Platysma muscle-cervical fascia-sternocleidomastoid muscle (PCS) flap for parotidectomy

Abstract

Background Parotidectomy is useful in the treatment of benign and malignant neoplasms of the parotid gland, but often leads to sequelae of facial deformity and Frey's syndrome. This paper presents a retrospective review of parotidectomy results in 21 consecutive patients treated with either traditional techniques or with the rotation and advancement of combined platysma muscle‐cervical fascia‐sternocleidomastoid flap (PCS). Methods The surgical procedures utilized for removal and reconstruction are described. Information on appearance and function was obtained by analysis of hospital and office records and telephone questionnaire for patients with and without the flap. Results Of the 21 patients eligible for this study, only 9 of 10 patients with the PCS flap and 10 of 11 patients without the flap provided sufficient data for analysis. In the flap group all 9 patients either noted a mild fullness on the operated side or no difference between sides. In the nonflap group, 4 patients felt they had a moderate depression, 2 patients noted a mild depression, and 4 patients noted no difference between sides. Frey's syndrome was classified as mild in 2 patients in the PCS group, whereas in the nonflap group, 4 patients thought it was mild and 1, severe. Complications were rare in either group. Conclusion The PCS flap prevents deformity and contributes to patient satisfaction following parotidectomy. The flap helps to prevent Frey's syndrome and is not associated with an increase in postoperative complications. The flap is recommended following removal of nonrecurrent or low‐grade malignant parotid tumors. © 1999 John Wiley & Sons, Inc. Head Neck 21: 428– 433, 1999.

Association between skin flap thickness and Frey's syndrome in parotid surgery

“…The fundamental aim for preventive techniques is to place a barrier between bare postganglionic parasympathetic nerve fibers and sweat glands of skin flap, meanwhile preventing the connection in between. However, the studies evaluating the efficacy of barriers showed conflicting results; some authors reported a positive effect, whereas some others did not . These conflicting results may be due to inhomogenous patient selection, low number of patients, and different methods for assessment of FS .…”

Functional Outcome After Total Parotidectomy Reconstruction

“…The deformity after total parotidectomy is shown in Figure 1A—D There is a retromandibular and superior cervical depression associated with an inferior‐medial and anterior rotation of the pinna Occasionally, this deformity can be troublesome for some patients Numerous techniques have been used to ameliorate the defect Dermalfat‐fascia free graft, 1 dermal‐fat free graft, 2 superficial musculoaponeurotic system flap, 3 temporopanetal fascia flap, 4 partial‐thickness sternocleidomastoid (SCM) muscle flap both superiorly based and inferiorly based, 5,6 vasculanzed fat graft, 7 and vasculanzed dermis‐fat graft 8 have been used with varying degrees of success The purposes of the present study were to present our results using the entire SCM muscle based inferiorly in patients who have had a total parotidectomy only and to compare the outcome with a similar group of patients who underwent total parotidectomy without reconstruction…”

Aesthetic consideration of parotidectomy – post‐aural approach and extended sternomastoid flap: how we do it

“…For small defect after partial parotidectomy, the parotid remnant and sternomastoid muscle can be sutured directly using non‐absorbable nylon. Various methods have been described to obliterate larger defect including dermal‐fat‐fascia free graft, dermal‐fat free graft, superficial musculoaponeurotic flap, temporoparietal fascia flap, partial‐thickness or full‐thickness sternocleidomastoid muscle flap both superiorly based or inferiorly based, vascularised fat graft, vascularised dermis‐fat graft 4–9 . The fat and muscle grafts have problem of resorption and atrophy, concave deformity will reappear.…”