Cutaneous sensory deficit following post-auricular incision

Introduction
Post-auricular incisions commonly performed for a range of otological procedures (Tympanoplasty, Mastoid Surgeries) Provides wide access and cosmetically better.

 Sensory n. supply to auricle complex and variable.

Nerve Greater Auricular

Derived from

Region Supplied

Cervical Plexus C2 C3

Medial surface and posterior part of lateral surface of pinna

Superior portion of medial surface Concha and Antihelix Tragus, Crus of the helix and adjacent helix Supplies root of concha

Lesser occipital Auricular Auriculo temporal

Cervical plexus C2

Vagus Mandibular division of trigeminal nerve

Facial

 Size of the initial cutaneous sensory deficit from the post-auricular incision, & subsequent potential for recovery difficult to predict from anatomy alone. Pts. often not warned of potential for numbness following post-auricular incision. Aim ascertain frequency and severity of post-auricular numbness & potential for recovery.

Methods
Patient selection hospital o.t. database Data acquisition
Questionnaire Medical notes Revision surgery

Assessment of area of anaesthesia/hypaesthesia lateral & oblique ear photographs; improvement, effect on quality of life.

Exclusion criteria
1. Procedure included complex, extensive soft tissue resections/ local flap reconstructions 2. Medical records not available

Results
General considerations:
146 pts. were sent questionnaires. 35 pts primary procedure with postauricular incision. 17 revision surgery

 Recovery of normal sensation & awareness of deficit

GROUP n Initially numb At 8 12 months
Not numb 26(74) numb 9(26)

Hypaesth esia

Anaest hesia

Area

Severity

Primary surgery Revision surgery Total

35

24(69)

7(78)

2(22)

6(67)

7(78)

16

11(69)

10(63)

6(38)

4(67)

2(33)

2(33)

2(33)

51

35(69)

36(71)

15(29)

11(73)

4(27)

8(53)

9(60)

 Duration of recovery :

 Cutaneous areas affected

Ongoing numbness
Numbness beyond 8 to 12 months post-op: Medial pinna (56 %) Area posterior to post-auricular sulcus (44%) Helical rim (67%) Similar pattern found in pts. undergoing revision surgery.

Temporary numbness
Areas affected: Helical rim (53%) Medial pinna (47%) Area posterior to post-auricular sulcus(40%) Upper half of lateral pinna(27%)

Discussion
Patients questioned afte parotid surgery ear numbness predisposes them to ear trauma in daily life. No published studies regarding sensory deficit following post-auricular incision, and recover of sensation over time.

 Study design
Previous studies objective measurement & multi modality testing Pts. Subjective questionnaire responses correlate well with calibrated anaesthesiometer testing

Results
Cutaneous supply of auricle complex Pattern of innervation varies between individuals Frequently areas of dual innervation Nerve injury sustained during post-auricular approach can encompass all degrees of severity

 Alternative mechanisms of sensation recovery Central nervous system

CONCLUSION
Patients undergoing post-auricular surgical approach
inform of likelihood of cutaneous deficit Improvement over time