Abstract
Importance:
Conventional reconstruction techniques for superficial parotidectomy have been criticized for their ability to provide long-term volumetric correction and to prevent Frey's syndrome.
Objective:
To demonstrate the long-term effectiveness of a pedicled and innervated sternocleidomastoid muscle flap (PISCMMF) to reconstruct superficial parotidectomy defects.
Design, Setting, and Participants:
This is a retrospective cohort study of patients treated by a single surgeon in a tertiary care center from July 2012 to March 2018. Seventeen of a possible 34 eligible adults having undergone reconstruction with a PISCMMF for benign parotid disease with at least 1 year of follow-up were included through convenience sampling. Patients with revision parotid surgery, malignant parotid tumors, neck dissections, or prior spinal accessory nerve dysfunction were excluded.
Intervention:
A PISCMMF was used to immediately reconstruct superficial parotidectomy defects.
Main Outcomes and Measures:
Participants underwent three-dimensional facial imaging, starch–iodine testing for Frey's syndrome, and completed a validated satisfaction questionnaire. The surface area of the positive starch–iodine tests was calculated. An average model was generated from participant images, allowing the calculation of surface millimeter differences comparing the operative with nonoperative sides.
Results:
Seventeen patients [7 male (41.2%), mean age 50.82 ± 12.37 years] underwent a PISCMMF to reconstruct excision (mean specimen weight = 21.45 ± 12.22 g) of benign lesions [9 pleomorphic adenomas (52.9%), 5 Warthin's tumors (29.4%), 2 cysts (11.8%), 1 chronic parotitis (5.9%)], with a mean follow-up time of 35.41 ± 12.30 months. Rates of objective and subjective Frey's syndrome were 29.4% and 11.8%, respectively. The average surface area affected was 2.32 cm2 [standard deviation (SD) = 1.95 cm2] compared with the average surface area of 16.35 cm2 (SD = 9.20 cm2) of the excised specimens. Facial symmetry analysis revealed an average millimeter difference of −1.57 ± 2.55 mm that was not significant at a threshold of 2 mm [t(16) = 0.69, p = 0.50]. No participants had postoperative shoulder or neck dysfunction. Overall satisfaction was 95.4%. Age (β = −0.51, p = 0.02) and case number (β = 0.44, p = 0.04) were significant predictors of smaller millimeter difference (R2 = 0.48, F(2,14) = 6.41, p = 0.01). The specimen mass (β = −0.05, p = 0.35) did not predict millimeter difference (R2 = 0.11, F(1,8) = 0.10, p = 0.35).
Conclusions and Relevance:
A PISCMMF immediately reconstructing parotidectomy defects successfully restores facial symmetry, prevents clinically significant Frey's syndrome, and results in high patient satisfaction in the long term without significant morbidity.
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