Prevention of Frey syndrome during parotidectomy.

Abstract

OBJECTIVE:

To evaluate the incidence of Frey syndrome (auriculotemporal nerve syndrome) after parotidectomy with and without placement of a subcutaneous implant and to examine the relationship between different implants and postoperative wound complications (hematoma, seroma, salivary fistula).

DESIGN:

A prospective nonrandomized controlled trial.

SETTING:

A primary care and referral university hospital center.

PATIENTS:

All patients scheduled for parotidectomy from April 1994 through August 1998 were eligible. Seventy patients were enrolled (2 refused). All 70 patients were evaluated for wound complications. Sixty patients with a follow-up of more than 1 year were evaluated for Frey syndrome.

INTERVENTION:

The choice of implant was left to the individual surgeon: 24 patients had no implant; 7, lyophilized dura implant; 7, polyglactin 910-polydioxanone (Ethisorb) implant; and 32, expanded polytetrafluoroethylene (e-PTFE) implant.

OUTCOME MEASURES:

The incidence of Frey syndrome was evaluated (1) subjectively by history (clinical Frey syndrome) and (2) objectively by using 2 newly developed tests. Both hemifaces were tested, with the normal side being used as a control.

RESULTS:

Clinical Frey syndrome was present in 12 patients: 11 without implants (11/24 [53%]) and 1 with an implant (1/46 [2%]) (P<.001). Objective tests were positive in 24 patients: 16 (76%) of 21 without implants and 8 (20%) of 39 with implants (P<.001). In the implanted patients, the objective tests were positive in 71% (5/7) of those with lyophilized dura, 14% (1/7) of those with Ethisorb, and 8% (2/29) of those with e-PTFE implants (P<.001). Wound complications included hematoma in 5 patients (7%), seroma in 4 patients (6%), and salivary fistula in 15 (21%). Salivary fistula occurred more frequently with Ethisorb (57%) and e-PTFE (25%) implants (P = .04).

CONCLUSIONS:

In patients without an implant, the incidence of Frey syndrome is 50% for subjective and 80% for objective evaluation. In patients with an implant, these incidences are 3% and 10%, respectively. Some implants are associated with a higher incidence of salivary fistula.

• Authors: P Dulguerov, D Quinodoz, G Cosendai, P Piletta, F Marchal, W Lehmann
• Journal: Archives of otolaryngology--head & neck surgery (Arch Otolaryngol Head Neck Surg) Vol. 125 Issue 8 Pg. 833-9 (Aug 1999) ISSN: 0886-4470 [Print] United States
• PMID: 10448728 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)

Chemical References

• Polydioxanone
• Polyglactin 910
• Polytetrafluoroethylene

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bone and Bones
• Child
• Desiccation
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Parotid Gland (surgery)
• Polydioxanone (therapeutic use)
• Polyglactin 910 (therapeutic use)
• Polytetrafluoroethylene (therapeutic use)
• Postoperative Complications
• Prospective Studies
• Prostheses and Implants
• Surgical Mesh
• Sweating, Gustatory (prevention & control, surgery)