Abstract:
Superficial and deep parotidectomies are known treatments for benign and malignant neoplasms of parotid glands. Due to the gland\'s proximity to facial nerve and other vital structures, this surgery carries the highest risk of facial nerve palsy. Another frequently overlooked complication, which can be detrimental to patient\'s life style is Frey\'s syndrome, or gustatory sweating. Other complications include flap necrosis and various contour deformities. We conducted this study on a group of 40 patients of parotid swellings to assess usage of sternocleidomastoid flap in prevention of Frey\'s syndrome, contour deformities, flap necrosis, salivary fistula and drain related injuries. We divided the patients in two groups based on the usage of sternomastoid flap. In Group A, the patients underwent superficial or total parotidectomies with a partial thickness, superiorly based sternomastoid flap. In Group B, no sternomastoid flap was placed. The incidence of Frey\'s syndrome was seen to be 3 times in Group B, while a visible contour deformity was seen in a third of patients in Group B, with Group A reporting no incidence. Also Group A, did not see any cases of flap necrosis or salivary fistula, while Group B saw 3 and 2 cases respectively. Also, among the two revision cases done in Group A, the one with previously placed sternomastoid flap (done by us 3 years back) had an excellent plane preserved, while another revision case without sternomastoid flap saw a complete adherence of facial nerve to overlying skin, resulting in Grade II permanent facial palsy. Parotidectomy is a technically challenging surgery in regards to important structures in the vicinity. Even with ostensibly perfect technique, facial nerve injury can occur for unknown reasons. All in all, sternomastoid flap is an acceptable modality to fill the parotidectomy defect, improve the facial contour and reduce the incidences of Frey\'s syndrome and skin necrosis.
摘要:
浅部和深部腮腺切除术是腮腺良性和恶性肿瘤的已知治疗方法。由于腺体靠近面神经和其他重要结构,这种手术患面神经麻痹的风险最高。另一个经常被忽视的并发症,对病人的生活方式有害的是弗雷综合征,或味觉出汗。其他并发症包括皮瓣坏死和各种轮廓畸形。我们对40例腮腺肿胀患者进行了这项研究,以评估胸锁乳突肌皮瓣在预防Frey综合征中的应用。轮廓畸形,皮瓣坏死,唾液瘘和引流管相关损伤。我们根据胸乳突肌皮瓣的使用情况将患者分为两组。A组,患者进行了浅层或全腮腺切除术,部分厚度,上基胸乳突肌皮瓣。B组,未放置胸乳突肌皮瓣。B组中Frey综合征的发生率为3倍,而B组中三分之一的患者可见轮廓畸形,A组报告无发病率。A组,没有看到任何皮瓣坏死或唾液瘘的病例,B组分别为3例和2例。此外,在A组的两个修订案例中,一个先前放置的胸骨乳突肌皮瓣(由我们3年前完成)有一个很好的平面保存,而另一个没有胸骨乳突肌皮瓣的翻修病例看到面神经完全粘附在皮肤上,导致II级永久性面神经麻痹。腮腺切除术对于附近的重要结构而言是技术上具有挑战性的手术。即使有表面上完美的技术,面神经损伤可因不明原因而发生。总而言之,胸乳突肌皮瓣是填补腮腺切除术缺损的一种可接受的方式,改善面部轮廓,减少Frey综合征和皮肤坏死的发生率。