Sternocleidomastoid Muscle Flap Preventing Frey Syndrome following Parotidectomy

Abstract

Frey syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in an attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid muscle (SCM) flap, have been used to prevent this condition. The purpose of this study was to evaluate the impact of using this flap on Frey syndrome. A series of 138 patients who underwent subtotal or total parotidectomy from January 1995 to December 2001 were divided into two groups. One group had an SCM flap reconstruction (n = 24), and the other group did not (n = 19). A subjective clinical questionnaire and the objective Minor's starch iodine test were used to evaluate the incidence of this syndrome. The postoperative period varied from 12 to 90 months. The frequency exact test of Fisher and the nonparametric test of Mann-Whitney were applied. The association with the absence of sweating and the presence of the SCM flap was significant (p = 0.0002). There was no association with flushing or pain and the flap. There was a significant association with the starch iodine test and the presence of the flap (p = 0.0016). The only significant association of the epidemiologic and clinical characterization of the patients with a negative or positive Minor's test was between sweating and a positive Minor's test (p = 0.0001). The only significant aspect in the diagnosis of Frey syndrome is gustatory sweating. There is a significant association with a negative Minor's test and the presence of the SCM flap and with sweating and a positive Minor's test. The SCM flap is an efficient method for preventing Frey syndrome following parotidectomy.

Prevalência da Síndrome de Frey após parotidectomia parcial

“…In this paper we found FS positiveness in 21% of the patients who underwent partial parotidectomy, in agreement with literature results that indicate partial parotidectomy as proper treatment for benign parotid tumors 14,15 , and corroborating the already reported surgical approaches to reduce FS, such as rotating the sternocleidomastoid muscle flap 16 .…”

Management of frey syndrome

“…27 In contrary, some other studies found a significant lower incidence of symptomatic Frey syndrome after parotidectomy in patients in whom a superiorly or inferiorly based sternocleidomastoid muscle flap was used as compared with those without. 24,28,29 This difference in incidence of Frey syndrome could not be confirmed in all studies in which a sternocleidomastoid flap interposition was used (Table 1). [30][31][32] Moreover, the incidence of abnormal greater auricular nerve function and abnormal facial sensation was higher in patients who underwent this interposition.…”

Meta-analysis of Surgical Techniques for Preventing Parotidectomy Sequelae

“…Techniques such as sternocleidomastoid (SCM) muscle flaps, superficial musculoaponeurotic system (SMAS) interposition, and artificial implants have been described with varying degrees of success. [4][5][6] This work is a metaanalysis of published studies of proposed methods for minimizing facial contour defects and Frey syndrome after superficial parotidectomy.…”