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Ali Al-Aroomi M, Ahmed Mashrah M, Zhoulu, Zhou W, Du W, Sun C, Xie F. Superficial parotidectomy with or without great auricular nerve preservation: is there a difference in postoperative sensory recovery rates and quality of life? Br J Oral Maxillofac Surg 2022; 60:933-939. [DOI: 10.1016/j.bjoms.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/29/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022]
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Nam IC, Joo YH, Cho JH, Kim CS, Kim SY, Kim GJ, Park YH, Sun DI. Effects of an antiadhesive agent on functional recovery of the greater auricular nerve after parotidectomy: a double-blind randomized controlled trial. Eur Arch Otorhinolaryngol 2019; 276:3185-3193. [PMID: 31338575 DOI: 10.1007/s00405-019-05574-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Periauricular sensory deficit occurs frequently after parotidectomy even in cases with preservation of the greater auricular nerve (GAN). This study was performed to evaluate the effects of antiadhesive agent in functional recovery of the GAN after parotidectomy. METHODS Ninety-eight patients undergoing partial parotidectomy for benign parotid tumors were prospectively enrolled in this multicenter, double-blind randomized controlled study and randomly assigned to either the study or control group. Antiadhesive agent was applied in the study group. The results of sensory tests (tactile, heat, and cold sensitivity) and a questionnaire on quality of life (QoL) were acquired at postoperative 1, 8, and 24 weeks after surgery. Clinical parameters, and the results of the sensory tests and the questionnaire, were compared between the two groups. RESULTS A total of 80 patients were finally enrolled. On sensory evaluation, tactile sensation and warm sensation in the ear lobule, and warm sensation in the mastoid area, showed significant improvement at 24 weeks postoperatively in the study group. There were no significant differences between the two groups on any questions in the QoL questionnaire, at any follow-up time point. CONCLUSIONS Antiadhesive agents have some positive effects on functional recovery of the GAN after parotidectomy. Therefore, applying antiadhesive agents after parotidectomy can reduce discomfort in patients.
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Affiliation(s)
- Inn-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222 Baonpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222 Baonpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jung-Hae Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222 Baonpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Choung-Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222 Baonpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang-Yeon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222 Baonpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young-Hak Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222 Baonpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong-Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222 Baonpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Min HJ, Lee HS, Lee YS, Jeong JH, Cho SH, Lee SH, Kim KR, Park CW, Tae K. Is it necessary to preserve the posterior branch of the great auricular nerve in parotidectomy? Otolaryngol Head Neck Surg 2016; 137:636-41. [PMID: 17903583 DOI: 10.1016/j.otohns.2007.05.061] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 04/16/2007] [Accepted: 05/24/2007] [Indexed: 11/24/2022]
Abstract
Objectives To evaluate the necessity of preserving the posterior branch of the great auricular nerve during parotidectomy. Study Design and Setting Forty-six patients undergoing parotidectomy were prospectively analyzed. Twenty-four patients had preservation of the posterior branch of the great auricular nerve; in the remaining 22 patients the nerve was sacrificed. A sensory index score was defined as the area involved multiplied by the intensity grade of sensory loss. Quality-of-life was evaluated with a questionnaire. Results The sensory index score was significantly higher in the sacrificed group as compared with the preserved group at both 1 week (41.87 vs 62.11) and 1 month (24.91 vs 46.11) after parotidectomy. The sensory deficit improved over time in both groups, and after 12 months only minimal sensory loss remained. Quality-of-life was not significantly different between the groups. Conclusions Irrespective of preservation of the posterior branch of the great auricular nerve, sensory deficit improved over time. Therefore, preservation of the posterior branch of the great auricular nerve might not be necessary during parotidectomy.
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Affiliation(s)
- Hyun Jung Min
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Sensory dysfunction and quality of life after great auricular nerve sacrifice during parotidectomy: our experience. The Journal of Laryngology & Otology 2015; 129:1121-7. [PMID: 26264365 DOI: 10.1017/s0022215115001863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to investigate the impact on patients' quality of life of great auricular nerve sacrifice during parotidectomy. METHODS A retrospective review was conducted of 191 consecutive patients who underwent parotidectomy with great auricular nerve sacrifice between 2006 and 2011. Residual sensory dysfunction and its impact on quality of life was analysed using an eight-item quality of life survey. RESULTS In all, 139 out of 191 patients (72.8 per cent) experienced one or more abnormal sensations in the ear or neck region after surgery. There was a moderate inverse correlation between the number of abnormal sensations and time elapsed since surgery. Moreover, the degree of discomfort correlated significantly with the frequency of symptom occurrence (p < 0.001), duration of the abnormal sensation (p < 0.001) and size of the affected area (p < 0.001). CONCLUSION Sacrifice of the great auricular nerve has only a small impact on patient quality of life; their daily activities are not significantly affected.
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Great auricular nerve preservation in parotid surgery: rationale and long-term results insights. Eur Arch Otorhinolaryngol 2014; 272:3515-20. [PMID: 25381094 DOI: 10.1007/s00405-014-3342-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
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.
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George M, Karkos PD, Dwivedi RC, Leong SC, Kim D, Repanos C. Preservation of greater auricular nerve during parotidectomy: sensation, quality of life, and morbidity issues. A systematic review. Head Neck 2013; 36:603-8. [PMID: 23766239 DOI: 10.1002/hed.23292] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objectives were to assess the evidence of preservation of the greater auricular nerve in parotidectomy with regard to morbidity and quality of life. METHODS This was a systematic review. Inclusion criteria were: English literature, prospective and retrospective studies. Exclusion criteria were: single case reports, "teaching" reviews. Outcome measures were: tactile sensation, pain, thermal sensitivity, and quality of life. RESULTS Although quality of life does not seem to be adversely affected when the greater auricular nerve is sacrificed, preservation of the posterior branch was recommended in 8 studies. When preserving the nerve, the incremental operative time increase is no more than 10 to 5 minutes after a rapid learning curve. CONCLUSIONS There is level Ib evidence that preservation of the greater auricular nerve minimizes the postoperative sensory disturbance and should be considered whenever tumor clearance is not compromised. There is no evidence that overall quality of life is affected when the greater auricular nerve is sacrificed.
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Affiliation(s)
- Michael George
- Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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Sensation recovery of auricle following chronic ear surgery by retroauricular incision. Eur Arch Otorhinolaryngol 2011; 269:101-6. [DOI: 10.1007/s00405-011-1638-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
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Hu J, Ye W, Zheng J, Zhu H, Zhang Z. The feasibility and significance of preservation of the lobular branch of the great auricular nerve in parotidectomy. Int J Oral Maxillofac Surg 2010; 39:684-9. [DOI: 10.1016/j.ijom.2010.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 10/09/2009] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
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Colella G, Rauso R, Tartaro G, Biondi P. Skin Injury and Great Auricular Nerve Sacrifice After Parotidectomy. J Craniofac Surg 2009; 20:1078-81. [DOI: 10.1097/scs.0b013e3181abb358] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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de Ru JA, van Benthem PPG, Hordijk GJ. Morbidity of parotid gland surgery: results 1 year post-operative. Eur Arch Otorhinolaryngol 2006; 263:582-5. [PMID: 16506039 DOI: 10.1007/s00405-006-0016-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 09/09/2005] [Indexed: 11/24/2022]
Abstract
Patients operated on for parotid gland tumours were evaluated prospectively to study morbidity after this procedure. Nowadays, major complications such as recurrence of tumour and permanent facial nerve paresis are rare after primary surgery. Therefore, this study especially takes minor complications such as Frey's syndrome and sensory deficits into account. The study documents morbidity in 45 patients who completed a 1 year follow-up. Among those with primary benign tumours, we found no recurrences and no permanent paresis, nor did starch-iodine testing reveal any cases of Frey's syndrome. However, two patients who had previously been operated on multiple times did test positive for Frey's syndrome, as did two others after surgery for malignancy. Furthermore, we found that patients whose posterior branch of the great auricular nerve was sacrificed had a larger area of sensory deficit than those whose nerve was preserved. We conclude that the morbidity of parotid gland surgery can be reduced further by giving minor complications more attention.
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Affiliation(s)
- J Alexander de Ru
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Abstract
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 of morbidity 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.
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Affiliation(s)
- Robert L. Witt
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, Christiana Care Health Systems, Wilmington, Del
- Department of Otolaryngology, Jefferson Medical College, Philadelphia
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Hui Y, Wong DSY, Wong LY, Ho WK, Wei WI. A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy. Am J Surg 2003; 185:574-9. [PMID: 12781889 DOI: 10.1016/s0002-9610(03)00068-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Yau Hui
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Rd., Hong Kong, PR China.
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Moss CE, Johnston CJ, Whear NM. Amputation neuroma of the great auricular nerve after operations on the parotid gland. Br J Oral Maxillofac Surg 2000; 38:537-8. [PMID: 11010790 DOI: 10.1054/bjom.2000.0466] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We found an incidence of 6% (5/81) of traumatic neuroma after section of the great auricular nerve during operations on the parotid gland. Excision permits definitive diagnosis, the stump being allowed to retract beneath the belly of the sternomastoid muscle. However, excision is not always indicated, and the diagnosis can be made clinically allowing for a more conservative treatment policy.
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Affiliation(s)
- C E Moss
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK
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Christensen NR, Jacobsen SD. Parotidectomy. Preserving the posterior branch of the great auricular nerve. J Laryngol Otol 1997; 111:556-9. [PMID: 9231091 DOI: 10.1017/s0022215100137892] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The great auricular nerve is often sacrificed in superficial parotidectomy, even though its posterior branch often can be preserved. By cautious dissection of the great auricular nerve it is possible to preserve the posterior branch in 70.5 per cent of the operations. Ninety-five patients who had undergone superficial parotidectomy were included. A significantly higher number of patients had subjective sequelae if the posterior branch of the nerve had been cut, compared to the patients with a preserved nerve. A significantly higher rate of sensory morbidity was found if the nerve had been cut. In patients with a preserved posterior branch of the great auricular nerve there was no increase in other potential sequelae after parotidectomy. Therefore, this additional dissection should be considered, where appropriate, in routine parotid surgery.
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Affiliation(s)
- N R Christensen
- Department of Otolaryngology, Hillerød County Hospital, Denmark
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Abstract
A case is described in which division of the great auricular nerve during parotidectomy was complicated by perichondritis of the ear cartilage following self-inflicted injury. The desirability of preserving the posterior branch of the nerve whenever possible is stressed.
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Affiliation(s)
- M J Fardy
- Department of Oral and Maxillofacial Surgery, Morriston Hospital, Swansea
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