Approximately 34–86% of neoplasms of the salivary glands are located in the parotid gland and parotidectomy is the first-line treatment for parotid gland tumors. Frey syndrome and cosmetic deformity are common complications experienced by patients following parotidectomy and the sternocleidomastoid muscle flap (SCMF) is used to prevent them. Numerous studies have been performed to examine the effectiveness of the SCMF for the prevention of cosmetic deformity and Frey syndrome, however, they provide contradictory results and possess small sample sizes with consequently low statistical power. In order to evaluate the effectiveness of the SCMF for the prevention of Frey syndrome and cosmetic deformity following parotidectomy, we performed a systematic review and meta-analysis based on published randomized controlled trials (RCTs), which were identified using PubMed and CNKI databases, and references of studies up to August 2012 were included. Using these criteria, we yielded 11 RCTs. Following an independent assessment of the methodological quality of these studies and the extraction of data, a systematic review and meta-analysis was conducted. The results of the meta-analysis demonstrated that there was a significant trend towards a lower risk of objective incidence [67%; risk ratio (RR), 0.33; 95% confidence interval (CI), 0.16–0.67; P<0.01] and subjective incidence (66%; RR, 0.34; 95% CI, 0.16–0.75; P= 0.01) of Frey syndrome in the SCMF group. The sensitivity analysis also indicated that this result was significant. Due to the considerable variation between the included studies, a meta-analysis was not applicable to assess cosmetic deformity. Two RCTs demonstrated that the difference between the SCMF and no SCMF group was not statistically significant, while the other seven RCTs detected a statistically significant difference between the two groups. Publication bias was detected. In conclusion, based on currently available evidence, the use of the SCMF is benefical for the prevention of Frey syndrome, however, whether it is also benefical for cosmetic deformity remains inconclusive.

Background:Vasoactive drugs and endoscopic therapy have been widely used in the management of acute variceal bleeding of cirrhosis patients. The current standard regimen of vasoactive drugs is in combination with endoscopic therapy and continues for up to 5 days; however, the necessity of vasoactive drugs after endoscopic hemostasis was still controversial. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and optimal duration of adjuvant vasoactive drugs after hemorrhage control by endoscopic therapy.Methods:A search was conducted of PubMed, EMBASE, and Cochrane Library databases until June, 2018. Lan DeMets sequential monitoring boundary was constructed to assess the reliability and conclusiveness of our major results.Results:Seven studies (639 patients) and 4 studies (435 patients) were included in the analyses to evaluate the efficacy and optimal duration of adjuvant vasoactive drugs therapy, respectively. Our analyses showed that adjuvant vasoactive drugs facilitated endoscopic hemostasis and reduced very early re-bleeding rate both in sclerotherapy (risk ratio [RR] 0.51, 95% confidence interval [CI] 0.34–0.78, P = .23, I2 = 31%) and band ligation (RR 0.48, 95% CI 0.27–0.83, P = .07, I2 = 62%). However, the 3 to 5-day therapy duration was not superior to a shorter course in very early re-bleeding rate and mortality rate in 42 days (RR 1.77, 95% CI 0.64–4.89, P = .70, I2 = 0%; RR 0.95, 95% CI 0.43–2.13, P = .81, I2 = 0%, respectively).Conclusion:Additional 5-day vasoactive drug after endoscopic hemostasis may significantly ameliorate very early re-bleeding rate, However, the 3 to 5 days’ adjuvant regimen was not superior to a shorter course.