Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy.
OBJECTIVE
Elevation of the superficial musculoaponeurotic system (SMAS) with or without fat graft interposition during superficial parotidectomy prevents a concave facial deformity and Frey's syndrome.


METHODS
Retrospective, case-control study.


METHODS
Charts for 248 patients who underwent superficial parotidectomy were reviewed for pathologic, radiographic, clinical, and operative data. Sixteen patients who underwent SMAS elevation and 34 patients who underwent SMAS elevation with fat graft interposition were included in two study groups. Nonreconstructed controls were randomly selected from a pool of patients who had unilateral, superficial parotidectomy and were matched based on pathologic specimen volume. Patients were surveyed for their postoperative symptoms.


RESULTS
Patients undergoing SMAS elevation alone (n = 16) compared with controls (n = 19) had greater facial symmetry (12% vs. 32%, P = .147) and a lower incidence of symptomatic Frey's syndrome (6.3% vs. 18.6%, P = .382). Patients undergoing SMAS elevation and fat graft interposition (n = 34) compared with controls (n = 38) had less facial asymmetry (9% vs. 39%, P = .002) and a lower incidence of symptomatic Frey's syndrome (6% vs. 28%, P = .04). Complications among the study and control groups were comparable.


CONCLUSIONS
Simultaneous reconstruction of a superficial parotidectomy defect using SMAS elevation with or without fat grafting may improve postoperative facial symmetry and decrease the incidence of symptomatic Frey's syndrome without increasing complications.
Curry
Joseph M
JM
Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. joseph.curry@jefferson.edu
Fisher
Kyle W
KW
Heffelfinger
Ryan N
RN
Rosen
Marc R
MR
Keane
William M
WM
Pribitkin
Edmund A
EA
D050153:Abdominal Fat / Q000637:transplantation*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004954:Esthetics; D005146:Facial Asymmetry / Q000453:epidemiology; D005154:Facial Nerve / Q000473:pathology / Q000601:surgery; D005205:Fascia / Q000473:pathology; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D040521:Subcutaneous Tissue / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013547:Sweating, Gustatory / Q000453:epidemiology