title: Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy.
abstract: 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.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. joseph.curry@jefferson.edu
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Curry
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Fisher
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Heffelfinger
authors.forename: Marc R
authors.initials: MR
authors.lastname: Rosen
authors.forename: William M
authors.initials: WM
authors.lastname: Keane
authors.forename: Edmund A
authors.initials: EA
authors.lastname: Pribitkin
mesh_terms: 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