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

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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

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