Functional outcome after total parotidectomy reconstruction.
OBJECTIVE
The objective was to compare and contrast the functional and cosmetic outcomes of patients who underwent total parotidectomy with and without reconstruction using an inferiorly based sternocleidomastoid muscle flap.


METHODS
Retrospective review in the setting of a university medical center.


METHODS
Twenty-four patients underwent a total parotidectomy. Fifteen patients had reconstruction with an inferiorly based sternocleidomastoid muscle flap, and nine patients had no reconstruction. Clinical examination was performed independently by two head and neck surgeons and one aesthetician to evaluate cosmetic outcome, presence of gustatory flushing or sweating, and return of facial nerve and greater auricular nerve function.


RESULTS
With the mean follow-up of 22 months, the group having reconstruction showed a better cosmetic outcome compared with the group without reconstruction. Objective testing for Frey syndrome demonstrated gustatory sweating in 20% of the group having reconstruction group versus 22% in the group without reconstruction. There was no difference in length of operation, hospital stay, or facial nerve function. Objective testing of facial sensation revealed that only 40% in the group having reconstruction had normal sensation to light touch compared with 78% in the group without reconstruction.


CONCLUSIONS
The inferiorly based sternocleidomastoid muscle flap offers improved cosmetic results in patients undergoing total parotidectomy. However, there is a decreased return of greater auricular nerve function, probably attributable to relocation of the nerve stump anteriorly. Benefit was not seen in prevention of Frey syndrome measured objectively; however, the group having reconstruction had fewer clinical symptoms of gustatory sweating or flushing.
Fee
Willard E
WE
Division of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA. wfee@stanford.edu
Tran
Lynn E
LE
D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D008297:Male; D010306:Parotid Gland / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013547:Sweating, Gustatory / Q000209:etiology; D016896:Treatment Outcome