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Singh C, Silky S, Agarwal AC, Gupta T, Sinha M, Sharma P. Perplexing First Branchialcleft Anomalies-A Case Series with Review of Literature. Indian J Otolaryngol Head Neck Surg 2024; 76:1454-1460. [PMID: 38440503 PMCID: PMC10909038 DOI: 10.1007/s12070-023-04243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 03/06/2024] Open
Abstract
Incomplete obliteration of the branchial apparatus results in the formation of branchial cleft anomalies. First branchial cleft anomalies may persist anywhere in the first branchial arch, from the external auditory canal at the level of the bony cartilaginous junction to the submandibular triangle. The majority of cases present in childhood as an opening in the skin though they may present as cysts or neck masses, mostly mistaken for neck abscesses which leads to inadequate treatment and complications. Here different cases of first branchial cleft anomalies with variable presentation and treatment are illustrated. The need for proper diagnosis and adequate treatment cannot be overemphasized to avoid mismanagement and complications.
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Affiliation(s)
- Charu Singh
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Silky Silky
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | | | - Tejaswi Gupta
- Mayo Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Mohit Sinha
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Pooja Sharma
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
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Marchese MR, Rossi F, Settimi S, Galli J. Late Prevalence of Typical and Atypical Symptoms of Frey's Syndrome after Parotidectomy for Benign Tumor. J Pers Med 2024; 14:96. [PMID: 38248797 PMCID: PMC10820002 DOI: 10.3390/jpm14010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of surgical procedure, the most common complication is Frey's syndrome (FS). Traditionally, FS includes unilateral gustatory sweating and flushing of the facial skin lining the parotid compartment. Recent research describes atypical discomfort associated with FS. The aim of this study was to assess the late prevalence and severity of both usual and atypical symptoms after parotidectomy for benign tumors. METHODS We conducted a cross-sectional study involving 86 subjects who underwent superficial parotidectomy at least one year before the study. The questionnaire included the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale supplemented by specific questions about symptoms. RESULTS Sixty-seven out of eighty-six (77.9%) cases reported almost one symptom. The most frequent symptom was itch (36/67-53.7%), followed by pain (35/67-52.2%), while 28/67 (41.8%) subjects complained of atypical symptoms without flushing or sweating. A desire to treat the discomfort was reported by 50/67 (74.6%) subjects. CONCLUSIONS Late postparotidectomy local discomfort is not infrequent and includes both usual and "unusual" symptoms almost equally. Our results suggest the importance of informing patients about the occurrence of the syndrome and the available treatment options during pre- and postoperative counseling.
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Affiliation(s)
- Maria Raffaella Marchese
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
| | - Federica Rossi
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Stefano Settimi
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Jacopo Galli
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
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Caliò B, Wenning GK, Fanciulli A, Colosimo C. Forehead and scalp gustatory sweating after temporomandibular joint surgery: an atypical presentation of Frey's syndrome. Clin Auton Res 2023. [PMID: 36843185 DOI: 10.1007/s10286-023-00931-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/31/2023] [Indexed: 02/28/2023]
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Crosetti E, Arrigoni G, Fantini M, Fondello G, Moniaci D, Carnino R, Succo G. Lipofilling after total parotidectomy: a useful option to prevent functional and aesthetic sequelae. Acta Otorhinolaryngol Ital 2022; 42:516-524. [PMID: 36654517 PMCID: PMC9853102 DOI: 10.14639/0392-100x-n2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023]
Abstract
Objective Parotidectomy is the main treatment for parotid tumours, but its functional and aesthetic sequelae can be very disturbing for patients. Methods 15 patients underwent total conservative parotidectomy, harvesting of a superficial musculoaponeurotic system (SMAS) flap and lipofilling between May 2014 and June 2020 for a benign parotid tumour. Aesthetic, functional sequelae and cosmetic results were assessed with the House-Brackmann scale, Luna-Ortiz's classification and a semiquantitative questionnaire. Lipofilling resorption was analysed by maxillofacial and neck MRI imaging at 2 years after surgery. The results were compared to a group of 21 patients who underwent total parotidectomy without harvesting a SMAS flap and lipofilling. Results No complications were observed. No facial defects were seen during follow-up. Post-operative MRI showed fat resorption was less than 20% in 12 patients and from 20 to 30% in 3 patients. Cosmetic satisfaction was 100% in all cases. Only 1 patient (6%) complained of Frey's syndrome. Conclusions Lipofilling is an excellent solution considering its efficacy, safety, simplicity, duration over time and economic costs. Donor site invasiveness is minimal, and reintervention is always possible. Face-lift incision and SMAS flap can improve aesthetic results and minimise the disfiguring impact of the surgical scar.
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Affiliation(s)
- Erika Crosetti
- ENT Unit, San Luigi Gonzaga Hospital, Orbassano (TO), Italy, Department of Oncology, University of Turin, Orbassano (TO), Italy,Correspondence Erika Crosetti ENT Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy, Regione Gonzole 10, 10043 Orbassano, Turin, Italy Tel. +39 011 9026463 E-mail:
| | | | | | | | - Diego Moniaci
- Vascular Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Riccardo Carnino
- Plastic Surgery Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo (TO), Italy
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Chkadua TZ, Visaitova ZY, Vereshchagina NV. [Determining the degree of risk of postoperative complications in patients with a benign tumor of the parotid salivary gland]. Stomatologiia (Mosk) 2022; 101:22-25. [PMID: 36268915 DOI: 10.17116/stomat202210105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
THE AIM OF THE STUDY Determination of the risk of postoperative complications in patients after surgical treatment of benign neoplasms of the parotid salivary glands. MATERIAL AND METHODS The results of treatment of 228 patients with benign neoplasms of the parotid salivary gland in the period from 2019 to 2021 were analyzed. A questionnaire of 7 questions was formed the answers to which allowed patients to be assigned to a certain risk group: low, medium, high or extremely high. This gradation allows choosing the optimal method and scope of surgical treatment for each patient individually. RESULTS Patients of the first and second groups (low and medium risk) are characterized by the occurrence of temporary isolated facial nerve dysfunction with a short recovery period (up to 1 month), as well as sialocele associated with the preservation of a fragment of the gland. For the patients of the third and fourth groups (high and extremely high risk) in which parotidectomy was performed typical features included persistent paresis of facial muscles and facial soft tissue asymmetry. CONCLUSION A personalized approach based on determining the degree of risk of postoperative complications helps surgeon in deciding on the scope of surgical treatment from subtotal resection to total parotidectomy.
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Affiliation(s)
- T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Z Yu Visaitova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - N V Vereshchagina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Jain A, Rai A. Meta-Analysis to Evaluate the Efficacy of Sternocleidomastoid Muscle Flap as a Reconstruction Modality in Prevention of Frey's Syndrome Following Parotidectomy. J Maxillofac Oral Surg 2021; 20:310-318. [PMID: 33927502 PMCID: PMC8041995 DOI: 10.1007/s12663-020-01380-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND One of the commonest complications following parotidectomy is Frey's syndrome (FS). The use of sternocleidomastoid muscle (SCM) flap to prevent FS is controversial. Hence, this study has been designed to compare the effect of SCM flap with no reconstruction in prevention of FS following parotidectomy. METHODOLOGY An exhaustive literature search was conducted in July 2019. Studies focusing on sternocleidomastoid flap following parotidectomy were included in the meta-analysis. A random effects model was used to generate pooled estimates. Odds ratio with a 95% confidence interval was calculated for subjective symptoms and objective test. RESULTS A total of 125 studies were identified, out of which 17 studies were recruited in the meta-analysis. Sixteen studies were analyzed for the subjective symptoms, and ten were analyzed for the objective signs. There was no statistically significant difference in the occurrence of FS with the use of SCM flap on objective analysis. However, the subjective analysis showed a statistically significant reduction in FS following reconstruction with SCM flap after parotidectomy. CONCLUSION The present meta-analysis suggests that the use of SCM flap following parotidectomy has no effect in reducing the incidence of Frey's syndrome.
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Affiliation(s)
- Anuj Jain
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
| | - Anshul Rai
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
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Aydin S, Erbay MF, Kizilay A. The effects of residual parotid volume on symptom-specific quality of life and complications in patients undergoing parotid surgery. Eur Arch Otorhinolaryngol 2021; 278:5003-5011. [PMID: 33723622 DOI: 10.1007/s00405-021-06742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To measure postoperative residual parotid volumes in parotidectomy patients and to measure the effect of residual parotid volumes on the symptom-specific quality of life (SSQOL) and complications. METHODS Between January 2010 and December 2016, 148 parotid gland surgeries were performed, and 74 patients were included in the study. Bilateral parotid gland volumes were measured by Magnetic Resonance Imaging (MRI). Parotidectomy Outcome Inventory-8 and aesthetic scale questionnaire were applied to the patients. The volumetric averages obtained were compared with the questions in the SSQOL scale, the aesthetic scale data, and complications. RESULTS In the volumetric examination performed with MRI, the mean residual volumes of the operated parotid glands were 9.5 cm3, while the non-operated side was 28.8 cm3. The width of the surgery and the residual parotid tissue volume was inversely correlated. There was a statistically significant difference between the residual parotid gland volume and the pain related to the surgical area, depression in the surgical site, Frey's syndrome, incision scar, and numbness. As the residual parotid gland volumes decreased, the patients' cosmetic problems related to the surgical field increased significantly, and their SSQOL decreased. CONCLUSION Postoperative residual parotid tissue volume could be an objective parameter to measure patients' SSQOL and complications. After parotidectomy, the maximum amount of disease-free tissue of the parotid gland should be left in place to increase patients' quality of life and minimize complications.
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Affiliation(s)
- Sukru Aydin
- Department of Otorhinolaryngology-Head and Neck Surgery, Malatya Training and Research Hospital, Malatya, Turkey.
| | - Mehmet Fatih Erbay
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ahmet Kizilay
- Department of Otorhinolaryngology-Head and Neck Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
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Mianroodi AA, Mohtashami S, Romero N, Fuson A, Joshi A, Sadeghi N. Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series. Ann Otol Rhinol Laryngol 2021; 130:1171-1180. [PMID: 33657862 PMCID: PMC8385583 DOI: 10.1177/0003489421999542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Frey’s syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey’s syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers. Materials and methods: Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes. Results: Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey’s syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site. Conclusion: In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey’s syndrome and preserved facial cosmesis in most patients.
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Affiliation(s)
- Aliasghar A Mianroodi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Sadaf Mohtashami
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nahir Romero
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Andrew Fuson
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Arjun Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
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Vahtsevanos K, Chatziavramidis A, Papadiochos IY, Koloutsos G, Stefanidis A, Kitikidou K, Ntomouchtsis A, Patrikidou A. Prevention of Frey's Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 "Formal" Parotidectomies for Benign Pathologies. Ann Otol Rhinol Laryngol 2021; 130:1036-1043. [PMID: 33554618 DOI: 10.1177/0003489421990185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Frey's syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. METHODS We conducted a 20-year retrospective study including the patients who had undergone "formal" (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. RESULTS We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey's syndrome was found after the use of dermal collagen interpositional barrier (P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor's test was positive at an incidence of 59.09% in Group A and 21.87% in Group B (P = .004, 95% CI). Severe Frey's syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B (P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey's syndrome in the compared groups. CONCLUSION Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey's syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.
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Affiliation(s)
- Kostas Vahtsevanos
- Department of Oral and Maxillofacial Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
| | | | | | - Georgios Koloutsos
- Department of Oral and Maxillofacial Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
| | | | - Kyriaki Kitikidou
- Department of Forestry and Management of the Environment and Natural Resources, Laboratory of Forest Biometry, Dimokritos University of Thrace, Orestias, Greece
| | - Aris Ntomouchtsis
- Department of Oral and Maxillofacial Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Anna Patrikidou
- Drug Development Unit, Sarah Cannon Research Institute and University London College Hospitals & UCL Cancer Institute, London, UK
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Kim JH, Kim DH, Lim JY, Won HR, Shin YS, Kim CH, Ban MJ, Park JH, Byeon HK, Hong HJ, Choi EC, Koh WY. Effect of human acellular dermal matrix (Megaderm™) on infra-auricular depressed deformities, Frey's syndrome, and first bite syndrome following parotidectomy: a multi-center prospective study. Gland Surg 2021; 10:670-677. [PMID: 33708549 DOI: 10.21037/gs-20-703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Parotidectomy is the primary treatment for parotid gland tumors. However, complications may include a prominent facial scar or infra-auricular depressed deformity, Frey's syndrome, first bite syndrome, or other facial pain, numbness, and paralysis. Acellular dermal matrix (ADM) has been widely used to prevent these complications in parotid surgery, but there have been no prospective, multi-center trials documenting its efficacy. This study evaluates the effectiveness of ADM implantation in preventing infra-auricular depressed deformity, Frey's syndrome and first bite syndrome after parotidectomy. Methods We analyzed 51 cases of standard parotidectomy and 58 cases of parotidectomy with implantation of Megaderm™ ADM through prospective multicenter trial. Acute complications including infection, seroma, hematoma, skin necrosis, and acute parotid area pain were evaluated 1 week postoperatively. Clinician grading of Frey's syndrome and blinded clinician evaluation of infra-auricular depressed deformities were conducted at 3, 6, and 12 months. Patients evaluated subjective satisfaction with neck appearance, Frey's syndrome quality, and acute parotid area pain at 3, 6, and 12 months. Results There was a higher incidence of seroma in the Megaderm™ group than in the control group at week 1. The incidence and total clinician-evaluated Frey's syndrome scores were significantly lower in the Megaderm™ group than in the control group at 3, 6, and 12 months. Both the objective and subjective evaluations of the facial contour showed a better outcome in the Megaderm™ group compared to the control group at 3, 6, and 12 months. There were no significant differences between the groups in the patient-reported Frey's syndrome quality scores at 3, 6, and 12 months, but the Megaderm™ group reported significantly less acute pain than the control group. Conclusions ADM implantation can effectively reduce the occurrence of Frey's syndrome, infra-auricular depressed deformity, and first bite syndrome after parotidectomy. ADM may be especially advantageous in complex parotidectomy cases when significant complications are expected.
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Affiliation(s)
- Joo Hyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Ryun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yoo Seob Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Ajou University College of Medicine, Kungki-do, Republic of Korea
| | - Chul-Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ajou University College of Medicine, Kungki-do, Republic of Korea
| | - Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woon Yoo Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Melong JC, Rigby MH, Corsten M, Trites JRB, Bulter A, Taylor SM. Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction. J Otolaryngol Head Neck Surg 2020; 49:72. [PMID: 33023674 PMCID: PMC7541257 DOI: 10.1186/s40463-020-00472-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022] Open
Abstract
Background Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement. Methods All patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010–2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement. Results Fifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient’s (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey’s Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery. Conclusion In the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system.
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Affiliation(s)
- Jonathan C Melong
- Department of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Matthew H Rigby
- Department of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Department of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R B Trites
- Department of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angela Bulter
- Department of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Department of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Ghassemi A, Modabber A, Brzoska PO, Sababi M. Vascularised fatty tissue: its role in prevention of the symptoms of Frey syndrome after parotidectomy. Br J Oral Maxillofac Surg 2018; 56:877-880. [PMID: 30337163 DOI: 10.1016/j.bjoms.2018.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
Abstract
We studied 37 consecutive patients who had parotidectomies between 2008 and 2017 and who had vascular fat flaps inserted to replace the excised parotid tissue and prevent Frey syndrome. They were followed up for 1-9 years to check for the relevant symptoms. We studied 17 female and 20 male patients, mean age 52 (range 19-78) years. The flaps took a maximum of 17minutes to dissect. There was no donor site morbidity, the vascular fat flap was stable in all cases for up to nine years, and none of the patients complained of symptoms of Frey syndrome.
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Affiliation(s)
- A Ghassemi
- Oral and Maxillofacial Surgery, Teaching Hospital, Georg-August-University Göttingen, Klinikum-Lippe, Röntgenstr. 18, 32756 Detmold, Germany; Medical Faculty University RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - A Modabber
- Oral and Maxillofacial Surgery, University Hospital RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - P O Brzoska
- Department of Internal Medicine, St. Marien-Hospital, Hospitalstraße 44, 52353 Düren, Germany
| | - M Sababi
- Department of Hearing Disorders Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND Frey's syndrome is a group of symptoms that include unilateral sweating with malar region and external ear reddening after eating or drinking some food. It is a lesion of the auriculotemporal nerve that is secondary to surgery, parotid gland infection or facial trauma. CLINICAL CASES Three children between 4 and two and a half years of age: two girls and one boy. They had self-limiting unilateral erythematous facial macules that reached the external ear, without rash, itching, angioedema and gastrointestinal or respiratory symptoms; its onset was associated with the consumption of acid and some sweet foods. Symptom reproduction of was observed in the path of the auriculotemporal nerve. Their histories included cesarean section delivery owing to cephalopelvic disproportion (case 1), birth by operative vaginal delivery with forceps (case 2) and cesarean delivery owing to preeclampsia (case 3). CONCLUSIONS Frey's syndrome is often mistaken with food allergy, leading to unnecessary dietary restrictions. Sweating is often absent in children owing to possible eccrine glands immaturity.
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Mantsopoulos K, Koch M, Goncalves M, Iro H. Investigation of the surgical strategies for unilateral multifocal cystadenolymphomas of the parotid gland. Oral Oncol 2018; 82:176-180. [PMID: 29909894 DOI: 10.1016/j.oraloncology.2018.05.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/26/2018] [Accepted: 05/25/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to compare multifocal extracapsular dissection with complete parotidectomy in the treatment of unilateral multifocal cystadenolymphomas of the parotid gland. MATERIALS AND METHODS The records from all patients treated for unilateral multifocal cystadenolymphomas of the parotid gland at a tertiary referral center between 2000 and 2016 were retrospectively analyzed. RESULTS 203 patients were included in the study. 96 patients were managed by multifocal extracapsular dissection, 107 patients underwent complete parotidectomy. Metachronous tumors were detected in 7 cases (3.4%) with a significant difference in the occurrence rate between multifocal extracapsular dissection (7/96, 7.3%) and complete parotidectomy (0/107, 0%) (p = 0.004). Permanent facial palsy was significantly more common after complete parotidectomy (21/107, 19.6%) than multifocal extracapsular dissection (2/96, 2.1%) (p = 0.000). CONCLUSIONS The functional benefit of multifocal extracapsular dissection was counterbalanced by the advantage of complete parotidectomy, in terms of recurrences. Extracapsular dissection is at its limit in cases of multifocal cystadenolymphomas and the indication for it should be thoroughly verified in each and every case.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Lovato A, Restivo DA, Ottaviano G, Marioni G, Marchese-Ragona R. Botulinum toxin therapy: functional silencing of salivary disorders. Acta Otorhinolaryngol Ital 2018; 37:168-171. [PMID: 28516981 PMCID: PMC5463526 DOI: 10.14639/0392-100x-1608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 01/21/2023]
Abstract
Botulinum toxin (BTX) is a neurotoxic protein produced by Clostridium botulinum, an anaerobic bacterium. BTX therapy is a safe and effective treatment when used for functional silencing of the salivary glands in disorders such as sialoceles and salivary fistulae that may have a post-traumatic or post-operative origin. BTX injections can be considered in sialoceles and salivary fistulae after the failure of or together with conservative treatments (e.g. antibiotics, pressure dressings, or serial aspirations). BTX treatment has a promising role in chronic sialadenitis. BTX therapy is highly successful in the treatment of gustatory sweating (Frey's syndrome), and could be considered the gold standard treatment for this neurological disorder.
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Affiliation(s)
- A Lovato
- Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy
| | - D A Restivo
- Department of Internal Medicine, Neurologic Unit, Nuovo "Garibaldi" Hospital, Catania, Italy
| | - G Ottaviano
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, Italy
| | - G Marioni
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, Italy
| | - R Marchese-Ragona
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, Italy
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Mehta R, Punjabi M, Soni R, Dagur M, Patidar P, Singh P. Sternocleidomastoid Flap in Parotid Surgery: A Case Series. Indian J Otolaryngol Head Neck Surg 2018; 70:434-7. [PMID: 30211104 DOI: 10.1007/s12070-018-1368-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022] Open
Abstract
Superficial and deep parotidectomies are known treatments for benign and malignant neoplasms of parotid glands. Due to the gland's proximity to facial nerve and other vital structures, this surgery carries the highest risk of facial nerve palsy. Another frequently overlooked complication, which can be detrimental to patient's life style is Frey's syndrome, or gustatory sweating. Other complications include flap necrosis and various contour deformities. We conducted this study on a group of 40 patients of parotid swellings to assess usage of sternocleidomastoid flap in prevention of Frey's syndrome, contour deformities, flap necrosis, salivary fistula and drain related injuries. We divided the patients in two groups based on the usage of sternomastoid flap. In Group A, the patients underwent superficial or total parotidectomies with a partial thickness, superiorly based sternomastoid flap. In Group B, no sternomastoid flap was placed. The incidence of Frey's syndrome was seen to be 3 times in Group B, while a visible contour deformity was seen in a third of patients in Group B, with Group A reporting no incidence. Also Group A, did not see any cases of flap necrosis or salivary fistula, while Group B saw 3 and 2 cases respectively. Also, among the two revision cases done in Group A, the one with previously placed sternomastoid flap (done by us 3 years back) had an excellent plane preserved, while another revision case without sternomastoid flap saw a complete adherence of facial nerve to overlying skin, resulting in Grade II permanent facial palsy. Parotidectomy is a technically challenging surgery in regards to important structures in the vicinity. Even with ostensibly perfect technique, facial nerve injury can occur for unknown reasons. All in all, sternomastoid flap is an acceptable modality to fill the parotidectomy defect, improve the facial contour and reduce the incidences of Frey's syndrome and skin necrosis.
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Henry N, Baker B, Iyer S. Frey's syndrome following a facial burn treated with botulinum toxin. Ann Burns Fire Disasters 2018; 31:47-48. [PMID: 30174572 PMCID: PMC6116648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Frey's syndrome occurs as a result of damage to the auriculotemporal nerve, which causes inappropriate regeneration of damaged parasympathetic fibres to salivary glands to innervate the sympathetic receptors of sweat glands in the face. The symptoms are pathological flushing and sweating with gustatory stimuli. It most commonly occurs following parotid surgery and has not previously been reported following burn injury. We present a 50-year-old man who sustained 1% TBSA full thickness burn to the right side of his face as a child. This was excised and reconstructed with skin grafts as well as further revision procedures in his adult life. He incidentally reported copious amounts of gustatory sweating over his right temple region that had been present since his initial injury, occurring prior to any reconstruction, consistent with Frey's syndrome. This was confirmed with a starch iodine test, and successfully treated with Botulinum toxin injections post reconstruction. This case is the first report of Frey's syndrome following burn injury. We highlight the potential development of Frey's syndrome following facial burns, even in the reconstructed area. Botulinum toxin treatment remains effective.
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Affiliation(s)
- N. Henry
- Royal Preston Hospital, Preston, UK
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Iwanaga J, Bobek SL, Fisahn C, Nakamura K, Miyazono Y, Tubbs RS. An unusual finding of the auriculotemporal nerve: possible risk factor during preauricular skin incisions. Gland Surg 2017; 5:647-649. [PMID: 28149814 DOI: 10.21037/gs.2016.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The auriculotemporal nerve (ATN) is a branch of the mandibular nerve and has been implicated for some migraines and its role in Frey's syndrome is well known. An adult cadaver was found to have a duplicated ATN. The anterior trunk ascended as the superficial temporal artery and gave off the branches to the temporomandibular joint, parotid gland, external acoustic meatus and temporal region and communicated with a posterior trunk of the ATN. The posterior trunk ascended via the subcutaneous tissues 1 mm anterior to the auricle and gave off the branches to the anterior auricular region, temporal region and communicated with the anterior trunk. Such a duplicated ATN might be injured with preauricular skin incisions. Knowledge of such an anatomical variation might assist surgeons in iatrogenic injury of the ATN.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, WA 98122, USA;; Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan;; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Samuel L Bobek
- Swedish Maxillofacial Surgery, Swedish Medical Center, Seattle, WA 98122, USA
| | - Christian Fisahn
- Seattle Science Foundation, Seattle, WA 98122, USA;; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA 98122, USA
| | - Ken Nakamura
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Yoshihiro Miyazono
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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Bayır Ö, Çelik EK, Saylam G, Tatar EÇ, Saka C, Dağlı M, Özdek A, Korkmaz MH. The Effects of Superficial Musculoaponeurotic System Flap on the Development of Frey's Syndrome and Cosmetic Outcomes After Superficial Parotidectomy. Turk Arch Otorhinolaryngol 2016; 54:158-164. [PMID: 29392039 DOI: 10.5152/tao.2016.1987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the outcomes of superficial musculoaponeurotic system (SMAS) flap and classic techniques in superficial parotidectomy in terms of Frey's syndrome (FS) and cosmetic satisfaction. Methods In this study, a retrospective chart review of patients that underwent superficial parotidectomy was performed. These patients were divided into two subgroups: group 1 included patients in which the SMAS flap was harvested and group 2 comprised the remaining patients on whom classic superficial parotidectomy was performed. All the patients were evaluated clinically and with Minor's starch-iodine test for FS. For the evaluation of the cosmetic results, the patient's satisfaction was queried according to the incision scar and surgical field skin retraction/facial symmetry. Both groups were compared in terms of complications and numbness of surgical area. Results Fifty-five patients (31 male and 24 female) with a mean age of 50.19 years were included in the study. Thirty-two patients were in group 1 and 23 in group 2. Thirteen patients (23.7%) described as having FS and six of them were in group 1, while seven were in group 2. Minor's starch-iodine test was positive in nine patients in group 1 (28.1%) and six patients in group 2 (26.1%) (p=1.000). With regard to cosmetic satisfaction, eight patients (25%) stated mild discomfort from the incision scar and two patients (6.3%) stated cosmetic dissatisfaction for facial asymmetry in group 1. In group 2 for the same factors the number of patients were 11 (47.8%) and 2 two (8.7%), respectively (p=0.027). There were no statistically significant differences in means of complication and numbness (p>0.05). Conclusion According to our study results, there was no superiority between both the groups in terms of FS and incision scar satisfaction. We determined that there was a significant benefit of SMAS flap application in the prevention of volume loss and surgical area retraction.
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Affiliation(s)
- Ömer Bayır
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Elif Kaya Çelik
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cem Saka
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muharrem Dağlı
- Department of Otolaryngology, Head and Neck Surgery, Abant İzzet Baysal University School of Medicine, Bolu, Turkey
| | - Ali Özdek
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology, Head and Neck Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Abstract
CONCLUSIONS We found that the great auricular nerve (GAN) passes at the median (m) point between the tips of the mandibular angle and mastoid process. We also established the GAN definitive line using this point for rapid identification of the trunk of the GAN and systematic parotidectomy combined with procedures for identification of the GAN, elevation of the skin flap, and exposure of the parotid capsule, which showed a high rate of preservation of the nerve and the lobular branch. OBJECTIVE The aim of this study was to improve parotidectomy and the rate of preservation of the GAN. METHODS This study comprised 74 consecutive patients who were scheduled to have parotidectomy for benign tumors at our department between November 2011 and April 2014. We examined whether our GAN definitive line including the m point was useful to identify the trunk of the GAN and whether anterograde dissection of the nerve could be performed simultaneously with skin flap elevation and exposure of the parotid capsule and contributed to preservation of the trunk to the lobular branch. RESULTS The trunk was identified under the GAN definitive line drawn preoperatively in 97.3% of cases (72/74). Combined surgery was successfully performed with a 95.9% (71/74) preservation rate of the GAN including the lobular branch.
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Affiliation(s)
- Hiroshi Iwai
- Department of Otolaryngology, Takii Hospital, Kansai Medical University , Osaka
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21
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Demirci U, Basut O, Noyan B, Demir UL, Afsin Ozmen O, Kasapoglu F, Hakan Coskun H, Onart S. The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response. Indian J Otolaryngol Head Neck Surg 2014; 66:291-8. [PMID: 24533401 PMCID: PMC3918314 DOI: 10.1007/s12070-012-0492-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022] Open
Abstract
The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis.
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Affiliation(s)
- Ugur Demirci
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Oguz Basut
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Behzat Noyan
- />Department of Physiology, Uludag University Medical Faculty, Bursa, Turkey
| | - Uygar Levent Demir
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - O. Afsin Ozmen
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Fikret Kasapoglu
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - H. Hakan Coskun
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Selcuk Onart
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
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Basut O, Noyan B, Demirci U. Evaluating the Efficacy of a Sternocleidomastoid Flap via Galvanic Skin Responses in Superficial Parotidectomy. Indian J Otolaryngol Head Neck Surg 2014; 66:242-5. [PMID: 24533391 DOI: 10.1007/s12070-011-0455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 12/26/2011] [Indexed: 10/14/2022] Open
Abstract
In the present study, we evaluated the efficacy of flaps via measurement of galvanic skin responses (GSR) in patients who had undergone superficial parotidectomy either with or without sternocleidomastoid (SCM) muscle flaps. Retrospective study design was used. The setting included University of Uludag School of Medicine Department of Otorhinolaryngology. Eleven patients who had undergone superficial parotidectomy for benign diseases in our clinic between June 2003 and August 2006 were included in the study. SCM muscle flaps were used in four patients. The GSR of the patients were measured using a MP 30 System. The Mann-Whitney U test was used for the analysis of data. There were complaints that resembled Frey's syndrome in three patients in whom flaps had not been performed. Patients with flaps had no complaints. In patients with flaps, no significant GSR changes were observed between the control and operated sides (P > 0.05). In patients without flaps, the GSR levels were significantly higher on the operated side compared to the control side (P < 0.05). GSR values on the control side did not show any differences between patients with and without a flap. However, there were significantly higher GSR values for the operated side in patients without flaps compared to patients with flaps (P < 0.05). Application of a SCM flap is an efficient method by which to prevent Frey's syndrome, and the GSR test is beneficial both in diagnosiing and determining the severity of the disease as well as evaluating the efficacy of surgical techniques used to prevent Frey's syndrome.
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