Role of Cervical Fascia-SCM Muscle Flap Preventing Frey`s Syndrome Following Parotidectomy

Abstract

Introduction: Although parotidectomy has been widely used as a treatment for tumors in the parotid gland, postoperative complications such as Frey`s syndrome and changes in facial contour can have a big impact in the patient`s quality of life. Although reconstruction using various flaps to overcome these problems has been reported, sternocleidomastoid muscle flap is used most commonly. However, its effectiveness is still controvertial. We investigated the significance of reconstructive surgery using cervical fascia-sternocleidomastoid(CSCM) muscle flap in patients who had undergone parotidectomy due to parotid tumors. Materials and Methods: Survery was carried out to 50 patients who underwent parotidectomy due to parotid tumors between June, 1996 and April, 2001. Twenty four patients were males and 26 patients were females. Twenty five patients underwent parotidectomy along with reconstructive surgery using CSCM muscle flap. Frey` syndrome and changes in facial contour were assessed by the questionnaires based on the patients`s subjective symptoms. Results: Of the 25 patients who had undergone parotidectomy without reconstructive surgery, 14(56%) patients complained of perspiration or flushing of the operated area during mastication, whereas only 3(12%) patients who had undergone reconstructive surgery had the same complications (p=0.02). Of the 42 patients who had superficial parotidectomy, 21 patients had reconstructive surgery using CSCM muscle flap and only 2(9.5%) patients had such complications. Among the other 21 patients who underwent superficial parotidectomy without reconstructive surgery, 13(61.9%) patients had the same complications. Among the 25 patients who underwent parotidectomy without reconstructive surgery, 8(32%) patients complained of changes in facial contour. While on the other hand, only 2(8%) patients who underwent reconstructive surgery along with parotidectomy had such complications(p=0.074). Among the 42 patients who underwent superficial parotidectomy, 21 patients had reconstructive using CSCM muscle flap and only 2(8%) patients had such complications while among the other 21 patients who only underwent superficial parotidectomy without reconstructive surgery 13(61.9%) patients had such complications. Only 4 pateints of the 25 patients who had reconstructive surgery with CSCM muscle flap complained of changes in the neck contour and only 2 patients who underwent reconstructive surgery complained of motion deficit of the neck or shoulder. Conclusion: This study shows that occurrence of Frey` syndrome after parotidectomy was sifnificantly lower in the group that underwent reconstructive surgery using CSCM muscle flap. The CSCM muscle flap helped prevent changes in the facial contour although it was not statistically significant.