Incidence and documentation of ear lobe numbness after parotidectomy: our 20 years' experience

Introduction: Parotidectomy carries a risk of postoperative complications including facial nerve palsy and Frey’s syndrome. Less attention, however, has been given to the management of the greater auricular nerve (GAN) during parotidectomy. Providing sensory supply to the auricle, the greater auricular nerve is often sacrificed for access to the parotid gland during surgery. This results in anaesthesia and paraesthesia of the ear lobe and significant patient morbidity. Aim: To review the electronically available documentation of post-parotidectomy ear lobe numbness in our follow-up clinic letters of the past 20 years. Methods: For this retrospective case series our departmental database of over 850 patients undergoing parotidectomy was used as the primary data source. The information collected from electronic records included documentation of intraoperative details, post-operative recovery and incidence of ear lobe numbness post-operatively. The current study was completed between October and November 2020. SPSS and Excel were used for data collection and analysis. Results: The incidence of ear lobe numbness was found to be higher in the patient cohort whose posterior branch of the GAN had been sacrificed during surgery (58% compared to 46%). This agrees with the published literature that preservation of the posterior branch of the GAN decreases the post-operative sensory deficit to the auricle. However, this audit was limited by the incomplete recording of GAN sacrifice intra-operatively and post-operative GAN dysfunction. Discussion: As any tissue removed, added or altered in surgery requires accurate record-keeping, the outcome of the greater auricular nerve during parotidectomy should always be included in the operation notes. A proforma made available within the department may allow for a standardised recording of recognised complications.