Meta-analysis of Surgical Techniques for Preventing Parotidectomy Sequelae

Rate of Fat Graft Volume Loss After Parotidectomy

“…3,15,23 However, both these options may not be suitable for larger defect volume replacement and harvesting SCM flaps carries a risk of spinal accessory nerve injury. 3,14,15 Implanting of ADM has been found to improve post-parotidectomy soft tissue depression, however, ADM has been shown to be associated with postoperative seroma, higher infection rates, foreign body reactions, and higher cost. 11,14,15,22,[28][29] Finally, free tissue transfer can be utilized for parotidectomy reconstruction, with benefits including increased volume for large defects, potential for skin harvest, fascia and nerve transfer for potential facial reanimation, and high soft tissue vascularity to withstand postoperative chemotherapy and radiation if needed.…”

“…For example, SCM rotational flaps have been shown to provide greater vascularity to the surgical bed if perforators are preserved, and both SCM and SMAS flaps are beneficial in preventing cosmetic deformity and preserving facial symmetry. 3,15,23 However, both these options may not be suitable for larger defect volume replacement and harvesting SCM flaps carries a risk of spinal accessory nerve injury. 3,14,15 Implanting of ADM has been found to improve post-parotidectomy soft tissue depression, however, ADM has been shown to be associated with postoperative seroma, higher infection rates, foreign body reactions, and higher cost.…”

“…Reconstructive techniques after parotidectomy including abdominal fat grafting, SMAS elevation, ADM implantation, SCM flaps, and free tissue transfer are frequently performed to obliterate resection cavities, prevent complications, and improve cosmetic outcomes. 3,[11][12][13][14][15][16] Reconstruction after parotidectomy has previously been shown to significantly decrease incidence of complications such as Frey syndrome and facial nerve paresis through mechanisms of restoring the natural barrier and protective functions of subcutaneous soft tissue layers. 3,11,12,[20][21][22][23] Fat grafting, implanting of ADM, elevating of SMAS, rotating of SCM are all thought to prevent Frey syndrome by barricading the permeation of acetylcholine and the regrowth of aberrant parasympathetic fibers from buccal skin, however, SCM flaps have not shown significant prevention of Frey syndrome.…”

“…3,14,15 Implanting of ADM has been found to improve post-parotidectomy soft tissue depression, however, ADM has been shown to be associated with postoperative seroma, higher infection rates, foreign body reactions, and higher cost. 11,14,15,22,[28][29] Finally, free tissue transfer can be utilized for parotidectomy reconstruction, with benefits including increased volume for large defects, potential for skin harvest, fascia and nerve transfer for potential facial reanimation, and high soft tissue vascularity to withstand postoperative chemotherapy and radiation if needed. 23 However, drawbacks to this option include poor skin color match to the recipient site, longer operative time, increased scarring, and greater risk of surgical complications such as hematoma, wound dehiscence, and infection.…”

“…2,6,[8][9][10] Reconstruction is often performed using acellular dermal matrix (ADM) implants, sternocleidomastoid flaps (SCM), superficial musculoa-poneurotic system (SMAS) elevation, and free abdominal fat grafts to obliterate the resection cavity, prevent complications, and improve cosmesis. 3,[11][12][13][14][15][16] Fat graft reconstructions reliably lose volume throughout an initial postoperative period until stabilizing to a constant volume, or steady state. 14,16,17 In the parotid, it has previously been shown using clinic-office photographs that over-correction of the restorative parotid volume by 30% during fat graft reconstruction will produce clinical fullness at the surgical site for the immediate postoperative period but will ultimately reduce, stabilize, and achieve adequate symmetry at 6 months postoperatively.…”