Variable Methods of Protection for the Exposed Facial Nerves after Parotidectomy

ABSTRACT

Two significant unsolved problems in parotidectomy procedures are Frey's syndrome and postoperative depression deformity. The recent trend in the management of these problems has been the use of the prophylatic procedures performed at the time of parotidectomy to prevent its postoperative symptoms or complaints. We used a tissue barrier between the elevated cheek skin flap and the exposed facial nerve in order to prevent Frey's syndrome and depression deformity on the cheek. We used buccal fat, dermis fat graft or flap, superficial temporal fascia(STF) island flap and skin island or free flap as a tissue barrier. Thirty-nine patients had been operated and reviewed for over 3 years and 23 of them were treated with various kinds of tissue barriers. Frey's syndrome, depression deformity and other complications were reviewed. As a result, there was no permanent facial nerve palsy, Frey's syndrome and dissatisfaction with facial contour excluding minor complications of hematoma, scar and temporary facial palsy compared to the cases without the barrier. We concluded that the buccal fat is easy and simple to perform and it can be the first choice in children and young women. The dermis fat graft or flap is suitable for the old patient who requires pertinent volume. STF island flap is a pliable, wide and well vascularized flap, so it is well fit to cover the wide defect in man or old patient. In malignant or extensive lesions, skin island or free flap is recommendable for the simultaneous reconstruction of skin resurfacing and volume filling after the radical resection including the parotid gland. Various autogenous tissue barriers can be effectively and properly applicable to prevent the serious complications after the parotidectomy depending on the cases.