Effects of an antiadhesive agent on functional recovery of the greater auricular nerve after parotidectomy: a double-blind randomized controlled trial.

PURPOSE: Periauricular sensory deficit occurs frequently after parotidectomy even in cases with preservation of the greater auricular nerve (GAN). This study was performed to evaluate the effects of antiadhesive agent in functional recovery of the GAN after parotidectomy. METHODS: Ninety-eight patients undergoing partial parotidectomy for benign parotid tumors were prospectively enrolled in this multicenter, double-blind randomized controlled study and randomly assigned to either the study or control group. Antiadhesive agent was applied in the study group. The results of sensory tests (tactile, heat, and cold sensitivity) and a questionnaire on quality of life (QoL) were acquired at postoperative 1, 8, and 24 weeks after surgery. Clinical parameters, and the results of the sensory tests and the questionnaire, were compared between the two groups. RESULTS: A total of 80 patients were finally enrolled. On sensory evaluation, tactile sensation and warm sensation in the ear lobule, and warm sensation in the mastoid area, showed significant improvement at 24 weeks postoperatively in the study group. There were no significant differences between the two groups on any questions in the QoL questionnaire, at any follow-up time point. CONCLUSIONS: Antiadhesive agents have some positive effects on functional recovery of the GAN after parotidectomy. Therefore, applying antiadhesive agents after parotidectomy can reduce discomfort in patients.

Nerve innervations in the human adult and fetal parotid duct

The human adult parotid duct is the longest of all major salivary gland ducts, approximately 6-8 cm in length. Its unique structure extends over the masseter muscle, penetrates through the buccinator muscle and opens into the oral cavity. Salivary secretion is under basic control of the sympathetic and parasympathetic divisions of the autonomic nervous system. Scarce reporting on the parotid duct nerve distribution led us to this study; to investigate the nervous distribution in the human adult and fetal parotid ducts using an antibody against protein gene product 9.5 (PGP9.5), a molecular marker for nerve cells and fibers. In order to identify the nerve fibers distributed throughout the parotid duct and confirm them to be part of the autonomic nervous system, we stained adult parotid ducts with tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT) for observation. PGP9.5 staining of the parotid duct’s inside wall where it traverses over the masseter prior to penetrating the buccinator revealed a dense concentration of nerve fibers in the area. Staining revealed both sympathetic and parasympathetic nerve fibers in the same area, with the majority of the sympathetic nerve fibers surrounding blood vessels. However, the section of the duct penetrating the buccinator showed less concentration of nerve fibers in both adult and fetal specimens. The difference in the nerve distribution of the parotid duct suggests its direct association with the salivary transport function of the duct. PGP9.5 expression in fetuses over five months of age further suggests that the nerve distribution in the human parotid duct is fully established at six months of gestation

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Relations of the facial nerve with the retromandibular vein: anatomic study of 132 parotid glands.

BACKGROUND: The retromandibular vein (rmv) is an important anatomical element, in radiology to localise a tumor in the parotid gland in relation to the facial nerve, and in surgery as a landmark to dissect the facial nerve and its branches. The aim of this study was to give a precise description of the anatomic variations of the relations of the facial nerve with the rmv. METHODS: One hundred and thirty-two parotid glands have been dissected by pre-auricular route. The rmv, the facial nerve trunk and its branches have been dissected and described. The relations of the facial nerve with the rmv have been noted in each case. RESULTS: The rmv was medial to the nerve in 65.2% and lateral in 13% to the nerve. In 6.8% the nerve was placed between a superficial and a deep venous plane. DISCUSSION: More variations were present in our description than in others. The situation of the rvm alone or associated with other anatomical elements is not a reliable landmark of the situation of a tumour either in the superficial part or in the deep part of the parotid gland in relation to the facial nerve. Some authors considered that the predictive value of these anatomical landmarks was near 65%.

The masticator space: from anatomy to pathology.

The masticator space is a deep facial space with a complex anatomical structure. The purpose of the present study was to precisely define the masticator space to eliminate the use of obsolete and confusing terms to describe the area, and to illustrate the common mass syndromes. Primary tumors are uncommon, usually benign and of a vascular or neural origin. Adjacent lesions, mainly pharyngeal with secondary extension into the masticator space, are especially frequent. Metastases are rare, and infectious pathology is often odontogenic. The most frequent lesion of the masticator space is the odontogenic abscess. Multidetector CT and MRI enable precise study of the space, its communications with other deep spaces and the etiology of any mass syndrome. Understanding the anatomy of the masticator space and how it links up with the other deep facial spaces helps the radiologist to recognize the different lesions of this space and to avoid unnecessary surgery, or any other less than optimal management.