Superficial musculoaponeurotic system flap in partial parotidectomy and clinical and subclinical Frey's syndrome. Cosmesis and quality of life

Abstract

Provided that the intensity of sweating is the main factor affecting the quality of life after surgery in patients, performing a SMAS flap renders the intervention worthwhile.

Auriculotemporal Syndrome (Frey Syndrome)

“…Bonanno and colleagues 19 found this technique overwhelmingly effective in preventing the development of Frey syndrome, while other groups failed to demonstrate its ability to do so. 10,20–23 However, although the incidence of postparotidectomy Frey syndrome was not significantly changed in these studies, the severity and overall surface area affected were significantly less. 23 Although this technique does serve to isolate the underlying regenerating nerve fibers, it is more commonly used in clinical practice for cosmetic reasons rather the prevention of Frey syndrome.…”

Parotidectomy: surgery in evolution

“…Their behaviour and management are dependent on their histological type and grade. While the principal aim of parotidectomy is to remove both benign and malignant disease with preservation of facial nerve function where possible, other important aesthetic and functional considerations include incision placement, contour deformity, great auricular nerve dysaesthesia, salivary fistula, Frey's syndrome and first bite syndrome …”

Comparing Modified with Conventional Parotidectomy for Benign Parotid Tumors

“…According to the literature, the incidence of Frey syndrome showed great variation, ranging from 2.6 to 97.6% [6], which could be explained by the different study designs, variable investigation periods with different diagnostic standards (e.g., objective testing [i.e., starch-iodine test] or the presence of clinical symptoms), and different surgical techniques. The presumed pathophysiology of Frey syndrome was that aberrant parasympathetic nerve outgrowth to the overlying sweat glands of the face caused the symptoms of sweating and flushing in association with eating [19,20]. Several prophylactic techniques based on the presumed pathophysiology have been proposed with the aim to place a barrier between the postganglionic parasympathetic nerve fibers and the sweat glands of the skin flap while at the same time preventing the connection in between [20,21].…”

“…The presumed pathophysiology of Frey syndrome was that aberrant parasympathetic nerve outgrowth to the overlying sweat glands of the face caused the symptoms of sweating and flushing in association with eating [19,20]. Several prophylactic techniques based on the presumed pathophysiology have been proposed with the aim to place a barrier between the postganglionic parasympathetic nerve fibers and the sweat glands of the skin flap while at the same time preventing the connection in between [20,21]. These techniques include the temporoparietal fascia flap, free forearm flap, platysma muscle-cervical fascia flap, and dermal fat graft, as well as biomaterials [22].…”