Anesth Pain Med.  2017 Jul;12(3):286-289. 10.17085/apm.2017.12.3.286.

Greater auricular nerve neuropraxia with beach chair positioning during open reduction and internal fixation with plate for clavicular fracture: A case report

• Kim JA
• Paek JH
• Min JH
• Kim JY
• Cho HR

• KMID: 2388849
• DOI: http://doi.org/10.17085/apm.2017.12.3.286

Abstract

Greater auricular nerve neuropathy is a reported as complication in some cases of shoulder arthroscopy in the beach chair position using a horse-shoe headrest. Due to this risk, intubation pad-type headrest is recommended for the beach chair position, to effectively prevent greater auricular nerve palsy. In this case report, we described a patient who experienced greater auricular nerve neuropraxia after open reduction and internal fixation with plate of clavicular fracture in beach chair position using an intubation pad-type headrest. A 49-year-old man was diagnosed with left clavicular fracture without accompanying injury or complication. He underwent an operation for open reduction and internal fixation with a plate. After surgery, the patient reported numbness, and a tingling sensation without pain or skin lesion in the auricular area and the lower margin of the left mandible. Based on the clinical symptoms, greater auricular nerve neuropraxia was diagnosed. The symptoms disappeared completely after four weeks of outpatient follow-up.

Keyword

Entrapment neuropathies; Hyperesthesia; Patient positioning; Postoperative complication

MeSH Terms

Arthroscopy
Follow-Up Studies
Humans
Hyperesthesia
Hypesthesia
Intubation
Mandible
Middle Aged
Nerve Compression Syndromes
Outpatients
Paralysis
Patient Positioning
Postoperative Complications
Sensation
Shoulder
Skin

Figure

• 

  Fig. 1 Neck position of the patient during the surgery, as reproduced by the model.

• 

  Fig. 2 Reduction in the diameter of the greater auricular nerve due to neck position change. Ultrasound images showing the diameters of nerve in (A) neutral neck position and (B) operative neck position. The arrows indicate the greater auricular nerve.

• 

  Fig. 3 Decreased greater auricular nerve diameter according to neck rotation; neutral position (A), rotation 5o (B), and full rotation (C). The arrows indicate the greater auricular nerve.

Reference

1. Zhang J, Moore AE, Stringer MD. Iatrogenic upper limb nerve injuries: a systematic review. ANZ J Surg. 2011; 81:227–36. DOI: 10.1111/j.1445-2197.2010.05597.x. PMID: 21418465.

2. Scully WF, Wilson DJ, Parada SA, Arrington ED. Iatrogenic nerve injuries in shoulder surgery. J Am Acad Orthop Surg. 2013; 21:717–26. DOI: 10.5435/00124635-201312000-00002. PMID: 24292928.

3. Park TS, Kim YS. Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy. Arthroscopy. 2005; 21:631. DOI: 10.1016/j.arthro.2005.02.003. PMID: 15891736.

4. LaPrade CM, Foad A. Greater auricular nerve palsy after arthroscopic anterior-inferior and posterior-inferior labral tear repair using beach-chair positioning and a standard universal headrest. Am J Orthop (Belle Mead NJ). 2015; 44:188–91. PMID: 25844590.

5. Ng AK, Page RS. Greater auricular nerve neuropraxia with beach chair positioning during shoulder surgery. Int J Shoulder Surg. 2010; 4:48–50. DOI: 10.4103/0973-6042.70824. PMID: 21072149. PMCID: PMC2966751.

6. Alberti PW. The greater auricular nerve. Donor for facial nerve grafts: a note on its topographical anatomy. Arch Otolaryngol. 1962; 76:422–4. DOI: 10.1001/archotol.1962.00740050434007.

7. Ginsberg LE, Eicher SA. Great auricular nerve: anatomy and imaging in a case of perineural tumor spread. AJNR Am J Neuroradiol. 2000; 21:568–71. PMID: 10730653.

8. Skyhar MJ, Altchek DW, Warren RF, Wickiewicz TL, O’Brien SJ. Shoulder arthroscopy with the patient in the beach-chair position. Arthroscopy. 1988; 4:256–9. DOI: 10.1016/S0749-8063(88)80040-9.

9. Loh PY, Nakashima H, Muraki S. Median nerve behavior at different wrist positions among older males. PeerJ. 2015; 3:e928. DOI: 10.7717/peerj.928. PMID: 25945317. PMCID: PMC4419528.

10. Brennan PA, Al Gholmy M, Ounnas H, Zaki GA, Puxeddu R, Standring S. Communication of the anterior branch of the great auricular nerve with the marginal mandibular nerve: A prospective study of 25 neck dissections. Br J Oral Maxillofac Surg. 2010; 48:431–3. DOI: 10.1016/j.bjoms.2009.07.015. PMID: 19709789.