Frey-Syndrom nach lateraler Parotidektomie

Background: Gustatory sweating is a common complication of parotid surgery.¶Patients and methods: In order to evaluate the incidence of Frey’s syndrome following superficial parotidectomy, 69 patients who underwent surgery due to adenoma were studied. Forty-three patients (62%) suffered from gustatory sweating following superficial parotidectomy, and 33 of them requested treatment. Nineteen patients felt that their quality of life had been decreased by the symptoms. Results: Minor’s starch iodine test proved that 85% of the patients who did not notice Frey’s syndrome after surgery actually had a subclinical manifestation. Eight patients were successfully treated with intracutaneous injections of botulinum toxin A. Within 1 week gustatory sweating disappeared. Conclusion: Frey’s syndrome is present in almost all patients following superficial parotidectomy and there is a strong need for treatment. Intracutaneous injection of botulinum toxin A is an effective treatment in severe cases of the syndrome.     

预防腮腺切除术后味觉出汗综合征的临床研究

目的：评价应用异种脱细胞真皮基质修复膜重建腮腺咬肌筋膜预防腮腺切除术后味觉出汗综合征的效果。方法：将2007年1-10月期间40例因腮腺肿瘤需进行腮腺浅叶或全叶切除的患者随机分成两组,研究组缝合术创时在面神经表面与皮瓣之间插入异种脱细胞真皮基质修复膜,重建被切除的腮腺咬肌筋膜;对照组不植入任何隔离物。术后进行追踪随访,采取主观问卷和客观评价的方法进行疗效评析。结果：术后随访10到18个月,平均13个月。所有患者的手术均获得成功,术后未见肿瘤复发;研究组味觉出汗综合征发病率为5%（1/20）;对照组味觉出汗综合症发病率为55%（11/20）,两组统计学有显著差异（P〉0.01）。结论：应用异种脱细胞真皮基质修复膜重建腮腺咬肌筋膜,有助于防止腮腺切除术后神经错位生长,减少出汗味觉综合征发生,是一种简单易行、值得推广的方法。     

颈阔肌瓣防治味觉出汗综合征

目的:探讨手术同期行颈阔肌瓣修复腮腺术区缺损对味觉出汗综合征的预防作用及美学效果,同时探讨味觉出汗综合征的病理生理机制.方法:回顾性分析近2 年9 例手术同期行颈阔肌瓣修复腮腺术区缺损患者,观察患者术后是否出现味觉出汗综合征及术区凹陷.结果:所有患者均未出现味觉出汗综合征,术区凹陷不明显.结论:同期行颈阔肌瓣修复腮腺术区缺损对预防味觉出汗综合征可能有一定的作用,且可降低术区凹陷,为一种理想的腮腺肿瘤术式.     

腮腺改良术式预防味觉出汗综合症的临床研究

目的：探讨胸锁乳突肌瓣即刻充填腮腺手术术区,同时保留腮腺咬肌筋膜对预防味觉出汗综合症的临床效果。方法：选择45例已行腮腺良性肿瘤切除术病例进行回顾性分析。观察组21例,腮腺肿瘤切除术后行胸锁乳突肌瓣即刻充填＋保留腮腺咬肌筋膜预防味觉出汗综合症;对照组24例,单纯行腮腺浅叶切除术。45例均按期随访,做碘-淀粉试验检查（Minor试验）进行客观评价。结果：经术后6～24个月随访,所有手术均获得成功,观察组Minor试验3例阳性,对照组Minor试验18例阳性,两组之间发病率有显著性差异（P〈0.01）。结论：腮腺术后术区胸锁乳突肌瓣即刻填塞＋同期保留腮腺咬肌筋膜可明显降低味觉出汗综合症的发病率。     

腮腺咬肌筋膜在腮腺肿瘤切除术中的应用

目的:探讨在腮腺切除手术中保留腮腺咬肌筋膜预防腮腺切除术后并发症的效果。方法 :对21例腮腺良性肿瘤患者行肿瘤切除术的同时保留了腮腺咬肌筋膜,术后随访6～30个月。结果:20例患者手术获得成功,仅有1例于19个月后肿瘤复发,4例出现味觉出汗综合征。结论:在腮腺良性肿瘤切除手术中完好地保留腮腺咬肌筋膜,对预防术后味觉出汗综合征有明显效果,并且是安全、可靠的。     

味觉出汗综合征的临床分析

为了观察味觉出汗综合征的发病情况,对100例行腮腺区手术的患者,作了客现的碘-淀粉试验检查。结果表明:行浅叶切除术者,其发病率(100％)明显高于包括肿瘤及其周围部分正常腺体的区域切除术者(发病率为18.18％)。放射治疗虽可降低味觉出汗综合征的发病率,但放射治疗后仍有复发可能。     

Contemporary management of benign parotid tumours – the increasing evidence for extracapsular dissection

Benign parotid tumours have historically often been managed surgically by superficial parotidectomy. While this approach usually gives a generous cuff of surrounding normal parotid tissue to increase tumour margins, it requires a much larger incision than the increasingly used extracapsular dissection (ECD) technique. Furthermore, superficial parotidectomy can result in marked facial hollowing, Frey syndrome and an increased risk of both temporary and permanent facial nerve weakness. ECD has been popularised as a safe alternative to parotidectomy primarily for the removal of mobile, benign parotid tumours with safe outcomes and reduced risk to the facial nerve. In this article, we review the growing body of evidence for ECD and include our own experience confirming the move away from superficial parotidectomy in contemporary practice for the treatment of benign parotid tumours.     

Accessory parotid gland tumours: 24 years of clinical experience

The accessory parotid gland (APG) is salivary tissue anterior to and anatomically separate from the parotid gland. APG is a common anatomical variation, but APG tumours are extremely rare. The authors report 6 patients with APG tumours emphasizing the diagnosis, clinical features, indications and rationales for different treatment approaches. Patients with primary tumours of the parotid gland or APG tumours who underwent surgical treatment were included. APG tumours comprised 1.23% of overall parotid tumours (6/488) and had a malignancy rate of 33.3% (2/6). There were three male and three female patients with a mean age of 39 years (range 14–70 years). 5 of 6 parotidectomies entailed superficial lobectomy, while one was a total parotidectomy with composite resection of masseter muscle. Concomitant selective lymphadenectomy was carried out in 3 of 6 patients. At 5 years disease-free survival was 83.3%. Mean follow-up was 161 months (range 14–253 months). Although nonsalivary diagnoses frequently occur in the buccal area, APG tumours should be considered in every differential diagnosis in patients presenting with a mid-cheek mass. From oncosurgical, cosmetic and functional standpoints, treatment by facelift parotidectomy or ‘S-incision’ with concomitant superficial lobectomy is the recommended surgical approach; high-grade malignancies require total parotidectomy with regional lymphadenectomy.     

The incidence of Frey's syndrome.

AIMS: The incidence of Frey's syndrome after parotidectomy greatly varies in the literature. The aim of this study was to analyse the incidence with the help of a new series of patients and to discuss and review the results. PATIENTS: 372 patients (age: 50.7+/-11.6 yrs) underwent unilateral parotidectomy. In 203 subjects the insertion of a sternocleidomastoideus flap in the parotid area was performed intraoperatively. METHODS: Patients were followed-up concerning the clinical presence of gustatory sweating and flushing after secretory stimulation, and were questioned about suffering in everyday life. RESULTS: 86 patients (23.5%) developed Frey's syndrome after an average of 12 months (12.3+/-9.9 months) following parotidectomy. Only 44% of the patients with Frey's syndrome were symptomatic. No benefit concerning Frey's syndrome following application of a sternocleidomastoideus flap was seen. CONCLUSION: Gustatory sweating after parotidectomy must still be regarded as an unpleasant and common complication. Nevertheless, it is more the subjective suffering of the patients than the incidence that makes prevention important.     

Cross-sectional study on the occurrence of Frey's syndrome following superficial parotidectomy or extracapsular dissection

BackgroundMost studies that examine postoperative outcomes after parotidectomy in patients with benign parotid gland tumors are based on retrospective chart reviews. Data about long-term results in patients with parotid gland surgery with patient contact are still sparsely published.MethodsDuring the period of 1960–2005, a total of 127 patients underwent either extracapsular dissection (ECD) or superficial parotidectomy (SP) and were available for interview. Patients were questioned about their postoperative outcome after parotid gland surgery.ResultsThe mean follow-up was 21.5 years. A total of 42 and 85 patients underwent ECD and SP, respectively. No significant differences were observed in the rates of permanent facial paralysis (SP 1.2% vs. ECD 7.1%; p = 0.1053) or recurrence (SP 4.7% vs. ECD 11.9%; p = 0.1557), and Frey's syndrome was diagnosed only after SP (10.6% vs. 0% after ECD, p = 0.0293). Frey's syndrome was detected more often compared to retrospective chart analysis.ConclusionWe conclude that Frey's syndrome is underdiagnosed after SP without standardized follow-up examinations. Long-term follow-up should be applied to detect and treat gustatory sweating.     

Feasibility of a new V-shaped incision for parotidectomy: a preliminary report

We report the design of a new V-shaped incision for parotidectomy that involves only preauricular and postauricular incisions and no hairline or upper cervical incision. It can be used to approach almost all the superficial parotid region, including the superior and anterior divisions, with minimal scarring. To evaluate its technical feasibility, safety, and cosmetic results, we prospectively enrolled 15 patients (between September 2015 and September 2016) who had partial parotidectomy as the primary treatment for benign parotid tumours. Operations were successfully completed through this approach alone in 14 (mean (range) operating time: 120 (105–142) minutes; drainage volume: 51 (23–70) ml; and duration of drainage: 2.6 (2–4) days). There were no serious complications such as paralysis of the facial nerve or necrosis of the wound. The mean (range) visual analogue scale (VAS) and Vancouver Scar Scale scores for the scars were 9 (8–10) and 0.9 (0–3), respectively. A V-shaped incision for partial parotidectomy is technically feasible and safe, and can produce good cosmetic results in selected patients with benign parotid tumours. Our results need to be confirmed in larger studies and case-control trials.     

Frey syndrome--delayed clinical onset: a case report

Frey syndrome is a disorder characterized by unilateral sweating and flushing of the facial skin in the area of the parotid gland occurring during meals. The syndrome is a sequela of parotidectomy and may follow other surgical, traumatic, and inflammatory injuries of the parotid and submandibular glands and the cervical and upper thoracic portions of the sympathetic trunk. Pathogenesis is based on regeneration of sectioned parasympathetic fibers with inappropriate innervation of cutaneous sweat glands. Various studies have reported the clinical incidence of Frey syndrome after parotidectomy to be as high as 53%. The reported incidence of Frey syndrome in patients not undergoing intraoperative preventive measures is 96% in patients evaluated by means of an iodine-starch test 12 months postoperatively. We present a case in which a patient developed symptoms of Frey syndrome 8(1/2) years after superficial parotidectomy. Although most patients with Frey syndrome have only mild-to-moderate symptoms (only 6% of patients experience severe symptoms), the potential for appearance of Frey syndrome years after the parotidectomy must be discussed with the patient before surgery in the parotid region.     

Tumour recurrence after surgical removal of parotid pleomorphic salivary adenoma using a retrograde facial nerve dissection technique

Recurrence after surgical removal of parotid pleomorphic salivary adenoma using retrograde facial nerve dissection is not well researched. We adopted retrograde nerve dissection for parotid surgery for benign disease as a standard procedure in 1995. The objective of this study was to establish the rate of recurrence of primary tumours associated with the technique after removal of parotid pleomorphic salivary adenoma. We recruited 59 patients over a 16-year (1995-2011) period and collected the data prospectively. Eight patients were excluded as they had died or had been lost to follow up. Male:female ratio was 16:35 and age range was 15-69 years. The mean tumour size as measured on magnetic resonance imaging (MRI) was 27.4mm. Thirty-eight patients had superficial parotidectomy, 8 had total parotidectomy, and 5 had partial superficial parotidectomy. Mean follow up from the date of operation was 104 months (median 98, range 17-171). All patients were reviewed and examined in 2011 to establish whether the tumour had recurred. One patient had developed a solitary nodular recurrence 8 years after the initial procedure. Recurrence was 2%. The rate of clinically apparent recurrence after parotidectomy for pleomorphic salivary adenoma in this study is low and is comparable with others reported.     

Fat injections for the management of post-parotidectomy Frey syndrome: A technical note

PurposeFrey syndrome (profuse sweating and cutaneous flushing in the area innervated by the auriculotemporal nerve) is a frequent and unpleasant complication of parotidectomy. Fat injections may be useful in preventing the abnormal nerve neo-anastomoses sprouting to the sweat glands that are responsible for gustatory sweating, but have never been used before.Material and methodsWe describe the use of fat injections into the parotid gland of four patients with post-parotidectomy Frey syndrome.ResultsAll of the patients experienced a clinical and subjective improvement, although slight sweating persisted. There were no untoward effects during the procedure and, in particular, no facial nerve impairment.ConclusionOn the basis of our experience minimally invasive fat injections can be considered in the case of post-parotidectomy Frey syndrome, but patients should be informed that subsequent procedures may be needed to achieve a definitive result.     

腮腺多形性腺瘤178例临床分析

目的:探讨腮腺多形性腺瘤的临床特征和术后并发症的防治。方法:对178例经病理确诊为腮腺多形性腺瘤的患者进行临床回顾性分析。结果:手术后发生暂时性面瘫31例,味觉出汗综合征6例,涎瘘7例,积液2例,复发3例。结论:腮腺多形性腺瘤治疗以外科手术为主,应注意对并发症的防治。     

腮腺多形性腺瘤区域性切除术与浅叶切除术的比较研究

目的 比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据.方法 总结1998年1月～2004年6月间收治的腮腺多形性腺瘤61例,其中24例采用腮腺区域性切除术,37例行腮腺浅叶切除术,随访时间3～9年.结果 采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异.结论 区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式.     

腮腺区域性切除术在治疗腮腺浅叶多形性腺瘤中的体会

目的探讨腮腺多形性腺瘤两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据。方法总结1999年1月至2007年1月间汕头市第二人民医院收治的腮腺多形性腺瘤90例,其中44例采用腮腺区域性切除术,46例行腮腺浅叶切除术,随访时间2～9年。结果采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而采用两种术式肿瘤的复发率差异无统计学意义。结论区域性切除术手术创伤小．并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式。     

Techniques for dissection of the facial nerve in benign parotid surgery: a cross specialty survey of oral and maxillofacial and ear nose and throat surgeons in the UK

We investigated techniques of dissection of the facial nerve currently being used in parotid surgery for benign disease in oral and maxillofacial (OMF) and ear, nose and throat (ENT) surgery. A postal questionnaire was sent to 300 OMF and 300 ENT consultants and 49% were returned(171(57%) OMF and 123 (41%) ENT. The antegrade technique was used routinely by 209 surgeons (87%), the retrograde technique by 9 (4%), and both techniques combined by 21 surgeons (9%). The antegrade technique was used by 135 surgeons (56%) for revision parotidectomy, by 193 (81%) for limited superficial parotidectomy, by 173 (72%) for obese patients with large tumours and by 75 (31%) for injury to the facial nerve. The retrograde technique was used by 21 surgeons (9%) for revision parotidectomy, by 22 (9%) for limited superficial parotidectomy, by 15 (6%) for obese patients with large tumours and by 29 surgeons (12%) for injury to the facial nerve. A combination of techniques was chosen by 83 surgeons (35%) in revision parotidectomy, by 24 surgeons (10%) in limited superficial parotidectomy, by 51 surgeons (21%) in obese patients with large tumours and by (56%) surgeons 135 for injury to the facial nerve.     

Prevention of Frey syndrome with superficial temporal fascia interpositioning: a retrospective study

Frey syndrome (FS) is a commonly documented postoperative complication following parotidectomy. The aim of this study was to clinically evaluate the efficacy of superficial temporal fascia (STF) as interpositioning barrier between the overlying skin flap and the parotid bed for the prevention of FS following superficial parotidectomy. A retrospective study was designed involving a population of patients from a single institution who underwent superficial parotidectomy for parotid tumours and refractory chronic sialadenitis from 2008 to 2011. Forty-eight cases were identified and divided into two groups: group I (n = 25) had undergone STF interpositioning between the skin flap and the parotid bed after extending the modified Blair's incision in the temporal region, and group II (n = 23) had undergone a superficial parotidectomy using the modified Blair's incision without any interpositioning. In group I, one of 25 cases (4%) developed mild FS; in group II, nine of 23 cases (39.1%) developed FS of varying severity. There were no cases of permanent facial palsy in either group. Alopecia along the temporal extension of the incision line was imperceptible in all group I cases. The use of an STF interpositioning barrier between the overlying skin flap and the parotid bed is a safe and effective procedure for the prevention of FS following superficial parotidectomy.