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Quality of Life After Great Auricular Nerve Sacrifice During Parotidectomy

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Quality of Life After Great Auricular Nerve Sacrifice During Parotidectomy ORIGINAL ARTICLE Quality of Life After Great Auricular Nerve Sacrifice During Parotidectomy Nilesh Patel, MD; Gady Har-El, MD; Richard Rosenfeld, MD, MPH Objective: To determine the impact of great auricular Even among patients experiencing symptoms, 23 (77%) nerve (GAN) sacrifice during parotidectomy on pa- reported only a little or no bother caused by the symp- tients’ quality of life. toms, and 27 (90%) reported no interference or almost none with their daily activities. The degree of bother or Design: Historical cohort survey of patients who had interference reported had a moderate positive correla- undergone GAN sacrifice during parotidectomy. tion with the number of abnormal sensations reported. Setting: Tertiary academic otolaryngologic practice. Conclusions: The results suggest that, while many pa- tients experienced sensory deficits, the overall quality of Patients and Methods: Fifty-three patients who had life was not significantly affected after GAN sacrifice dur- undergone GAN sacrifice during parotidectomy com- ing parotidectomy. Patients who report multiple abnor- pleted an 8-item quality-of-life survey with a 7-point re- mal sensations, however, would benefit from additional sponse scale designed to measure outcome after GAN sac- counseling and from reassurance that the number of sen- rifice during parotidectomy. sations will diminish with time. Further study evaluat- ing the effect of preservation of the posterior branch of Results: Thirty patients (57%) reported experiencing at the GAN during parotidectomy on patients’ quality of life least 1 abnormal symptom, but the mean number of symp- is needed. toms decreased significantly with time, from a mean of 2.3 during the first year to 0.2 after 5 years (P,.001). Arch Otolaryngol Head Neck Surg. 2001;127:884-888 AROTIDECTOMY IS a rela- the mandible, while the posterior branch tively common surgical pro- innervates the skin over the mastoid, the cedure for treatment of pa- posteroinferior surface of the auricle, the rotid neoplasms and is lobule, and the concha. occasionally performed for Although clinical experience and an- Pinflammatory and autoimmune condi- ecdotal reports clearly identify morbidity tions. Potential complications include associated with GAN sacrifice during pa- hemorrhage, infection, seroma forma- rotidectomy, no study has systematically tion, salivary fistula, keloid formation, fa- evaluated the short- and long-term con- cial nerve paralysis or paresis, auriculo- sequences on patients’ quality of life. In ad- temporal syndrome (gustatory sweating or dition, there has been some interest in the Frey syndrome), and great auricular nerve preservation of the posterior branch of the (GAN) anesthesia.1-3 While much atten- GAN, when feasible, to decrease surgical tion and discussion is focused on facial morbidity.4-6 The purpose of this cohort nerve injury and Frey syndrome, conse- study was to evaluate the quality of life af- quences of GAN sacrifice have not been ter GAN sacrifice during parotidectomy well studied. and thereby provide a basis of compari- The GAN is a sensory nerve arising son for future studies with preservation of from fibers of the second and third cervi- the posterior branch of the GAN. cal rami. As it ascends across the sterno- cleidomastoid muscle toward the parotid RESULTS From the Department of gland, it divides into anterior and poste- Otolaryngology, State rior branches. The anterior branch pro- The study sample consisted of 53 pa- University of New York Health vides sensory innervation to the skin over- tients who underwent GAN sacrifice dur- Science Center at Brooklyn. lying the parotid gland and at the angle of ing parotidectomy between June 16, 1993, (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 127, JULY 2001 WWW.ARCHOTO.COM 884 ©2001 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 Thank you for taking the time to answer the following questions regarding PATIENTS AND METHODS your parotid surgery. Please answer as accurately as possible. 1) Please check any of the following sensations you may be experiencing around your ear or neck since your surgery. The cohort for the study consisted of 75 patients ❏ Stinging who had undergone GAN sacrifice during paroti- ❏ Abnormal sensation dectomy at the State University of New York Health ❏ Burning ❏ Science Center at Brooklyn and its affiliated hospi- Lack of feeling ❏ Pain tals. Subjects were identified through review of ❏ Lack of sensitivity medical records. Exclusion criteria included pa- ❏ Discomfort tients who had undergone a second surgical proce- ❏ Hypersensitivity dure at the time of parotidectomy, such as a neck If you did not check any of the above, you may stop here. dissection, and patients who could not be contacted Otherwise, please complete the remainder of the survey. for participation in the study, because of change of 2) How often have you experienced any of the above sensations within the address or death. Inclusion criteria included a mini- past month? mum of 3 months’ follow-up, age older than 18, and 1- Never English literacy. Data obtained from the remaining 2- Almost none of the time 53 patients’ medical charts included age, sex, time 3- A little bit of the time 4- Some of the time since surgery, surgical procedure, and final surgical 5- A good bit of the time pathologic findings. 6- Most of the time A quality-of-life survey consisting of 8 ques- 7- Always tions was designed to measure outcome after GAN 3) How long does it last? sacrifice during parotidectomy (Figure). Face va- 1- Up to 1 minute lidity was ensured through targeted discussion with 2- Up to 10 minutes other otolaryngologists and head and neck sur- 3- Up to 30 minutes geons and by discussion with patients. In designing 4- Up to 60 minutes 5- Up to 12 hours the survey, a 7-point ordinal response scale was 6- More than 1 day used for most questions to increase reliability. Sur- 7- All the time vey research suggests that the minimum number of 4) How much does it bother you? categories used by raters should be 5 to 7.7 In addi- 1- Not at all tion, the 7-point responses for the questions assess- 2- Almost none ing frequency, severity, and degree of interference 3- A little were adapted from previously validated health-re- 4- Somewhat lated quality-of-life surveys.8 The survey was ad- 5- A good amount 6- A lot ministered to and completed by the patients 3 to 69 7- A tremendous amount months after surgery. 5) How large is the affected area? Statistical analyses of the data were performed using commercially available software9 for medical 1- Smaller than the size of a penny 2- About the size of a penny statistics. Differences were considered significant at 3- About the size of a quarter P,.05 (2-tailed). Relationships between survey 4- About the size of a half-dollar question responses were assessed using correlation 5- Larger than the size of a half-dollar coefficients based on a priori hypothesis. Spearman 6) How much does it interfere with your daily activities? rank correlation was used, which is a distribution- 1- Not at all free method suitable for the modest sample size in 2- Almost none this study. 3- A little 4- Somewhat 5- A good amount 6- A lot 7- A tremendous amount 7) How does it interfere with your daily activities? (shaving, combing your and December 30, 1998. The mean±SD age was 54±16 hair, etc) years (range, 20-84 years). Twenty-eight (53%) of the pa- 8) How often are you worried or concerned about any of the above tients were men. Surveys were completed a median of 22 sensations? months after surgery (range, 3-69 months). At least 15 1- Never months of follow-up data were available for 40 (75%) pa- 2- Almost never tients studied. Forty-six patients underwent a superfi- 3- A little bit of the time 4- Some of the time cial parotidectomy; 1 patient, a subtotal parotidectomy; 5- A good bit of the time and 6 patients, a total parotidectomy. The most com- 6- Most of the time mon surgical pathologic finding was pleomorphic ad- 7- All of the time enoma, followed by Warthin tumor, benign lympho- epithelial lesion, chronic sialadenitis, and low-grade Qualify-of-life survey following parotidectomy. mucoepidermoid carcinoma (Table 1). Thirty patients (57%) reported experiencing at lack of sensitivity in 13 (25%), or other abnormal sen- least 1 or more abnormal sensations in the ear or neck sation in 8 (15%). Only 1 abnormal sensation was noted region after surgery, including pain in 5 (9%), burning by 12 (23%), but 10 (19%) had 2, 5 (9%) had 3, and in 1 (2%), stinging in 2 (4%), discomfort in 5 (9%), hy- 3 (6%) complained of having at least 4. The number of persensitivity in 4 (8%), lack of feeling in 24 (45%), abnormal sensations reported had a moderate inverse (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 127, JULY 2001 WWW.ARCHOTO.COM 885 ©2001 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 Table 1. Distribution by Surgical Pathologic Finding* Table 4. Symptom Duration for 30 Patients Reporting Abnormal Sensations Surgical Pathologic Finding No. (%) Duration No. (%) Pleomorphic adenoma 22 (42) Warthin tumor 9 (17) Up to 1 min 5 (17) Benign lymphoepithelial lesion 7 (13) Up to 10 min 4 (13) Chronic sialadenitis 4 (8) Up to 30 min 0 Low-grade mucoepidermoid carcinoma 3 (6) Up to 60 min 0 Parotid cyst 2 (4) Up to 12 h 0 Monomorphic adenoma 1 (2) .1 d 3 (10) Lymphoma 1 (2) Always 18 (60) Other 4 (8) *Percentages do not sum to 100 because of rounding. Table 5. Degree of Bother Caused by Abnormal Sensations Table 2.
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