecutive patients who underwent standard superficial, subtotal, or total parotidectomy for benign tumors and to illustrate postsurgical findings regarding the sensibility of the pinna and mandibular angle as subjectively reported in the early postsurgical period and after 3, 6, and 12 months from surgery.

Improving the quality of life of parotid surgery patients through a modified facelift incision and great auricular nerve preservation.

Postoperative quality of life after parotidectomy depends not only on surgical outcomes, such as the complete removal of a tumour, non-recurrence and the preservation of facial nerve function, but also on scar satisfaction and the degree of sensory dysfunction in the upper cervical area and at the ear lobe.Especially young patients and women consider the scar in the infra-auricular area and in the neck region to be distressing and even disfiguring. Resection of the great auricular nerve leads to paraesthesia and hypoesthesia, which leads to discomfort in many patients especially when using the telephone, shaving or wearing earrings. A modified approach to the parotid gland via a facelift incision and the careful exposure of the great auricular nerve can reduce the aforementioned problems considerably and improve postoperative quality of life. We present our experiences with the modified approach at our institution.

Study on the clinical significance of conserving the greater auricular nerve in parotidectomy of benign parotid tumors

Objective To investigate the feasibility,technique and clinical significance of preserving the great auricular nerve in parotid benign tumors surgery during the first postoperative year.Methods Fifty-two patients with parotid benign tumors were randomly divded into 2 groups.24 patients (group sacrificed) underwent classic parotidectomy with sacrifice of the great auricular nerve.The surgeons spare the nerve in the 32 patients with FOCUS ultrasonic harmonic scalpel (group preserved).Results After surgery,both groups showed lower levels of subjective sensation and sensory function test at auricle.These alterations were less pronounced in group preserved.Both groups showed improvement over time.In group preserved the sensory function reached normal level by 12 months after surgery.The recuperation in group sacrificed was partial at 12 months after operation.Conclusion The great auricular nerve preservation during parotidectomy is feasible,It can decrease sensory disturbance in the early postoperative period and avoid the permanent sequelae that occur when the nerve is sacrificed.The FOCUS ultrasonic harmonic scalpel technique can reduce the operation time. Key words: Parotid tumor; Parotidectomy; Great auricular nerve

Comparative Study of Sensation with or without Preservation of Great Auricular Nerve during Parotidectomy

Received December 9, 2010 Revised January 25, 2011 Accepted January 26, 2011 Address for correspondence Joon Kyoo Lee, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun 519-763, Korea Tel +82-61-379-7760 Fax +82-61-379-7761 E-mail joonkyoo@chonnam.ac.kr Background and ObjectivesZZWhether to sacrifice the posterior branch of great auricular nerve (GAN) during parotidectomy is disputatious. This study was to provide a guideline for decision-making. Subjects and MethodZZThirty-two patients who underwent parotidectomy due to parotid mass were randomized into two groups. Three patients who underwent further treatment were excluded. Fourteen patients underwent classic parotidectomy by sacrificing GAN whereas 15 patients underwent surgery that preserved the nerve. A two-point discrimination test, sensation of light touch, sharp instrument, blunt instrument and temperature were evaluated preoperatively, and at 7 days, 1, 3, 6, 12 months and 45 months, postoperatively. Patients’ preference for the operation time to preserve the nerve was also evaluated. ResultsZZThe mean preservation time was 156 seconds. There was no difference in touch sensation, preoperatively, between the two groups. The two-point discrimination test of the infra-auricular area showed significant differences at 1 week postoperatively (p<0.05). The two-point discrimination test of lobule showed significant differences at 1 month (p<0.05), but these differences disappeared at 1 and 3 months. All measured data had no statistically sig-nificant differences at 3 and 6 months. At one year, light touch sensation of lobule and temperature sensation of infra-auricular area showed significant differences (p<0.05). Differences in temperature were found at 45 months of follow-up. Of the patients, 95% wanted to preserve the nerve. ConclusionZZThe authors suggest that the posterior branch of GAN was preserved according to patients’ preference for the sensation of temperature in the infra-auricular area. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:208-12

A comparison between endoscope-assisted partial parotidectomy and conventional partial parotidectomy

To report the feasibility of endoscope-assisted parotidectomy with an ultrasonic scalpel. Randomized clinical trial. A total of 38 patients were randomly assigned to conventional (20 patients) or endoscope-assisted (18 patients) partial parotidectomy. Via retrograde approach, endoscopic and surgical instruments were inserted through two 20- to 25-mm incisions (retromandibular and postauricular). The endoscopic surgery lasted for 108.61 +/- 11.86 minutes and the bleeding volume was significantly lower than in the conventional group. All 18 patients were satisfied with their cosmetic results; 14 patients (65%) were satisfied with the great auricular nerve preservation; only one patient had temporary facial paresis and salivary fistula. There was no tumor recurrence in both groups during the follow-up after 26 to 40 months) the endoscope-assisted parotidectomy group (median 30 months, range 26-40 months) and conventional group (median 32 months, range 26-40 months). Endoscope-assisted parotidectomy is a feasible technique. This procedure may serve as an alternative approach that allows a smaller incision.

SENSATION RECOVERY IMPROVED BY GREAT AURICULAR NERVE PRESERVATION IN PAROTIDECTOMY: A PROSPECTIVE DOUBLE‐BLIND STUDY

The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery. Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two-point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long-term subjective assessment was also carried out beyond 2 years postoperatively. A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12-42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation. Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised.

Minimally Invasive Surgery for Parotid Pleomorphic Adenoma

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve--defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve--is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved To test this hypothesis, the author conducted a retrospective study of 30 patients--15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms ofmorbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.

Minimally invasive technique of parotidectomy for benign parotid tumors

To evaluate a minimally invasive technique of parotidectomy in treatment of benign parotid tumors. This retrospective review included 49 patients with benign parotid gland tumors. The modified technique included incision, flap elevation, facial nerve dissection, the great auricular nerve preservation and postoperative disposal. All tumors were resected completely. The operation lasted 1.5 approximately 2.5 h; the average length of incisions was from 5.5 cm to 7.5 cm, and the average postoperative hospital stay was 4 days. There were no permanent facial nerve injury, no obvious scars and no depressed deformity observed postoperatively. During the 6 months approximately 5 years following-up, no tumor recurrence was found. The minimally invasive technique of parotidectomy reduces the disadvantages of the traditional procedure, and improves the quality of operation.T.

A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy

Background Earlier reports of the advantages of preservating the posterior branches of the great auricular nerve (GAN) at parotidectomy were conflicting. This prospective study was aimed at clarifying the controversy. Methods Eighty-one patients in a university otolaryngology department were recruited. The posterior branches were preserved whenever initial dissection showed that tumor clearance would not be compromised. Touch-pressure sensation was monitored in predefined territories supplied by the GAN using a Semmes-Weinstein aesthesiometer, preoperatively and postoperatively. Minimal pressure thresholds obtained were compared between the two groups. Results Preservation of the GAN was achievable in 69% of patients; sensory deficit was transient. With the GAN divided, measurable sensory depression occurred up to 2 years after surgery. The difference is statistically significant. Patients’ subjective assessment of numbness also conformed to these trends. Additional time taken for preservation of the GAN was about 10 minutes. Conclusions The posterior branches should always be preserved if tumor clearance is not compromised.