Return to: Parotidectomy with Facial Nerve Dissection

External Ear Innervation

• Auriculotemporal (CN V) - superior and external part of the ear and anterior ear canal; Inject anesthetic superiorly and anteriorly to the tragus
• Great auricular nerve (C2, C3) - inferior part of the ear both surfaces; Inject on posterior sulcus
• Auricular branch of vagus (CN X) - concha and posterior ear canal
• CN VII and IX also contribute to the concha and ear canal

Case History and Images 

Tail of parotid 1.3 cm pleomorphic adenoma resected with clear margins. Note retrograde dissection of the facial nerve permitted limiting the extent of the skin incision and parotid dissection.Although anterior branches of the great auricular nerve generally need to be severed to perform even a limited parotidectomy, the posterior branch(es) are usually preserved. The dissection adds time to the procedure but is generally felt to be worth it by improving the chance of return of sensation to the ear lobe (usually after 6 months) and providing a cable graft nerve available at some point the future were it needed.

The great auricular nerve should not be preserved if doing so increases the chance of tumor recurrence (compromising a margin). Three months post-op the patient returns with sensation beginning to return to the earlobe. Near-normal sensation is expected at one year postop.

note retrograde dissection of facial nerve (marked by stars) permits resection of tail of parotid without pre-auricular incision. Also note great auricular nerve overlying benign tumor	great auricular nerve is dissected free without compromising margins	resection complete with preservation of great auricular nerve	3 months post-op with sensation returning to ear