Effects of Preserving the Posterior Branch of the Greater Auricular Nerve at Parotidectomy on Postoperative Peri-Auricular Sensation

BACKGROUND AND OBJECTIVES: The posterior branch of the greater auricular nerve is a sensory nerve that serves the skin over the mastoid process and the postero-inferior region of the auricle. The greater auricular nerve is often sacrificed in parotidectomy, even though its posterior branch can be preserved. By cautious dissection of the greater auricular nerve it is possible to preserve the posterior branch in 69 per cent of the operations. However, the efficiency of this procedure is not clear. So, we have compared the patients whose nerve had been preserved with those sacrificed, to evaluate the validity of the posterior branch of greater auricular nerve preservation during parotidectomy. SUBJECTS AND METHOD: Thirty patients undergoing parotidectomy were divided into two groups. Fifteen patients underwent parotidectomy with preservation of the posterior branch of the greater auricular nerve (group A) and they were compared with fifteen patients who underwent parotidectomy with sacrificing the nerve (group B). Using questionnaire, we have researched about numbness, pain or other subjective symptoms on peri-auricular area after parotidectomy and the function of the nerve has been tested by two point tactile discrimination test and temperature sensitivity test. RESULTS: Postoperatively, twenty-nine patients felt lack of sensitivity, pain, itching or other symptoms. These symptoms recovered within 12 months, subjectively. However, in group B, permanent sensory loss was found in three patients. The two-point discrimination test revealed in group B, the decreased sensitivity on the operated side in comparison with the unoperated side (p=0.008). It also showed the decreased sensitivity on operated side in group B, compare with group A (p=0.012). CONCLUSION: From this study, despites of no significant difference on subjective symptoms, there was objective improvement on function of the greater auricular nerve. It seems reasonable to spare the greater auricular nerve during parotidectomy