Tactile Sensation Recovery after Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: One of the common complications after parotidectomy is a decrease in skin sensation around the parotid gland. This is known to be associated with damage to the great auricular nerve (GAN). The purpose of this study was to investigate the pattern of tactile sensory recovery after parotidectomy and the difference in sensory recovery according to the preservation or sacrifice of the GAN. SUBJECTS AND METHOD: Fifty-two patients who underwent parotidectomy were enrolled in this study. The Touch Test Sensory Evaluator was used to measure the minimum tactile threshold value at 6 sites around the auricle before surgery and at 1 week, 1, 3, 6 and 12 months after surgery. RESULTS: The tactile threshold was the highest at 1 month after parotidectomy in all 6 sites. After 1 month, the threshold value gradually decreased until 12 months after surgery. However, the threshold was not completely recovered to the preoperative threshold level. At least one branch and the main trunk of GAN were preserved in 39 patients; one of GAN branches was preserved but the main trunk of GAN was partially injured in 3 patients, and the main trunk of GAN was completely injured in 10 patients. The tactile sensory recovery showed no significant differences in relation to the GAN status. CONCLUSION: The tactile sensory value kept decreasing up to one month following parotidectomy and then gradually recovered. However, the tactile sensory did not recover completely even one year after surgery. The GAN preservation did not affect tactile sensory recovery.

Communication of the anterior branch of the great auricular nerve with the cervical branch of facial nerve and its variant nerve endings deep in the parotid gland / Comunicación del ramo anterior del nervio auricular mayor con el ramo cervical del nervio facial y sus terminaciones nerviosas profundas variantes en la glándula parótida

The communications between the branches of cervical plexus and cervical branch of facial nerve are common and are well known. However, this communication usually occurs between the transverse cervical nerve and cervical branch of facial nerve. During routine dissection classes for the Medical undergraduate students, we came across an anatomical variant of anterior division of great auricular nerve. This variation was found in a 60-year-old male cadaver of South Indian origin and it was unilateral. The great auricular nerve arose from the loop of ventral rami of C2 and C3 spinal nerves and divided into anterior and posterior branches. The anterior branch ran obliquely upwards and forwards on the surface of the sternocleidomastoid muscle along with the external jugular vein towards the apex of parotid gland and divided into many branches. One of these branches gave a communicating branch to cervical branch of facial nerve outside the parotid gland. Nerve endings of the remaining branches were found to penetrate the interlobular septa and a few of them were seen deep in the gland along the ducts and near the vessels. The functional significance of anatomic variations of nerve endings in relation to ducts, thin vessels deep in the parotid gland, observed in the present case are yet to be evaluated...

Las comunicaciones entre los ramos del plexo cervical y ramo cervical del nervio facial son comunes y bien conocidos. Sin embargo, esta comunicación por lo general ocurre entre el nervio cervical transverso y el ramo cervical del nervio facial. Durante las clases de disección de rutina para los estudiantes de pregrado de medicina, nos encontramos con una variante anatómica de la división anterior del nervio auricular mayor, unilateral, en un cadáver de sexo masculino de 60 años, del Sur de la India. El nervio auricular mayor se originó desde el bucle de los ramos ventrales de los nervios espinales C2 y C3, y dividió en ramos anterior y posterior. El ramo anterior se dirigió oblicuamente hacia arriba y adelante sobre la superficie del músculo esternocleidomastoideo junto con la vena yugular externa hacia el ápice de la glándula parótida y se dividió en numerosos ramos terminales. Uno de estos ramos dió un ramo comunicante al ramo cervical del nervio facial fuera de la glándula parótida. Las terminaciones nerviosas de los ramos restantes penetraron en los septos interlobulares. Algunos de éstos se observaron profundos en la glándula a lo largo de los conductos y cerca de los vasos. La importancia funcional de las variaciones anatómicas de las terminaciones nerviosas en relación a los conductos y vasos finos profundos en la glándula parótida aquí observados aún no se han evaluado...

The great auricular nerve in fetuses / El nervio auricular mayor en fetos

The great auricular nerve (GAN) is the largest branch of the superficial cervical plexus that winds around the posterior border of the sternocleidomastoid muscle, accompanied by the external jugular vein. Forty fetuses (right side: 40/80; left: 40/80) with gestational ages between 15 to 28 weeks were microdissected to document the anatomy of the GAN. The results obtained were classified as: i) Incidence and morphometry: GAN was present in 100 percent of the fetal specimens with average length on the right and left sides recorded as 12.65 +/- 2.14 mm and 12.55 +/- 2.82 mm respectively. ii) Course: GAN was located parallel to the transverse cervical nerve and the external jugular vein. Duplicate external jugular veins were observed in 5 percent (4/80) with GAN located anterior to one of the tributaries; iii) Branching Pattern: 16 percent (13/80) of specimens depicted a single branch. Duplicate branches in 67 percent (54/80) (referred to as Type I: anterior and posterior branches and 33 percent (26/80) referred to as Type II: anterior and posterior branches; iv) Variation: the transverse cervical nerve formed a communication with GAN, inferior to the parotid gland in 1 percent. The anatomical knowledge of the course, bifurcation pattern and variations of GAN may prevent complications during surgical procedures such as parotidectomies.

El nervio auricular mayor (NAM) es el ramo más grande del plexo cervical superficial que gira alrededor del margen posterior del músculo esternocleidomastoideo, acompañado de la vena yugular externa. Cuarenta fetos (lado derecho: 40/80; izquierdo: 40/80), con edades gestacionales de 15 a 28 semanas fueron microdisecados para describir la anatomía del NAM. Los resultados obtenidos se clasificaron en: i) Incidencia y morfometría: NAM estaba presente en el 100 por ciento de las muestras fetales con una longitud media de los lados derecho e izquierdo de 12,65+/-2,14mm y 12,55+/-2,82mm, respectivamente. ii) Curso: NAM se encuentra paralelo al nervio cervical transverso y la vena yugular externa. Duplicación de las venas yugulares externas se observaron en el 5 por ciento (4/80) con el NAM situado por delante de uno de los afluentes, iii) Patrón de ramificación: 16 por ciento (13/80) de las muestras presentaba una solo ramo. Ramos duplicados en el 67 por ciento (54/80) de Tipo I, ramos anterior y posterior y, el 33 por ciento (26/80) Tipo II, ramos anterior y posterior, y iv) Variación: el nervio cervical transverso formando una comunicación con NAM, inferior a la glándula parótida en el 1 por ciento. El conocimiento anatómico del curso, patrón de bifurcación y variaciones del NAM pueden prevenir las complicaciones durante los procedimientos quirúrgicos como la parotidectomía.

Study on the clinical significance of conserving the greater auricular nerve in parotidectomy of benign parotid tumors / 中国基层医药

Objective To investigate the feasibility,technique and clinical significance of preserving the great auricular nerve in parotid benign tumors surgery during the first postoperative year.Methods Fifty-two patients with parotid benign tumors were randomly divded into 2 groups.24 patients (group sacrificed) underwent classic parotidectomy with sacrifice of the great auricular nerve.The surgeons spare the nerve in the 32 patients with FOCUS ultrasonic harmonic scalpel (group preserved).Results After surgery,both groups showed lower levels of subjective sensation and sensory function test at auricle.These alterations were less pronounced in group preserved.Both groups showed improvement over time.In group preserved the sensory function reached normal level by 12 months after surgery.The recuperation in group sacrificed was partial at 12 months after operation.Conclusion The great auricular nerve preservation during parotidectomy is feasible,It can decrease sensory disturbance in the early postoperative period and avoid the permanent sequelae that occur when the nerve is sacrificed.The FOCUS ultrasonic harmonic scalpel technique can reduce the operation time.