Specific Diseases and Procedures
Michele Barletta, Jane Quandt, Rachel Reed in 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 Open Arterial Vascular Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The incidence of nerve injury depends on the diligence with which one looks for it, as well as on the timing of investigation, because most will resolve with time [14]. The incidence of permanent injury is estimated to be 0.5%, while early transient malfunctions of any degree could be seen in up to 15%–20% of cases. Risk factors include reoperative neck surgery (prior CEA or other neck procedures), high carotid bifurcations or lesions, and anatomic variants. Most studies report the hypoglossal nerve as the most frequently affected with ipsilateral tongue deviation. The marginal mandibular branch of the facial nerve can be affected by upward retraction on the mandible and will manifest as drooping of the side of the mouth on the ipsilateral side. The vagus can be affected by injudicious clamping of the common carotid and will manifest by dysfunction of its recurrent laryngeal branch with hoarseness; bilateral injury will cause airway obstruction. Injury to the glossopharyngeal and spinal accessory nerves is very rare and is seen with high lesions. They are manifested, respectively, by dysphasia/aspiration or shoulder droop, pain, and scapular winging. Greater auricular nerve damage is not uncommon; it is a sensory nerve and supplies the ear and mandible.
Head and Neck
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
The cervical nerves also provide sensory innervation for two true (i.e., branchiomeric) head muscles via the cervical plexus: nerve C2 and C3 to the sternocleidomastoid and nerves C3 and C4 to the trapezius. The cervical nerves also provide cutaneous innervation to the skin of the neck and posterior region of the head. The lesser occipital nerve, great auricular nerve, transverse cervical nerve, and the supraclavicular nerve are branches of the cervical plexus that enter the superficial fascia posteriorly to the sternocleidomastoid to supply distinct areas: the scalp, the skin of the lower part of the ear and angle of mandible and mastoid process, the skin of the anterior triangle of the neck, and the skin of the superior region of the shoulder, respectively. In contrast, the dorsal rami of the cervical spinal nerves mainly pierce the trapezius and go superficially to innervate the back of the head and neck. One of these nerves is the greater occipital nerve, hence the name “lesser occipital nerve” for the nerve coming from the cervical plexus.
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.
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.
Related Knowledge Centers
- Deep Fascia
- Outer Ear
- Parotitis
- Spinal Nerve
- Sternocleidomastoid Muscle
- Cervical Plexus
- Parotid Gland
- Cutaneous Nerve
- Mastoid Part of The Temporal Bone
- Parotid Fascia