Preventing post-surgical complications by modification of parotidectomy

The aim of this paper was to evaluate the complications of patients with benign parotid disease treated by modified parotidectomy through conserving the sub-superficial musculoaponeurotic system (sub-SMAS), great auricular nerve (GAN), and reconstruction by sternocleidomastoid flap (SF). Between 1997 and 2001, 226 patients with benign parotid disease were operated. Patients were retrospectively assigned to four groups according to the surgical technique: I (94) sub-SMAS flap, II (42) sub-SMAS and reconstruction by SF, III (57) subcutaneous flap (sub-CF), and IV (33) sub-CF and reconstruction by SF. The GAN was conserved in all patients.

After a minimum follow up of 24 months, Frey's syndrome (FS) and cosmetic appearance were evaluated. The incidence of FS in Groups I and II was significantly lower than in patients with sub-CF. A significant difference between the groups with and without SF existed in preventing the concavity of the auricular lobule at 3, 6 and 12 months after operation, but no significant difference existed between Group I vs II and Group II vs III at 12 months after surgery. The sensitivity of the auricular lobule was not changed.

Complete parotidectomy with sub-SMAS successfully prevents FS, and combined with SF provides improved aesthetic results. Conserving GAN can prevent the sensation of the auricular lobule.