Sensory disturbance after parotidectomy according to degree of great auricular manipulation.

backgroundAlthough preservation of the greater auricular nerve (GAN) during parotidectomy is standard, the magnitude of postoperative sensory discomfort according to degree of intraoperative manipulation remains controversial. We evaluated postoperative sensory outcomes and discomfort according to intraoperative GAN status of preserved, not identified, sacrificed, or stretched.

methodsThis retrospective cohort included 74 consecutive parotidectomy patients with ≥12 months follow up. GAN status was categorized as preserved (n = 16, 21.6%), not identified (n = 21, 28.4%,), sacrificed (n = 17, 23.0%), or stretched (n = 20, 27.0%). Patient reported numeric rating scales (NRS) for sensation loss, pain, and discomfort were recorded preoperatively and at 1, 6, and 12 months.

resultsMost patients underwent partial parotidectomy (96%) for pleomorphic adenoma (93%). Sensation loss at 1 month was similar among the groups (p = 0.057). At 6 and 12 months, these scores differed (both p < 0.001), with the most severe loss in the stretched group and the least severe in the not identified group. The stretched group showed the worst discomfort at 1, 6, and 12 months (all p < 0.001), peaking at 1 month and decreasing over time but remaining higher than the other groups at 12 months.

conclusionsIn this retrospective cohort, cases in which the GAN appeared to be stretched tended to report higher sensation loss and discomfort through 12 months compared with other intraoperative nerve states. Patients in whom the GAN was preserved without apparent stretching generally tended to show a more favorable patient-reported sensory profile over follow-up, whereas preservation accompanied by traction did not consistently translate into better long-term symptoms. This study suggests that preserving the GAN while minimizing excessive traction may help reduce persistent sensory symptoms when oncologically and technically feasible.