Effects of free fat grafting on the prevention of <scp>F</scp>rey's syndrome and facial depression after parotidectomy: A prospective randomized trial

Wang, Shaoxin; Li, Ling; Chen, Jin; Li, Xiaoxia; Yin, Jun; K, Liu; Li, Chunhua; Wang, Zhaohui; Li, Chao; Zhu, Guiquan

doi:10.1002/lary.25714

Cited by 33 publications

(35 citation statements)

References 27 publications

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“…Wang et al randomized 36 patients undergoing parotidectomy (including both superficial and total) into an FFG group and an acellular dermis group. 17 There was no significant difference noted in the comparison of the incidence of FS between these groups, and only one of 36 patients in this study self-reported symptoms suspicious for this entity. Another case series evaluating aesthetic outcomes of 130 patients who underwent parotidectomy with FFG at a single institution noted only one incidence of a patient reporting gustatory sweating; 24 it should be pointed out that no objective testing, such as an Iodine-Starch test, was used in that analysis, as the primary purpose of that case series was not to review the effectiveness of FFG in preventing FS.…”

Section: Discussioncontrasting

confidence: 50%

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Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

et al. 2018

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A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of grafting techniques used to prevent Frey Syndrome. The authors performed a sensitivity analysis to calculate what the probability of preventing Frey Syndrome would have to be and maximum costs associated with using grafting techniques to warrant their use as more "cost-effective" choice than using neither. Decision pathways utilized were uses of (1) free fat graft (FFG), (2) acellular dermis, and (3) no grafting. The probability of developing Frey syndrome and costs were extracted from previous studies to construct the decision tree. The primary effectiveness was the ICER of FFG or acellular dermis to prevent Frey syndrome. The initial outcomes included preventing Frey syndrome (effectiveness = 1) or developing Frey syndrome (effectiveness = 0). Compared with not using a graft, the ICER of using FFG and acellular dermis were $10,628 and $50,813, respectively. Frey syndrome was found in 2.6% of patients postoperatively in FFG group, 9.8% of patients in acellular dermis group, and 30.7% of patients who did not have a graft. The ICER shows absolute dominance of FFG with lower cost and high effectiveness over acellular dermis. This economic evaluation strongly supports the use of FFG over acellular dermis as cost-effective approach for prevention of postparotidectomy Frey syndrome.

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Section: Discussioncontrasting

confidence: 50%

“…To account for this variable, the authors used the cost of additional OR time needed for FFG compared with acellular dermis. 17,18 They then performed a sensitivity analysis with this additional cost added to the FFG decision analysis.…”

Section: Discussionmentioning

confidence: 99%

Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

et al. 2018

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“…According to the literature, Frey syndrome occurred in around 30% cases from 12.5% to 62%, with more than 50% cases at 5 years and up to 90% with Minor's starchiodine test 38,39 This aberrant reinnervation seems to be avoid thanks to interface, autologous, or exogenous, placed between facial nerve and sweat as in our study with fat or skin pallet. [40][41][42] We are aware of the limitations of our studies. This is a retrospective study for which we have no control cases and we reported only cases from eight patients.…”

Section: Discussionmentioning

confidence: 95%

Facial functional outcomes analysis after reconstruction by vascularized thoracodorsal nerve free flap following radical parotidectomy with facial nerve sacrifice

et al. 2020

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“…Frey syndrome is a historically common complication following parotidectomy described as gustatory sweating due to aberrant reinnervation of secretory parasympathetic fibers from parotid tissue to dermal tissue. Reconstructive procedures that provide a barrier between parotid tissue and the dermal surface have been shown to decrease the incidence of Frey Syndrome [15, 17–20]. These reconstructions include rotating a sternocleidomastoid flap into the defect, elevating a superficial musculoaponeurotic flap prior to performing parotidectomy, grafting free abdominal fat, and insertion of acellular dermis.…”

Section: Discussionmentioning

confidence: 99%

Reconstructive trends and complications following parotidectomy: Incidence and predictors in 11,057 cases

Bovenzi

Ciolek

Crippen

et al. 2019

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundParotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.MethodsA retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events.ResultsThere were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation.ConclusionsThere are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.

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Effects of free fat grafting on the prevention of Frey's syndrome and facial depression after parotidectomy: A prospective randomized trial

Abstract: 1b.

Cited by 33 publications

References 27 publications

Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

Facial functional outcomes analysis after reconstruction by vascularized thoracodorsal nerve free flap following radical parotidectomy with facial nerve sacrifice

Reconstructive trends and complications following parotidectomy: Incidence and predictors in 11,057 cases

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