Injuries of the great auricular nerve in rhytidectomy

The great auricular nerve is most frequently injured in the course of rhytidectomy. Frequency of such injuries is many times higher than that of all other nerves combined. Estimate of such frequency cannot be obtained because many surgeons pay little attention to this complication. Patients often accept the discomfort of anesthesia of the external ear as a normal sequel of the operation, although an occasional neurotic patient may complain of the sensation of having his ear cut off. If the proximal end of the cut nerve becomes attached to the skin flap, neuroma will cause a trigger point on the lateral part of the neck. This may lead to a bizarre complaint of migraine-like pain on the side of the face. Two patients with neuroma of the great auricular nerve were seen, 1 and 2 years, respectively, after rhytidectomy. Diagnosis was confirmed by an operation. Repair of this nerve, either at the time of the operation or several years later, has a very favorable prognosis.The anatomy of this nerve and the precautions necessary to avoid injury during rhytidectomy will be discussed.