Prospective cohort study comparing subcutaneous and sub-superficial musculoaponeurotic system flaps in superficial...

To compare subcutaneous and sub-superficial musculoaponeurotic system (SMAS) flaps with regard to aesthetic result and Frey's syndrome following superficial parotidectomy.

A tertiary care centre.

A prospective cohort study of 45 patients who underwent superficial parotidectomies for benign disease between 1991 and 1996. All 45 patients completed self-administered questionnaires. Questions regarding perception of a facial contour deformity, Frey's syndrome, and scar rating were included. A total of 28 patients agreed to further direct patient evaluation where starch-iodine testing, photographs of the facial scar and contour, and facial nerve assessment were performed.

Overall aesthetic results were acceptable in both groups. Scar rating was consistently higher in the sub-SMAS cohort compared with the subcutaneous group. Similarly, facial contour was found to be superior in the sub-SMAS group. Facial nerve function was normal in both groups. The overall incidence of subjective Frey's syndrome on questionnaire was 45%; however, the incidence of objective Frey's syndrome by starch-iodine testing was higher at 65%. We did not find a significant difference in the incidence of Frey's syndrome between the subcutaneous and the sub-SMAS groups.

Sub-SMAS flaps result in superior facial contours and incisional scars following superficial parotidectomy compared with the subcutaneous flap elevation technique. We found no difference between these flaps with regard to the incidence of Frey's syndrome.