Sternocleidomastoid Muscle Flap after Parotidectomy
27 January 2015
23 February 2015
27 March 2015 (eFirst)
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.
- 1 Blumenfeld RJ, Friedman JE. Intratympanic surgical treatment of Frey's syndrome. Arch Otolaryngol 1967; 86 (1) 2-7
- 2 Smith Jr RO, Hemenway WG, Stevens KM, Ratzer ER. Jacobson's neurectomy for Frey's syndrome. Am J Surg 1970; 120 (4) 478-481
- 3 Yu LT, Hamilton R. Frey's syndrome: prevention with conservative parotidectomy and superficial musculoaponeurotic system preservation. Ann Plast Surg 1992; 29 (3) 217-222
- 4 Kornblut AD, Westphal P, Miehlke A. A reevaluation of the Frey syndrome following parotid surgery. Arch Otolaryngol 1977; 103 (5) 258-261
- 5 Laage-Hellman JE. Gustatory sweating and flushing after conservative parotidectomy. Acta Otolaryngol 1957; 48 (3) 234-252
- 6 Morfit HM, Kramish D. Auriculotemporal syndrome (Frey's syndrome) following surgery of parotid tumors. Am J Surg 1961; 102: 777-780
- 7 Wallis KA, Gibson T. Gustatory sweating following parotidectomy: correction by a fascia lata graft. Br J Plast Surg 1978; 31 (1) 68-71
- 8 Conley JJ, Clairmont AA. Dermal-fat-fascia grafts. Otolaryngology 1978; 86 (4 Pt 1) ORL-641-ORL-649
- 9 Nosan DK, Ochi JW, Davidson TM. Preservation of facial contour during parotidectomy. Otolaryngol Head Neck Surg 1991; 104 (3) 293-298
- 10 Kim SY, Mathog RH. Platysma muscle-cervical fascia-sternocleidomastoid muscle (PCS) flap for parotidectomy. Head Neck 1999; 21 (5) 428-433
- 11 Rubinstein RY, Rosen A, Leeman D. Frey syndrome: treatment with temporoparietal fascia flap interposition. Arch Otolaryngol Head Neck Surg 1999; 125 (7) 808-811
- 12 Bugis SP, Young JE, Archibald SD. Sternocleidomastoid flap following parotidectomy. Head Neck 1990; 12 (5) 430-435
- 13 Sanabria A, Kowalski LP, Bradley PJ , et al. Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: a systematic review. Head Neck 2012; 34 (4) 589-598
- 14 Casler JD, Conley J. Sternocleidomastoid muscle transfer and superficial musculoaponeurotic system plication in the prevention of Frey's syndrome. Laryngoscope 1991; 101 (1 Pt 1) 95-100
- 15 Rappaport I, Allison GR. Superficial musculoaponeurotic system amelioration of parotidectomy defects. Ann Plast Surg 1985; 14 (4) 315-323
- 16 Foustanos A, Zavrides H. Face-lift approach combined with a superficial musculoaponeurotic system advancement flap in parotidectomy. Br J Oral Maxillofac Surg 2007; 45 (8) 652-655
- 17 Allen RJ, Kaplan J. Reconstruction of a parotidectomy defect using a paraumbilical perforator flap without deep inferior epigastric vessels. J Reconstr Microsurg 2000; 16 (4) 255-257 , discussion 258–259
- 18 Baker DC, Shaw WW, Conley J. Microvascular free dermis-fat flaps for reconstruction after ablative head and neck surgery. Arch Otolaryngol 1980; 106 (8) 449-453
- 19 Dulguerov P, Quinodoz D, Cosendai G, Piletta P, Marchal F, Lehmann W. Prevention of Frey syndrome during parotidectomy. Arch Otolaryngol Head Neck Surg 1999; 125 (8) 833-839
- 20 Marx RE, McDonald DK. The sternocleidomastoid muscle as a muscular or myocutaneous flap for oral and facial reconstruction. J Oral Maxillofac Surg 1985; 43 (3) 155-162
- 21 Chow TL, Lam CY, Chiu PW, Lim BH, Kwok SR. Sternomastoid-muscle transposition improves the cosmetic outcome of superficial parotidectomy. Br J Plast Surg 2001; 54: 409-411
- 22 Terris DJ, Tuffo KM, Fee Jr WE. Modified facelift incision for parotidectomy. J Laryngol Otol 1994; 108 (7) 574-578
- 23 Appiani E, Delfino MC. Plastic incisions for facial and neck tumors. Ann Plast Surg 1984; 13 (4) 335-352
- 24 Hussain A, Murray DP. Preservation of the superficial lobe for deep-lobe parotid tumors: a better aesthetic outcome. Ear Nose Throat J 2005; 84 (8) 518-524 , 520–522, 524
- 25 Lin SD, Tsai CC, Lai CS, Lee SS, Chang KP. Endoscope-assisted parotidectomy for benign parotid tumors. Ann Plast Surg 2000; 45 (3) 269-273
- 26 Fee Jr WE, Tran LE. Functional outcome after total parotidectomy reconstruction. Laryngoscope 2004; 114 (2) 223-226
- 27 Gooden EA, Gullane PJ, Irish J, Katz M, Carroll C. Role of the sternocleidomastoid muscle flap preventing Frey's syndrome and maintaining facial contour following superficial parotidectomy. J Otolaryngol 2001; 30 (2) 98-101
- 28 Kornblut AD, Westphal P, Miehlke A. The effectiveness of a sternomastoid muscle flap in preventing post-parotidectomy occurrence of the Frey syndrome. Acta Otolaryngol 1974; 77 (5) 368-373
- 29 Sood S, Quraishi MS, Jennings CR, Bradley PJ. Frey's syndrome following parotidectomy: prevention using a rotation sternocleidomastoid muscle flap. Clin Otolaryngol Allied Sci 1999; 24 (4) 365-368
- 30 Malatskey S, Rabinovich I, Fradis M, Peled M. Frey syndrome—delayed clinical onset: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94 (3) 338-340