Evaluation of superficial musculoaponeurotic system flap and fat graft outcomes for benign and malignant parotid disease.
OBJECTIVE
(1) To evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. (2) To evaluate the long-term viability of the free fat graft following parotidectomy for benign and malignant disease, including in the postradiation setting.


METHODS
Prospective study of consecutive patients.


METHODS
Academic tertiary care medical center. Subjects and Methods Thirty-one consecutive patients underwent parotidectomy with SMAS flap and free fat graft reconstruction from 2006 to 2012. Data were compiled through a manual chart review.


RESULTS
Twenty-three of the 31 total patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. The 8 remaining patients (9 parotidectomies) underwent surgery for malignant disease, followed by postoperative radiation. The average age was 56 years (range, 16-84 years). The mean follow-up was 22.5 months. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. Magnetic resonance imaging confirmed long-term fat graft viability in the postradiation setting. There was 1 case of Frey syndrome and no cases of unexpected, permanent facial nerve weakness among the patients.


CONCLUSIONS
The combined technique of SMAS flap and free fat graft is effective for immediate reconstruction of the parotidectomy defect with minimal morbidity and low complication rates. This study demonstrates long-term viability of the free fat graft even in the setting of postoperative radiation.
Department of Otorhinolaryngology, University of Maryland, Baltimore, Maryland, USA.
Bryan T
BT
Ambro
Lindsay A
LA
Goodstein
Robert E
RE
Morales
Rodney J
RJ
Taylor
D000046:Academic Medical Centers; D000273:Adipose Tissue / Q000601:surgery / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010305:Parotid Diseases / Q000473:pathology* / Q000601:surgery*; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D040521:Subcutaneous Tissue / Q000601:surgery / Q000637:transplantation*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
SMAS flap; fat graft; parotidectomy; reconstruction; superficial musculoaponeurotic system