Superficial Musculoaponeurotic System Amelioration of Parotidectomy Defects

Rappaport, Irving; Allison, Glenn R.

doi:10.1097/00000637-198504000-00004

Cited by 39 publications

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“…A fascia lata graft and SMAS flap as the sacrifice of the donor site are not thick enough to prevent depressed deformity. 2,4,6 In addition, human dura is costly and too thin to prevent a depressed deformity and foreign-body reaction. However, a dermofat graft after parotidectomy has the following advantages: (1) a dermofat graft is less significant because the incision line is placed within the underwear; (2) it is a less time-consuming procedure with the cooperation of 2 surgeons simultaneously (plastic surgeon and ear, nose, throat surgeon); (3) a sufficient amount can be obtained and designed according to the recipient's parotid bed shape; and (4) the operation is easier compared with others, and it has advantages to protect from the Frey syndrome and a depressed deformity.…”

Section: Discussionmentioning

confidence: 99%

Dermofat Graft After Superficial Parotidectomy Via a Modified Face-Lift Incision to Prevent Frey Syndrome and Depressed Deformity

Yoo

Lee²,

Park³

et al. 2011

Journal of Craniofacial Surgery

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Superficial parotidectomy is a well-established treatment for the early stages of tumors involving the parotid gland. However, there are 3 problems with traditional superficial parotidectomies: (1) cosmetic problems, such as scars, especially around the neck; (2) depressed deformities; and (3) Frey syndrome. A superficial parotidectomy via a modified face-lift incision with dermofat graft provides a solution for these problems and should be considered as an alternative technique in select patients.Key Words: Superficial parotidectomy, modified face-lift incision, dermofat graft, Frey syndrome (J Craniofac Surg 2011;22: 1021Y1023) S uperficial parotidectomy is a well-established treatment for earlystage tumors involving the parotid. The traditional superficial parotidectomy, however, leaves obvious cervical scars. Although a face-lift incision may improve the postoperative appearance by concealing the wounds, a face-lift incision without reconstruction of the hollow parotid bed does not prevent depressed deformities or the Frey syndrome.1,2 Many methods, such as the superficial musculoaponeurotic system (SMAS) advancement flap, fascia lata flap, and sternocleidomastoid (SCM) muscle flap, have been attempted to overcome these problems. 3Y7 However, because these procedures use the tissues around the wound, they have the disadvantage of causing donor-site morbidity. We report a patient with an early-stage tumor of the parotid gland for which we used a dermofat graft after a superficial parotidectomy via a modified facelift incision. CLINICAL REPORTA 15-year-old girl sought evaluation at the hospital for a palpable right parotid gland mass (23.3 Â 22.6 mm). She met the criteria of a clinically discrete parotid gland mass and was immediately transferred to the OtolaryngologyYHead and Neck Surgery Department of Ajou University Hospital. A computed tomogram scan was obtained to establish an accurate diagnosis and identify the exact site of the tumor (Figs. 1 and 2).The surgery was performed with the patient in the supine position under general anesthesia. The following procedures were performed by a plastic and reconstructive surgeon, with the patient's head tilted 45 degrees and the ipsilateral buttock was tilted 30 degrees in the sagittal plane. A temporal incision was made from the projected point at the beginning of the hairline to the junction of the ear and temporal skin. The incision was continued along the junction of the ear and cheek and was extended distally around the origin of the earlobe to the retroauricular fold. The occipital incision was extended horizontally into the hairy scalp for the huge mass. The next step was to elevate the flap superficial to the parotidomasseteric fascia. During the dissection, the great auricular nerve was identified and preserved.A superficial parotidectomy was performed by the otolaryngologyYhead and neck surgeon. The mastoid insertion site and anterior border of the SCM muscle were identified, and the posterior belly of the digastrics muscle was exposed. In the...

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Section: Discussionmentioning

confidence: 99%

Dermofat Graft After Superficial Parotidectomy Via a Modified Face-Lift Incision to Prevent Frey Syndrome and Depressed Deformity

Yoo

Lee²,

Park³

et al. 2011

Journal of Craniofacial Surgery

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“…4,8,9 Resection of the chorda tympani nerve in addition to Jacobson's nerve has been reported to increase effectiveness to 90%, but this will add dry mouth sequelae. 10 Several authors 3,6,8,[11][12][13] also believed that they could treat or prevent Frey's syndrome by interposing a graft between the parotid bed and the overlying skin. These techniques have the added advantage of filling the parotidectomy defect, thus preventing the contour deformities created by the parotidectomy procedures.…”

Section: Discussionmentioning

confidence: 99%

“…These techniques have the added advantage of filling the parotidectomy defect, thus preventing the contour deformities created by the parotidectomy procedures. These procedures have included fascia lata grafts, 8,13 dermal/fat grafts, 12 and SCM and superficial musculoaponeurotic system (SMAS) flap reconstructions. 6,[9][10][11]13 Although few reported cases of fascia lata grafts and dermal fat grafts were successful, the need for a separate incision is an obvious disadvantage.…”

Section: Discussionmentioning

confidence: 99%

“…These procedures have included fascia lata grafts, 8,13 dermal/fat grafts, 12 and SCM and superficial musculoaponeurotic system (SMAS) flap reconstructions. 6,[9][10][11]13 Although few reported cases of fascia lata grafts and dermal fat grafts were successful, the need for a separate incision is an obvious disadvantage. Kornblut et al 3 have deemed the SCM flap to be good for contour reconstruction, but without any affect on the prevention of Frey's syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Rapport and Allison's SMAS reconstruction techniques consisted of extending the SMAS to the platysmal layer, 13 the incidence of Frey's syndrome being only 4% (1 in 25 patients). Our technique also uses primarily the platysma muscle and cervical fascia (a part of the SMAS) and frequently adds the superficial portion of the SCM.…”

Section: Discussionmentioning

confidence: 99%

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Platysma muscle-cervical fascia-sternocleidomastoid muscle (PCS) flap for parotidectomy

Kim

Mathog

1999

Head Neck

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Background Parotidectomy is useful in the treatment of benign and malignant neoplasms of the parotid gland, but often leads to sequelae of facial deformity and Frey's syndrome. This paper presents a retrospective review of parotidectomy results in 21 consecutive patients treated with either traditional techniques or with the rotation and advancement of combined platysma muscle‐cervical fascia‐sternocleidomastoid flap (PCS). Methods The surgical procedures utilized for removal and reconstruction are described. Information on appearance and function was obtained by analysis of hospital and office records and telephone questionnaire for patients with and without the flap. Results Of the 21 patients eligible for this study, only 9 of 10 patients with the PCS flap and 10 of 11 patients without the flap provided sufficient data for analysis. In the flap group all 9 patients either noted a mild fullness on the operated side or no difference between sides. In the nonflap group, 4 patients felt they had a moderate depression, 2 patients noted a mild depression, and 4 patients noted no difference between sides. Frey's syndrome was classified as mild in 2 patients in the PCS group, whereas in the nonflap group, 4 patients thought it was mild and 1, severe. Complications were rare in either group. Conclusion The PCS flap prevents deformity and contributes to patient satisfaction following parotidectomy. The flap helps to prevent Frey's syndrome and is not associated with an increase in postoperative complications. The flap is recommended following removal of nonrecurrent or low‐grade malignant parotid tumors. © 1999 John Wiley & Sons, Inc. Head Neck 21: 428– 433, 1999.

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