Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T14:15:15.142Z Has data issue: false hasContentIssue false

Free fat grafting in superficial parotid surgery to prevent Frey's syndrome and improve aesthetic outcome

Published online by Cambridge University Press:  09 July 2013

L S Chan*
Affiliation:
Department of Otolaryngology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
M S Barakate
Affiliation:
Department of Otolaryngology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
T E Havas
Affiliation:
Department of Otolaryngology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
*
Address for correspondence: Dr Lyndon Chan, 20 Ducane St, Forrest, ACT, Australia2603 Fax: +61 2 4922 3344 E-mail: [email protected]

Abstract

Background:

Frey's syndrome and cosmesis are important considerations in parotid surgery. Placement of an interpositional barrier can prevent these complications; however, surgical technique and efficacy remain controversial.

Methods:

A prospective case series was collected comprising all patients undergoing primary superficial parotidectomy for benign pathology with abdominal free fat grafting between June 2007 and December 2010, performed by a single surgeon. A survey was also distributed to otorhinolaryngology consultants across Australia to assess current practice.

Results:

Twenty-eight patients were included. No patient had clinical symptoms of Frey's syndrome. Seventy-five per cent of patients were completely satisfied with their aesthetic outcome, 18 per cent scored 4/5 and the remaining 7 per cent (2 patients) scored 3/5. The survey revealed that 79 per cent of respondents did not use interpositional grafts.

Conclusion:

Abdominal free fat is ideal for grafting as it is an effective, safe, simple, accessible, fast and inexpensive method of providing an interpositional graft.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster at the Australian Society of Otolaryngology Head and Neck Surgery 2012 Annual Scientific Meeting, 1 April 2012, Adelaide, South Australia, Australia

References

1Albergotti, W, Nguyen, S, Zenk, J, Gillespie, MB. Extracapsular dissection for benign parotid tumours: a meta-analysis. Laryngoscope 2012;122:1954–60CrossRefGoogle ScholarPubMed
2Curry, J, King, N, Reiter, D, Fisher, K, Heffelfinger, R, Pribitkin, E. Meta-analysis of surgical techniques for preventing parotidectomy sequelae. Arch Facial Plast Surg 2009;11:327–31CrossRefGoogle ScholarPubMed
3Sanabria, A, Kowalski, L, Bradley, P, Hartl, D, Bradford, C, de Bree, R et al. Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: a systematic review. Head Neck 2012;34:589–98CrossRefGoogle ScholarPubMed
4Bianchi, B, Ferri, A, Ferrari, S, Copelli, C, Sesenna, E. Improving esthetic results in benign parotid surgery: statistical evaluation of facelift approach, sternocleidomastoid flap, and superficial musculoaponeurotic system flap application. J Oral Maxillofac Surg 2011;69:1235–41CrossRefGoogle ScholarPubMed
5Asal, K, Köybaşioğlu, A, Inal, E, Ural, A, Uslu, S, Ceylan, A et al. Sternocleidomastoid muscle flap reconstruction during parotidectomy to prevent Frey's syndrome and facial contour deformity. Ear Nose Throat J 2005;84:173–6CrossRefGoogle ScholarPubMed
6Bonanno, P, Palaia, D, Rosenberg, M, Casson, P. Prophylaxis against Frey's syndrome in parotid surgery. Ann Plast Surg 2000;44:498501CrossRefGoogle ScholarPubMed
7Taylor, S, Yoo, J. Prospective cohort study comparing subcutaneous and sub-superficial musculoaponeurotic system flaps in superficial parotidectomy. J Otolaryngol 2003;32:71–6CrossRefGoogle ScholarPubMed
8Ahmed, O, Kolhe, P. Prevention of Frey's syndrome and volume deficit after parotidectomy using the superficial temporal artery fascial flap. Br J Plast Surg 1999;52:256–60CrossRefGoogle ScholarPubMed
9Cesteleyn, L, Helman, J, King, S, Van de Vyvere, G. Temporoparietal fascia flaps and superficial musculoaponeurotic system plication in parotid surgery reduces Frey's syndrome. J Oral Maxillofac Surg 2002;60:1284–97CrossRefGoogle ScholarPubMed
10Elliott, R, Weinstein, G, Low, D, Wu, L. Reconstruction of complex total parotidectomy defects using the free anterolateral thigh flap: a classification system and algorithm. Ann Plast Surg 2011;66:429–37CrossRefGoogle ScholarPubMed
11Valentini, V, Cassoni, A, Marianetti, TM, Battisti, A, Terenzi, V, Iannetti, G. Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap? J Craniofac Surg 2008;19:1148–53CrossRefGoogle ScholarPubMed
12Dulguerov, P, Quinodoz, D, Cosendai, G, Piletta, P, Marchal, F, Lehmann, W. Prevention of Frey syndrome during parotidectomy. Arch Otolaryngol Head Neck Surg 1999;125:833–9CrossRefGoogle ScholarPubMed
13Sachsman, S, Rice, D. Use of AlloDerm implant to improve cosmesis after parotidectomy. Ear Nose Throat J 2007;86:512–13CrossRefGoogle ScholarPubMed
14Sinha, U, Saadat, D, Doherty, C, Rice, D. Use of AlloDerm implant to prevent Frey syndrome after parotidectomy. Arch Facial Plast Surg 2003;5:109–12CrossRefGoogle ScholarPubMed
15Nosan, D, Ochi, J, Davidson, T. Preservation of facial contour during parotidectomy. Otolaryngol Head Neck Surg 1991;104:293–8CrossRefGoogle ScholarPubMed
16Harada, T, Inoue, T, Harashina, T, Hatoko, M, Ueda, K. Dermis-fat graft after parotidectomy to prevent Frey's syndrome and the concave deformity. Ann Plast Surg 1993;31:450–2CrossRefGoogle ScholarPubMed
17Curry, J, Fisher, K, Heffelfinger, R, Rosen, M, Keane, W, Pribitkin, E. Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Laryngoscope 2008;118:210–15CrossRefGoogle ScholarPubMed
18Conger, B, Gourin, C. Free abdominal fat transfer for reconstruction of the total parotidectomy defect. Laryngoscope 2008;118:1186–90CrossRefGoogle ScholarPubMed
19de Bree, R, van der Waal, I, Leemans, C. Management of Frey syndrome. Head Neck 2007;29:773–8CrossRefGoogle ScholarPubMed
20Luna-Ortiz, K, Sansón-RíoFrío, J, Mosqueda-Taylor, A. Frey syndrome. A proposal for evaluating severity. Oral Oncol 2004;40:501–5CrossRefGoogle ScholarPubMed
21Mohammed, F, Asaria, J, Payne, R, Freeman, J. Retrospective review of 242 consecutive patients treated surgically for parotid gland tumours. J Otolaryngol Head Neck Surg 2008;37:340–6Google ScholarPubMed
22Linder, T, Huber, A, Schmid, S. Frey's syndrome after parotidectomy: a retrospective and prospective analysis. Laryngoscope 1997;107:1496–501CrossRefGoogle ScholarPubMed
23Owen, E, Banerjee, A, Kissin, M, Kark, A. Complications of parotid surgery: the need for selectivity. Br J Surg 1989;76:1034–5CrossRefGoogle ScholarPubMed
24Clayman, M, Clayman, S, Seagle, M. A review of the surgical and medical treatment of Frey syndrome. Ann Plast Surg 2006;57:581–4CrossRefGoogle ScholarPubMed
25Bray, D, Hopkins, C, Roberts, D. A review of dermal fillers in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2010;18:295302CrossRefGoogle ScholarPubMed
26Neuber, G. Fat transplantation [in German]. Chir Kongr Verhandl Dtsch Gesellsch Chir 1893;22:66Google Scholar
27Boyce, R, Nuss, D, Kluka, E. The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck. Otolaryngol Clin North Am 1994;27:3968CrossRefGoogle ScholarPubMed
28Ersek, R. Transplantation of purified autologous fat: a 3-year follow-up is disappointing. Plast Reconstr Surg 1991;87:219–27CrossRefGoogle ScholarPubMed
29Matsudo, P, Toledo, L. Experience of injected fat grafting. Aesthetic Plast Surg 1988;12:35–8CrossRefGoogle ScholarPubMed
30Pinski, K, Roenigk, HJ. Autologous fat transplantation. Long-term follow-up. J Dermatol Surg Oncol 1992;18:179–84CrossRefGoogle ScholarPubMed
31Fontdevila, J, Serra-Renom, J, Raigosa, M, Berenguer, J, Guisantes, E, Prades, E et al. Assessing the long-term viability of facial fat grafts: an objective measure using computed tomography. Aesthet Surg J 2008;28:380–6CrossRefGoogle ScholarPubMed
32Witt, R. The significance of the margin in parotid surgery for pleomorphic adenoma. Laryngoscope 2002;112:2141–54CrossRefGoogle ScholarPubMed
33Casler, J, Conley, J. Sternocleidomastoid muscle transfer and superficial musculoaponeurotic system plication in the prevention of Frey's syndrome. Laryngoscope 1991;101:95100CrossRefGoogle ScholarPubMed
34Bonanno, P, Casson, P. Frey's syndrome: a preventable phenomenon. Plast Reconstr Surg 1992;89:452–6CrossRefGoogle ScholarPubMed
35Allison, G, Rappaport, I. Prevention of Frey's syndrome with superficial musculoaponeurotic system interposition. Am J Surg 1993;166:407–10CrossRefGoogle ScholarPubMed
36Taylor, S, Yoo, J, Matthews, T, Lampe, H, Trites, J. Frey's syndrome and parotidectomy flaps: a retrospective cohort study. Otolaryngol Head Neck Surg 2000;122:201–3CrossRefGoogle ScholarPubMed
37Wille-Bischofberger, A, Rajan, G, Linder, T, Schmid, S. Impact of the SMAS on Frey's syndrome after parotid surgery: a prospective, long-term study. Plast Reconstr Surg 2007;120:1519–23CrossRefGoogle ScholarPubMed
38Teknos, T, Nussenbaum, B, Bradford, C, Prince, M, El-Kashlan, H, Chepeha, D. Reconstruction of complex parotidectomy defects using the lateral arm free tissue transfer. Otolaryngol Head Neck Surg 2003;129:183–91CrossRefGoogle ScholarPubMed
39Rappaport, I, Allison, G. Superficial musculoaponeurotic system amelioration of parotidectomy defects. Ann Plast Surg 1985;14:315–23CrossRefGoogle ScholarPubMed
40Arden, R, Miguel, G. Aesthetic parotid surgery: evolution of a technique. Laryngoscope 2011;121:2581–5CrossRefGoogle ScholarPubMed
41Kornblut, A, Westphal, P, Miehlke, A. A reevaluation of the Frey syndrome following parotid surgery. Arch Otolaryngol 1977;103:258–61CrossRefGoogle ScholarPubMed
42Athavale, S, Phillips, S, Mangus, B, Datta, J, Sinard, R, Netterville, J et al. Complications of alloderm and dermamatrix for parotidectomy reconstruction. Head Neck 2012;34:8893CrossRefGoogle ScholarPubMed