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

  • Maged Ali Al-Aroomi
    Affiliations
    Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China

    Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
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  • Mubarak Ahmed Mashrah
    Affiliations
    Jibla University for Medical Sciences, Jibla Hospital, Ibb, Yemen
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  • Lu Zhou
    Affiliations
    Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
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  • Wanhang Zhou
    Affiliations
    Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
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  • Weidong Du
    Affiliations
    Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
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  • Changfu Sun
    Correspondence
    Corresponding authors at: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China (C. Sun). Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, Lanzhou, China (F. Xie).
    Affiliations
    Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
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  • Fuqiang Xie
    Correspondence
    Corresponding authors at: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China (C. Sun). Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, Lanzhou, China (F. Xie).
    Affiliations
    Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, Lanzhou, China
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Published:January 31, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.01.007

      Abstract

      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.

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      References

        • Murphy R.
        • Dziegielewski P.
        • O’Connell D.
        • et al.
        The great auricular nerve: an anatomic and surgical study.
        J Otolaryngol Head Neck Surg. 2012; 41: S75-S77
        • Hui Y.
        • Wong D.S.
        • Wong L.Y.
        • et al.
        A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy.
        Am J Surg. 2003; 185: 574-579
        • Biglioli F.
        • D’Orto O.
        • Bozzetti A.
        • et al.
        Function of the great auricular nerve following surgery for benign parotid disorders.
        J Craniomaxillofac Surg. 2002; 30: 308-317
        • Vieira M.B.
        • Maia A.F.
        • Ribeiro J.C.
        Randomized prospective study of the validity of the great auricular nerve preservation in parotidectomy.
        Arch Otolaryngol Head Neck Surg. 2002; 128: 1191-1195
        • Laccourreye H.
        • Laccourreye O.
        • Cauchois R.
        • et al.
        Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients.
        Laryngoscope. 1994; 104: 1487-1494
        • Colella G.
        • Rauso R.
        • Tartaro G.
        • et al.
        Skin injury and great auricular nerve sacrifice after parotidectomy.
        J Craniofac Surg. 2009; 20: 1078-1081
        • George M.
        • Karkos P.D.
        • Dwivedi R.C.
        • et al.
        Preservation of greater auricular nerve during parotidectomy: sensation, quality of life, and morbidity issues. A systematic review.
        Head Neck. 2014; 36: 603-608
        • Weinstein S.
        Fifty years of somatosensory research: from the Semmes-Weinstein monofilaments to the Weinstein Enhanced Sensory Test.
        J Hand Ther. 1993; 6 (discussion 50): 11-22
        • Robertson M.S.
        • Blake P.
        A method of using the tympanomastoid fissure to find the facial nerve at parotidectomy.
        Aust N Z J Surg. 1984; 54: 369-373
        • Ryan W.R.
        • Fee W.E.
        Long-term great auricular nerve morbidity after sacrifice during parotidectomy.
        Laryngoscope. 2009; 119: 1140-1146
        • Min H.J.
        • Lee H.S.
        • Lee Y.S.
        • et al.
        Is it necessary to preserve the posterior branch of the great auricular nerve in parotidectomy?.
        Otolaryngol Head Neck Surg. 2007; 137: 636-641
        • Baumann I.
        • Cerman Z.
        • Sertel S.
        • et al.
        Development and validation of the Parotidectomy Outcome Inventory 8 (POI-8). Measurement of quality of life after parotidectomy in benign diseases.
        HNO. 2009; 57 (In German): 884-888
        • Patel N.
        • Har-El G.
        • Rosenfeld R.
        Quality of life after great auricular nerve sacrifice during parotidectomy.
        Arch Otolaryngol Head Neck Surg. 2001; 127: 884-888
        • Brown A.M.
        • Wake M.J.
        Accidental full thickness burn of the ear lobe following division of the great auricular nerve at parotidectomy.
        Br J Oral Maxillofac Surg. 1990; 28: 178-179
        • Yan F.
        • Desiato V.M.
        • Nguyen S.A.
        • et al.
        Impact of greater auricular nerve sacrifice during parotidectomy on quality of life.
        Head Neck. 2021; 43: 70-78
        • Hu J.
        • Ye W.
        • Zheng J.
        • et al.
        The feasibility and significance of preservation of the lobular branch of the great auricular nerve in parotidectomy.
        Int J Oral Maxillofac Surg. 2010; 39: 684-689
        • Brown J.S.
        • Ord R.A.
        Preserving the great auricular nerve in parotid surgery.
        Br J Oral Maxillofac Surg. 1989; 27: 459-466
        • Christensen N.R.
        • Parotidectomy J.SD.
        Preserving the posterior branch of the great auricular nerve.
        J Laryngol Otol. 1997; 111: 556-559
        • Porter M.J.
        • Wood S.J.
        Preservation of the great auricular nerve during parotidectomy.
        Clin Otolaryngol Allied Sci. 1997; 22: 251-253
        • Suen D.T.
        • Chow T.L.
        • Lam C.Y.
        • et al.
        Sensation recovery improved by great auricular nerve preservation in parotidectomy: a prospective double-blind study.
        ANZ J Surg. 2007; 77: 374-376
        • Yokoshima K.
        • Nakamizo M.
        • Ozu C.
        • et al.
        Significance of preserving the posterior branch of the great auricular nerve in parotidectomy.
        J Nippon Med Sch. 2004; 71: 323-327
        • Moretti A.
        • Citraro L.
        • Petrucci A.G.
        • et al.
        Great auricular nerve preservation in parotid surgery: rationale and long-term results insights.
        Eur Arch Otorhinolaryngol. 2015; 272: 3515-3520
        • Grammatica A.
        • Mancini P.P.
        • Bozzola A.
        • et al.
        Great auricular nerve preservation in parotid gland surgery: long-term outcomes.
        Laryngoscope. 2015; 125: 1107-1112
        • Grosheva M.
        • Shabli S.
        • Volk G.F.
        • et al.
        Sensation loss after superficial parotidectomy: a prospective controlled multicenter trial.
        Head Neck. 2017; 39: 520-526
        • Bulut O.C.
        • Hohenberger R.
        • Oladokun D.
        • et al.
        Long-term quality of life and sensory impact of great auricular nerve preservation in parotid surgery as measured with the Parotidectomy Outcome Inventory-8.
        Clin Otolaryngol. 2019; 44: 743-748
        • Beutner D.
        • Wittekindt C.
        • Dinh S.
        • et al.
        Impact of lateral parotidectomy for benign tumors on quality of life.
        Acta Otolaryngol. 2006; 126: 1091-1095