应用面部浅表肌肉腱膜系统折叠瓣和异体脱细胞真皮基质预防腮腺血管瘤切除术后Frey综合征

目的 探讨应用面部浅表肌肉腱膜系统(SMAS)折叠瓣和异体脱细胞真皮基质(ADM)预防腮腺血管瘤切除术后面部凹陷畸形和Frey综合征的效果.方法43例腮腺血管瘤患儿(男33例,女10例)经耳前和耳后切口切除整个腮腺,并将ADM置入腮腺床,再用SMAS折叠瓣进一步修补.通过调查问卷,由3位口腔颌面外科医师评估术后面部外形满意度.用Minor淀粉碘试验评估术后是否出现Frey综合征.结果 术后无明显并发症出现,术后瘢痕隐蔽好,双侧面部对称.88.4％( 38/43)的患儿术后面部轮廓极好,11.6％(5/43)非常满意.用Minor淀粉碘试验检测术后患者的Frey综合征发生率是4.7％(2/43).腮腺血管瘤无复发.结论 经耳前后入路切除腮腺,置入ADM并用SMAS折叠瓣修复腮腺床,术后外观良好,大大降低了Frey综合征的发生率,提高了术后面部外形满意度.

Use of superficial musculoaponenrotic system folded flap and aliograft dermal matrix to improve cosmetic outcome and to prevent Frey's syndrome after removal of parotid haemangiomas

Objective To evaluate the reliable and aesthetic effect of using a superficial musculoaponeurotic system (SMAS) folded flap and allograft dermal matrix (ADM) repair of the parotid bed following parotid haemangiomas incision.Methods Forty-three infant patients (33 males and 10 females ) with parotid gland haemangiomas underwent total parotidectomy in a pre-and retroauricular approach with ADM placed within the parotid bed.The patients' parotid bed was further repaired with SMAS folded flaps.Three oral and maxillofacial surgeons assessed the cosmetic outcomes.All of the patients were evaluated by a short questionnaire.Postoperative gustatory sweating was assessed by a modification of Minor's starch-iodine test.Results All the postoperative patients' scars were hidden well and facial symmetry was good.The postoperative facial contour was excellent in 88.4％ (38/43)and satisfactory in 11.6％ (5/43) of patients.The objective incidence of Frey's syndrome by the MSIT was 4.7％(2/43),None of the patients recurs.Conclusion Using a pre- and retroauricular approach and intraoperative placement of ADM and repair of the parotid bed with SMAS fold flaps provides a satisfactory aesthetic outcome with a low incidence of Frey's syndrome in patients suffering from parotid gland haemangiomas.