Superficial parotidectomy is a well-established treatment for the early stages of tumors involving the parotid gland. However, there are 3 problems with traditional superficial parotidectomies: (1) cosmetic problems, such as scars, especially around the neck; (2) depressed deformities; and (3) Frey syndrome. A superficial parotidectomy via a modified face-lift incision with dermofat graft provides a solution for these problems and should be considered as an alternative technique in select patients.Key Words: Superficial parotidectomy, modified face-lift incision, dermofat graft, Frey syndrome (J Craniofac Surg 2011;22: 1021Y1023) S uperficial parotidectomy is a well-established treatment for earlystage tumors involving the parotid. The traditional superficial parotidectomy, however, leaves obvious cervical scars. Although a face-lift incision may improve the postoperative appearance by concealing the wounds, a face-lift incision without reconstruction of the hollow parotid bed does not prevent depressed deformities or the Frey syndrome.1,2 Many methods, such as the superficial musculoaponeurotic system (SMAS) advancement flap, fascia lata flap, and sternocleidomastoid (SCM) muscle flap, have been attempted to overcome these problems. 3Y7 However, because these procedures use the tissues around the wound, they have the disadvantage of causing donor-site morbidity. We report a patient with an early-stage tumor of the parotid gland for which we used a dermofat graft after a superficial parotidectomy via a modified facelift incision. CLINICAL REPORTA 15-year-old girl sought evaluation at the hospital for a palpable right parotid gland mass (23.3 Â 22.6 mm). She met the criteria of a clinically discrete parotid gland mass and was immediately transferred to the OtolaryngologyYHead and Neck Surgery Department of Ajou University Hospital. A computed tomogram scan was obtained to establish an accurate diagnosis and identify the exact site of the tumor (Figs. 1 and 2).The surgery was performed with the patient in the supine position under general anesthesia. The following procedures were performed by a plastic and reconstructive surgeon, with the patient's head tilted 45 degrees and the ipsilateral buttock was tilted 30 degrees in the sagittal plane. A temporal incision was made from the projected point at the beginning of the hairline to the junction of the ear and temporal skin. The incision was continued along the junction of the ear and cheek and was extended distally around the origin of the earlobe to the retroauricular fold. The occipital incision was extended horizontally into the hairy scalp for the huge mass. The next step was to elevate the flap superficial to the parotidomasseteric fascia. During the dissection, the great auricular nerve was identified and preserved.A superficial parotidectomy was performed by the otolaryngologyYhead and neck surgeon. The mastoid insertion site and anterior border of the SCM muscle were identified, and the posterior belly of the digastrics muscle was exposed. In the...

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A male infant was diagnosed with obstetric brachial plexus injury, congenital muscular torticollis and cleft palate 17 days after birth. His mother presented with gestational diabetes and premature rupture of membranes. Although it is possible that these three disorders arose independently, it is very likely that all three have the same etiologic cause, and we propose that a possible mechanism for this concurrence is related to maternal gestational diabetes. Maternal hyperglycemia mostly affects fetal structures deriving from the neural crest, including the palatine bone, and may have caused the cleft palate observed in this case. Gestational diabetes is also associated with increased frequency of large for gestational age infants and, by extension, with increased risk of birth injuries such as obstetric brachial plexus injury or congenital muscular torticollis associated with large for gestational age infants. Since the children of mothers with gestational diabetes are at increased risk for congenital defects such as cleft palate as well as being large for gestational age, precautions indicated for each respective disorder must be taken during prenatal testing and during birth. However, further studies of more cases are required to evaluate whether the concurrence of obstetric brachial plexus injury, congenital muscular torticollis and cleft palate in this case are complications specifically associated with gestational diabetes or just a simple coincidence.