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Greater auricular nerve neuropraxia with beach chair positioning during shoulder surgery.

Ng AK, Page RS - Int J Shoulder Surg (2010)

Bottom Line: The greater auricular nerve, a superficial branch of the cervical plexus, is vulnerable to neuropraxia due to its superficial anatomical location.In this case series, we present three cases of neuropraxia associated with direct compression by a horseshoe headrest, used in routine positioning for uncomplicated shoulder surgery.We outline the risk of using devices of this nature and discourage the use of similar headrest devices due to the potential complications in headrest devices that exert pressure on the posterior auricular area to maintain head position during surgery.

View Article: PubMed Central - PubMed

Affiliation: Barwon Orthopaedic Research Unit, The Geelong Hospital, Geelong, Victoria 3220, Australia.

ABSTRACT
Neuropraxia of the greater auricular nerve is an uncommon complication of shoulder surgery, with the patient in the beach chair position. The greater auricular nerve, a superficial branch of the cervical plexus, is vulnerable to neuropraxia due to its superficial anatomical location. In this case series, we present three cases of neuropraxia associated with direct compression by a horseshoe headrest, used in routine positioning for uncomplicated shoulder surgery. We outline the risk of using devices of this nature and discourage the use of similar headrest devices due to the potential complications in headrest devices that exert pressure on the posterior auricular area to maintain head position during surgery.

No MeSH data available.


Related in: MedlinePlus

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Figure 0002: Arrow indicating compression on the greater auricular nerve

Mentions: In this series, we focus more on the headrest used in the beach-chair approach as it is similar to the one described by Park et al.[5] The headrest is horseshoe shaped, with a black cushion covering the metal, which become prominent at the ends when the head is in position. This device is mounted on a ball and socket metallic joint that can be rotated and moved to accommodate the patient’s head in the beach chair [Figure 1]. The edge of the pillow in contact with the patient has potential to cause compression to branches of the greater auricular nerve that run superficially on top of the sternocleidomastoid muscle and postauricular region [Figure 2]. Security of positioning of the head is usually accomplished with the use of a strap attached to the headrest, which encircles the head and attaches it to the headrest. Perioperatively, the patient is given general anesthesia and is placed in the beach-chair position, which may result in loss of position of the head and neck and precipitating neurological damage.


Greater auricular nerve neuropraxia with beach chair positioning during shoulder surgery.

Ng AK, Page RS - Int J Shoulder Surg (2010)

Arrow indicating compression on the greater auricular nerve
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2966751&req=5

Figure 0002: Arrow indicating compression on the greater auricular nerve
Mentions: In this series, we focus more on the headrest used in the beach-chair approach as it is similar to the one described by Park et al.[5] The headrest is horseshoe shaped, with a black cushion covering the metal, which become prominent at the ends when the head is in position. This device is mounted on a ball and socket metallic joint that can be rotated and moved to accommodate the patient’s head in the beach chair [Figure 1]. The edge of the pillow in contact with the patient has potential to cause compression to branches of the greater auricular nerve that run superficially on top of the sternocleidomastoid muscle and postauricular region [Figure 2]. Security of positioning of the head is usually accomplished with the use of a strap attached to the headrest, which encircles the head and attaches it to the headrest. Perioperatively, the patient is given general anesthesia and is placed in the beach-chair position, which may result in loss of position of the head and neck and precipitating neurological damage.

Bottom Line: The greater auricular nerve, a superficial branch of the cervical plexus, is vulnerable to neuropraxia due to its superficial anatomical location.In this case series, we present three cases of neuropraxia associated with direct compression by a horseshoe headrest, used in routine positioning for uncomplicated shoulder surgery.We outline the risk of using devices of this nature and discourage the use of similar headrest devices due to the potential complications in headrest devices that exert pressure on the posterior auricular area to maintain head position during surgery.

View Article: PubMed Central - PubMed

Affiliation: Barwon Orthopaedic Research Unit, The Geelong Hospital, Geelong, Victoria 3220, Australia.

ABSTRACT
Neuropraxia of the greater auricular nerve is an uncommon complication of shoulder surgery, with the patient in the beach chair position. The greater auricular nerve, a superficial branch of the cervical plexus, is vulnerable to neuropraxia due to its superficial anatomical location. In this case series, we present three cases of neuropraxia associated with direct compression by a horseshoe headrest, used in routine positioning for uncomplicated shoulder surgery. We outline the risk of using devices of this nature and discourage the use of similar headrest devices due to the potential complications in headrest devices that exert pressure on the posterior auricular area to maintain head position during surgery.

No MeSH data available.


Related in: MedlinePlus