Prevention of Frey syndrome during parotidectomy.
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).


METHODS
A prospective nonrandomized controlled trial.


METHODS
A primary care and referral university hospital center.


METHODS
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.


METHODS
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.


METHODS
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.
Dulguerov
P
P
Division of Head and Neck Surgery, Geneva University Hospital, Switzerland. pavel.dulguerov@hcuge.ch
Quinodoz
D
D
Cosendai
G
G
Piletta
P
P
Marchal
F
F
Lehmann
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones; D002648:Child; D003890:Desiccation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000601:surgery*; D016687:Polydioxanone / Q000627:therapeutic use; D011098:Polyglactin 910 / Q000627:therapeutic use; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D019736:Prostheses and Implants; D013526:Surgical Mesh; D013547:Sweating, Gustatory / Q000517:prevention & control* / Q000601:surgery
D016687:Polydioxanone; D011098:Polyglactin 910; D011138:Polytetrafluoroethylene