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. 2013 Dec 16:2:Doc20.
doi: 10.3205/iprs000040. eCollection 2013.

Improving the quality of life of parotid surgery patients through a modified facelift incision and great auricular nerve preservation

Kai J Lorenz  1 , Pia A Behringer  1 , Dörte Höcherl  1 , Frank Wilde  2
Affiliations

Improving the quality of life of parotid surgery patients through a modified facelift incision and great auricular nerve preservation

Kai J Lorenz et al. GMS Interdiscip Plast Reconstr Surg DGPW. .

Abstract
in English, German

Postoperative quality of life after parotidectomy depends not only on surgical outcomes, such as the complete removal of a tumour, non-recurrence and the preservation of facial nerve function, but also on scar satisfaction and the degree of sensory dysfunction in the upper cervical area and at the ear lobe. Especially young patients and women consider the scar in the infra-auricular area and in the neck region to be distressing and even disfiguring. Resection of the great auricular nerve leads to paraesthesia and hypoesthesia, which leads to discomfort in many patients especially when using the telephone, shaving or wearing earrings. A modified approach to the parotid gland via a facelift incision and the careful exposure of the great auricular nerve can reduce the aforementioned problems considerably and improve postoperative quality of life. We present our experiences with the modified approach at our institution.

Die postoperative Lebensqualität nach Parotidektomien hängt nicht nur vom chirurgischen Ergebnis, also der kompletten Entfernung und dem nicht erneuten Auftreten des Tumors und dem Erhalt der N. facialis-Funktion, sondern auch von der Zufriedenheit mit der Narbe und dem Grad der Sensibilitätsstörungen im Bereich der präauriculären Haut und des Ohrläppchens ab.Insbesondere von jüngeren Patienten und Frauen wird die Narbe in der infraauriculären und Halsregion als störend und teilweise entstellend empfunden.Die Para- und Hyästhesien in Folge der Durchtrennung des N. auricularis schildern viele Patienten besonders beim Telefonieren, Rasieren oder Tragen von Ohrschmuck als unangenehm.Durch einen modifizierten Zugang zur Glandula parotidea im Sinne einer Facelift-Schnittführung und der subtilen Präparation des N. auricularis können die genannten Probleme deutlich reduziert und die postoperative Lebensqualität verbessert werden. Wir stellen unsere Erfahrungen mit der Modifikation des chirurgischen Zugangs in unserer Klinik vor.

Keywords: Blair incision; facelift incision; loss of sensation; parotidectomy; quality of life.

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Figures

Table 1
Table 1. Data of patients with great auricular nerve sacrifice or preservation
Table 2
Table 2. Data of patients who underwent a Blair incision or a facelift incision
Table 3
Table 3. Results of parotid surgery using a Blair incision or a modified facelift incision. Scars were assessed using a scale from 1 (very good) to 6 (very poor).
Figure 1
Figure 1. Exposure and preservation of the posterior branch of the great auricular nerve. The posterior branch is demonstrated with forceps. The anterior branches are resected during parotidectomy.
Figure 2
Figure 2. A standard Blair incision for parotidectomy. It starts at the root of the helix, continues along the tragus and the ear lobe and follows a natural skin crease in a curved fashion.
Figure 3
Figure 3. A modified facelift incision. It starts at the root of the helix, continues along the ear lobe in a retro-auricular direction and along the hairline in a caudal direction (b). Location of the tumour (a), Blair incision (c).
Figure 4
Figure 4. Results of the one-point discrimination test at the auricular lobe
Figure 5
Figure 5. Results of the two-point discrimination test at the auricular lobe
Figure 6
Figure 6. Results of the one-point discrimination test at the neck
Figure 7
Figure 7. Results of the two-point discrimination test at the neck
Figure 8
Figure 8. Complete exposure of the parotid gland using a Blair incision. (a) Outline of the incision before surgery. (b) Complete exposure of the parotid gland. (c) Appearance of the incision after wound closure.
Figure 9
Figure 9. Exposure of an anterior central pleomorphic adenoma of the parotid gland. (a) Outline of the incision before surgery. (b) Exposure of the parotid gland. (c) Location of the tumour. (d) Appearance of the incision after wound closure
Figure 10
Figure 10. Tumour locations and their suitability for a facelift incision. Green (medio-central area) – excellent suitability; yellow – limited suitability; red (caudal, anterior and cranial areas) – poor suitability
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