title: Improving esthetic results in benign parotid surgery: statistical evaluation of facelift approach, sternocleidomastoid flap, and superficial musculoaponeurotic system flap application.
abstract: OBJECTIVE
  The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed.
  
  
  METHODS
  From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant.
  
  
  RESULTS
  No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically (P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant (P = .3467).
  
  
  CONCLUSIONS
  Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap.
authors: Maxillofacial Surgery Division, Head and Neck Department, University and Hospital of Parma, Parma, Spain.
authors: Bernardo
authors: B
authors: Bianchi
authors: Andrea
authors: A
authors: Ferri
authors: Silvano
authors: S
authors: Ferrari
authors: Chiara
authors: C
authors: Copelli
authors: Enrico
authors: E
authors: Sesenna
mesh_terms: D000235:Adenolymphoma / Q000601:surgery; D008949:Adenoma, Pleomorphic / Q000601:surgery; D000328:Adult; D000368:Aged; D003560:Cysts / Q000209:etiology; D004954:Esthetics; D005158:Facial Paralysis / Q000209:etiology; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000637:transplantation*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010305:Parotid Diseases / Q000209:etiology; D010307:Parotid Neoplasms / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D015361:Rhytidoplasty / Q000706:statistics & numerical data*; D013524:Surgical Flaps; D013547:Sweating, Gustatory / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult