Prophylaxis against Frey's syndrome in parotid surgery

Area of Science:

• Otolaryngology
• Plastic Surgery
• Neurosurgery

Background:

• Frey's syndrome, characterized by gustatory sweating and flushing, is a common complication following parotid gland surgery.
• Previous studies suggested that interposing living tissue could prevent Frey's syndrome, but definitive evidence was lacking.
• The incidence of Frey's syndrome ranges from 5% to 50% in typical parotidectomy patients.

Purpose of the Study:

• To definitively evaluate the efficacy of the superficial musculoaponeurotic system (SMAS) flap in preventing Frey's syndrome.
• To assess the long-term outcomes of using SMAS flaps in a large patient cohort undergoing parotidectomy.

Main Methods:

• A prospective study involving 160 patients undergoing subtotal or total parotidectomy by a single surgical team.
• Utilized a superficial musculoaponeurotic system (SMAS) flap, placed between the resected gland bed and the skin.
• Follow-up ranged from 5 to 22 years, including patient history and Minor's starch-iodine test for Frey's syndrome.

Main Results:

• No cases of Frey's syndrome were observed in any of the 160 patients, despite intensive testing.
• The SMAS flap successfully created a tissue barrier, preventing aberrant nerve-to-sweat gland connections.
• Prevention of post-parotidectomy retromandibular depression was less satisfactory, though patient satisfaction with appearance was generally high.

Conclusions:

• The superficial musculoaponeurotic system (SMAS) flap is a highly effective method for preventing Frey's syndrome after parotidectomy.
• The SMAS flap should be considered the standard of care for preventing Frey's syndrome in parotid surgery patients.
• A temporoparietal fascial flap serves as a viable alternative if an SMAS flap cannot be utilized.