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

https://doi.org/10.1016/S0002-9610(03)00068-0Get rights and content

Abstract

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.

Section snippets

Patients and methods

This was a prospective study. All patients who underwent superficial or total conservative parotidectomy from January 1995 to December 1998 in our department were recruited. Patients with preoperative clinical suspicion of malignancy, fine-needle aspiration cytology evidence of malignancy, redo parotid operations, age over 65 years, and those with mental disability were excluded.

In the preoperative period, all patients received explanation on the risks of parotidectomy including morbidity

Results

Eighty-one patients conformed to our inclusion criteria and their data were used for analysis. There were 59 male (73%) and 22 female (27%) patients. Mean overall age was 47.9 years (range 18 to 64, SD = 12.5). Preservation of the posterior branches was achieved in 56 patients (69%). The GAN was divided in the remaining 25 patients (31%). The two groups of patients were comparable in terms of age, sex distribution, pathology, and tumor characteristics (Table 1).

The pattern of change in skin

Comments

The side effects of GAN sacrifice are a result of hypoasthesia in the area of skin it supplied. Patients have been reported to be unable to wear earrings [17], to experience discomfort when being touched or kissed [18], to be susceptible to burns and injuries [15], [16], to sustain cuts when shaving [18], or even forced to give up skiing owing to the discomfort felt in cold weather [18]. Preservation therefore appeared to be desirable. Preservation of the posterior branches of the GAN was

Conclusions

Preservation of the GAN is achievable in 69% of patients. The additional time required for surgical dissection is estimated to be about 5 to 10 minutes. Patients with GAN preservation showed faster and more complete recovery in sensory function. For patients with the nerve divided, recovery remained incomplete after 2 years and the subjective feeling of numbness often persisted.

With the above finding, the authors recommended that the posterior branches of the GAN should always be preserved in

References (31)

  • D.W Eisele et al.

    Salivary gland neoplasms

  • J Conley

    Search for and identification of the facial nerve

    Laryngoscope

    (1978)
  • J.R Saunders et al.

    Salivary glands

    Surg Clin North Am

    (1986)
  • J.M.S Johnstone et al.

    Operations on the neck and salivary glands

  • M Hobsley

    Parotidectomy

  • Cited by (56)

    • Great auricular nerve conservation and parotidectomy for tumor

      2023, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
    • Great auricular nerve conservation and parotidectomy for tumor

      2023, European Annals of Otorhinolaryngology, Head and Neck Diseases
    • Superficial parotidectomy with or without great auricular nerve preservation. Is there a difference in postoperative sensory recovery rates and quality of life?

      2022, British Journal of Oral and Maxillofacial Surgery
      Citation Excerpt :

      The great auricular nerve (GAN) is a somatic sensory nerve that responds to tactile, thermal, pruritic (itchy), and pain sensations in the skin overlying the lower aspect of the pinna and angle of the mandible.1 Its main trunk follows a consistent course over the middle of the sternocleidomastoid muscle and bifurcates into anterior lobular and posterior auricular branches.2 It is frequently sacrificed or unintentionally injured during parotid surgery.

    • Impact of great auricular nerve sacrifice on sensory disturbance after parotidectomy

      2022, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
      Citation Excerpt :

      The current body of literature shows somewhat conflicting evidence on whether GAN preservation is associated with improved sensation postoperatively. Most studies suggest a significant association between GAN sacrifice and postoperative sensory disturbance [1,2,3,5–11]. However, Porter et al. conducted a prospective study in 1997 with 31 patients which showed no statistically significant association between sensory loss and sacrificing the posterior branch of the GAN up to 12 months after surgery [12].

    View all citing articles on Scopus
    View full text