Sternocleidomastoid Muscle Flap after Parotidectomy

Abstract

Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.

Sternocleidomastoid Flap in Parotid Surgery: A Case Series

“…Then a superiorly based partial-thickness flap was taken from the SCM and rotated anteriorly to be sutured by 3-0 Vicryl interrupted sutures to the remnants of the parotid fascia and SMAS and preserved the healthy parotid tissue. This covered the facial nerve and its branches, retromandibular vein, and external carotid artery and its terminal branches, filling the defect that appears after parotidectomy, to achieve better facial contour restoration [15].…”

Intra-auricular modification of facelift incision decreased the risk of Frey syndrome

“…Frey syndrome is a common complication after parotidectomy. The incidence of symptomatic Frey syndrome is around 12%–43% [12345]. This is due to the aberrant reinnervation of parasympathetic nerves from auriculotemporal nerve to the sweat glands and vessels of the subcutaneous tissue in the preauricular and facial area [67].…”

“…Symptoms include flushing, sweating, burning, neuralgia, and itching in the preauricular and facial area [8910]. There were many methods to decrease the incidence of Frey syndrome: fascia lata grafts, free dermal-fat-fascia grafts, dermal-fat grafts, platysma muscle flaps, temporoparietal fascia flaps, sternocleidomastoid muscle (SCM) flaps, superficial musculoaponeurotic system (SMAS) flaps, but they showed no good effectiveness [5]. This study compares the incidence of Frey syndrome between two incisions: lazy-S incision with SCM flap or intra-auricular modification of facelift incision with SCM flap and discusses why the former is a better way to prevent Frey syndrome.…”

Smart flap of sternocleidomastoid muscle in anterior cervical spine surgery: Surgical anatomical dissection technique

“…The pedicle flap of sternocleidomastoid (SCM) muscle was firstly described by Jianu in 1909 . Since then, it has had several applications in different surgical fields (reconstruction in Head and Neck oncology; prevention of Frey's syndrome after parotidectomy; close pharyngocutaneous or esophageal fistulae).…”