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Specific Diseases and Procedures
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
A recent study in cadaver horses describes a two-injection technique that may be useful for providing local anesthesia of the ear, while avoiding inadvertent injection of the parotid gland that may lead to inflammation (Cerasoli et al. 2017). The great auricular nerve can be located by digital palpation at the cranial edge of the wing of the atlas (Figure 11.5). This nerve arises from the second cervical vertebral nerve and passes superficially toward the base of the ear, dividing into a variable number of branches to innervate both external and internal surfaces of the pinna. This study identified success using dissections and imaging after subcutaneous injection of 2 ml of solution. The second injection was made with the pinna facing rostrally. The parotid gland was palpated and a 21-gauge needle was inserted between the parotid gland and the base of the ear, to a depth of about 2 cm (Warmblood breed) and 10 ml of solution injected (Figure 11.6).
Complications of Absorbable Fillers
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Maurizio Cavallini, Gloria Trocchi, Izolda Heydenrych, Koenraad De Boulle, Benoit Hendrickx, Ali Pirayesh
The zone includes the region in which the great auricular nerve emerges from beneath the sternocleidomastoid muscle, making it susceptible to injury when dissecting over the muscle. The great auricular nerve originates from the cervical plexus branching off spinal nerves C2 and C3 and provides sensation to the skin on the mastoid area, parotid area, and the outer ear surface. Permanent injury to this nerve results in numbness of or painful dysesthesia (in case of neuroma) of lower two-thirds of the ear and adjacent neck and cheek skin.
Salivary Gland Anatomy
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The superficial (lateral) surface of the gland is concave and covered by the parotid fascia, skin and the posterior border of platysma. Some branches of the great auricular nerve lie superficial to the gland tissue and superficial lymph nodes lie on or deep to the fascia as well as within the gland. The great auricular nerve arises from the cervical plexus and provides sensation to the lower two-thirds of the pinna as well as to the parotid fascia and it is often possible to preserve at least its posterior branch during parotid surgery.
Role of MPR image reconstruction in guiding the diagnosis and treatment strategy of facial nerve schwannoma
Published in Acta Oto-Laryngologica, 2022
Xiaoyu Li, Qiaohui Lu, Yang Liu
In patients 2-1 to 2-5, the lesions invaded the tympanic segment to the parotid segment. The conventional HRCT presentation was a benign temporal bone space-occupying lesion with no characteristic images. MRI revealed a benign space-occupying lesion in the temporal bone and parotid gland, but MPR reconstruction showed that the lesion exhibited expansive growth with the facial nerve as the center (Figure 1(C)). Patients 2-1 to 2-3 showed mild-to-moderate ipsilateral facial palsy and moderate conductive deafness due to severe external auditory canal posterior wall and ossicle destruction. The preoperative facial nerve MPR neuropathy lesion area was determined, and the nerve length was estimated. During surgery, a suitable length of the great auricular nerve was used for tumor resection + great auricular-facial nerve neurorrhaphy + external auditory canal closure. Patient 2-4 was an elderly woman with total ipsilateral deafness, and MRI showed vagus segment involvement. In consideration of the greater impact on masticatory and swallowing function after hypoglossal nerve neurorrhaphy, as well as the reduced facial nerve function recovery requirements after a long history of facial palsy, only tumor resection + external auditory canal closure were performed after the patient provided consent. Patient 2-5 was one of the earliest to be treated in our department. The patient had total ipsilateral deafness and a larger tumor diameter (> 4 cm); the patient underwent tumor resection + hypoglossal-facial nerve neurorrhaphy + external auditory canal closure.
Comparative outcomes of extracapsular dissection and superficial parotidectomy
Published in Acta Oto-Laryngologica, 2019
Kerem Ozturk, Arin Ozturk, Goksel Turhal, Isa Kaya, Serdar Akyildiz, Umit Uluoz
The excised total volume of a benign tumour and parotid gland directly affects postoperative complication rates in parotid surgery. Scaring and sunken defect due to volume loss is common especially in patients undergoing total or partial parotidectomy. None of the patients that underwent ECD had cosmetic deformities on the operation site. Also, there were no significant postoperative surgical complications including hematoma, seroma and salivary fistula in the ECD group. On the other hand, 19.2% (15/78) of patients in the SP group showed minor postoperative complications. As a minor complication, greater auricular nerve injury during dissection ends up with sensory deficit on the skin. Previous studies reported that nerve integrity could be preserved around 65% of cases in SP procedure [14,15]. Since the collection of data is retrospective in our study, subjective complaints that affect the patient’s quality of life were not evaluated with questionnaires.
Corneal Neurotization: Review of a New Surgical Approach and Its Developments
Published in Seminars in Ophthalmology, 2019
Natalie Wolkow, Larissa A. Habib, Michael K. Yoon, Suzanne K. Freitag
Jowett and Pineda described an approach that avoided the use of the frontal nerve branches, but which still uses an interpositional graft.22 Instead of using a supraorbital or supratrochlear nerve as the donor sensory nerve, the greater auricular nerve was selected. A sural nerve graft was used to connect the greater auricular nerve to the anesthetic cornea. The sural nerve was harvested from the leg endoscopically. The ipsilateral greater auricular nerve was exposed through an infra-auricular neck incision. A fornix-based inferior peritomy was performed 7 mm posterior to the limbus. A Wright fascial needle was passed below the tarsus of the lower eyelid through the inferior peritomy, through the cheek and out the neck incision. The sural nerve graft was threaded through the eye of the needle and tunneled through the cheek to connect the greater auricular nerve to the ocular surface. The sural nerve fascicles were inserted into scleral-corneal tunnels in the corneal stroma and the conjunctival incision was closed. The greater auricular nerve was connected to the sural nerve with 10-0 nylon sutures. This procedure was performed on two patients, both of whom had improved corneal sensation. Post-operatively abnormal sensations were described in the earlobes.