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STERNOCLEIDOMASTOID FLAP DURING PAROTIDECTOMY TO PREVENT FREY'S SYNDROME
FREY'S SYNDROME
Profuse sweating and flushing over the preauricular and parotid regions of the face during mastication constitutes the symptom complex known as Frey's syndrome. Also referred to as auriculotemporal syndrome or gustatory sweating, it is most commonly encountered in post-parotidectomy patients. Its incidence is not known for certain, but it is estimated that approximately 50% of post-parodidectomy patients will report symptoms, while over 90% will test positive for gustatory sweating using objective tests. Symptoms usually become apparent within several months of surgery.
Duphenix, a French surgeon, first described this entity in 1757 after observing gustatory sweating following the drainage of a parotid abscess. The syndrome was named for the Polish neurologist Lucja Frey. In 1923, Frey described the occurrence of gustatory sweating in a patient who had sustained a gunshot wound to the parotid region.
The pathophysiology of Frey's syndrome is believed to have its origins intra-operatively, when postganglionic parasympathetic cholinergic secretomotor fibers, which normally innervate the parotid gland, are severed during parotidectomy. The severed fibers then undergo abnormal regeneration of the cut ends of post-ganglionic cholinergic sympathetics to the sweat glands of the overlying skin. Because of these aberrant neural connections, when salivation is stimulated, local sweat glands are inadvertently activated and the patient's cheek becomes flushed and wet.
According to Ileri et al, two possible complications of parotidectomy are Frey's syndrome and facial contour deformity:
* Frey's syndrome
* Facial contour deformity frequently occurs as a result of a surgically created mild depression in the pre- and infraauricular area.
To prevent Frey's syndrome and obliterate the depression caused by the removal of the parotid gland, Ileri et al described a superior sternocleidomastoid flap to cover the facial nerve.
(Ileri,F et al. Ear Nose and Throat Journal, March 1, 2005)
A superiorly based sternocleidomastoid muscle flap is rotated into the parotidectomy defect..
Otolaryngology Houston
Bechara Y. Ghorayeb, MD
OTOLARYNGOLOGY - HEAD & NECK SURGERY
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