Skin injury and great auricular nerve sacrifice after parotidectomy

The great auricular nerve (GAN) is often sacrificed during parotidectomy, and one of the most important side effect is anesthesia of the region innervated by the nerve itself. The GAN across the sternocleidomastoid muscle toward the parotid gland divides into anterior and posterior branches. Little importance is given to the GAN sacrifice sequela, and it is considered a small price to pay for the removal of the main disease.

The medical records of all patients who underwent parotid gland surgery from 1993 to 2007 in the Department of Head and Neck Surgery of an academic tertiary care referral center were reviewed. Three patients are observed in which division of the anterior and posterior superficial branches of the GAN during parotidectomy were complicated by self-inflicted injury.

Three cases of self-inflicted skin lesion after GAN sacrifice during parotidectomy are reported. In the first patient, the lesion was at the skin of the cheek, whereas in the other patients, the lesions were localized at the earlobe. The first patient revealed a severe lesion of the skin shaving due to numbness of the preauricular area. A psychiatric postoperative evaluation showed an obsessive-compulsive disorder in the other 2 patients.

The small number of reports in the literature and our data suggest that the most patients who experienced abnormal symptoms did not report any significant degree of interference with their daily activities, but our patients could emphasize the desirability of preserving the GAN when surgical or oncological results would not be compromised.