# The Impact of Greater Auricular Nerve Injury in Parotidectomy: A Narrative Review of Sensory Outcomes and Quality of Life

## TL;DR

This review examines how injuring the greater auricular nerve during parotidectomy affects sensory outcomes and quality of life, finding that nerve preservation may improve long-term comfort and function.

## Contribution

The study provides a comprehensive synthesis of evidence on the impact of greater auricular nerve preservation during parotidectomy on sensory outcomes and quality of life.

## Key findings

- Preservation of the greater auricular nerve is linked to better early sensory recovery and fewer long-term anesthesia issues.
- 35% of patients with GAN sacrifice experience functional limitations in daily activities like using phones or wearing earrings.
- Global quality of life scores show no significant long-term differences, but localized sensory issues persist in the sacrifice group.

## Abstract

Background/Objectives: Postoperative sensory loss is a frequent morbidity following parotidectomy, yet the necessity of preserving the greater auricular nerve (GAN) during parotidectomy remains debated. While some surgeons prioritize nerve sacrifice for better oncological exposure, others advocate for preservation to maintain quality of life (QoL). This narrative review provides a comprehensive synthesis of current evidence regarding the impact of GAN sacrifice on objective sensory modalities, subjective disturbances, and long-term QoL. Methods: A literature search was performed (January 2000–August 2025). Twenty studies, including RCTs and cohorts, were reviewed to synthesize evidence on objective sensory modalities and patient-reported outcomes. Sensory assessments (Semmes–Weinstein monofilaments, VAS, and two-point discrimination) and the POI-8 QoL questionnaire were analyzed. Results: GAN preservation, particularly of the lobular branch, is associated with better early sensory recovery (1–6 months). In the long term (>12 months), although the sensory gap narrows between groups, the sacrifice group exhibits significantly higher rates of persistent anesthesia in localized regions, notably the earlobe. Regarding QoL, while global scores often show no significant long-term differences, 35% of patients with GAN sacrifice continue to experience functional limitations in specific activities, such as telephone use or wearing earrings. Conclusions: Although patients demonstrate adaptation to sensory loss, GAN preservation offers potential benefits in daily function and comfort; thus, it is advised when oncologically feasible. To overcome the high heterogeneity in current evidence, future multicenter trials utilizing unified objective measurements on predefined regions of interest are necessary to further clarify the functional benefits of nerve preservation and establish definitive surgical guidelines.