A device for applying postsurgical pressure to the lateral face.

OBJECTIVE: The purpose of this study was to improve the effect of pressure applied on the lateral face after operations, particularly after parotid surgery for prevention of complications, especially the formation of salivary fistula. STUDY DESIGN: A pressure instrument (face pad) was designed to fit all types of facial morphology. The blood flow velocity of the superficial temporal artery was measured by means of a Doppler detector in 30 healthy volunteers under 2 different conditions, with and without the face pad. Values for 2 parameters, peak velocity and average peak velocity, were determined for the purpose of selecting an appropriate pressure. Each of 47 patients who had undergone regional parotidectomy received pressure with the face pad for 3 days; the results were compared with those in a control group of 44 patients who had undergone similar operations but received traditional packing dressings. RESULTS: The peak velocities of the superficial temporal artery with and without the face pad were not significantly different (t = 1.541, P = .132) when a pressure value of 4 to 5 N was applied. However, the average peak velocity of the superficial temporal artery increased significantly (t = 3.678, P = .001) with the face pad. The 47 patients with the face pad had no postoperative parotid fistula; in contrast, salivary fistula developed in 5 of the 44 control cases, for an overall fistula rate of 11.36%. A significant difference existed between the 2 groups (P = .023). CONCLUSIONS: The face pad worked quantitatively and was stable and comfortable. A pressure of 4 to 5 N on the lateral face did not influence the blood flow of the superficial temporal artery. The higher peak velocity was correlated with regional stenosis of the temporal vein caused by pressure. Evidently, the face pad can reduce postoperative complications after parotidectomy; moreover, it makes pressure dressing easy and shortens the in-hospital days of the patient as well.

Use of a parotid fascia flap to prevent postoperative fistula.

OBJECTIVE: The purpose of this study was to investigate the usefulness of a fascia flap technique designed to improve the post-operative results of regional excision in cases of benign tumor in the superficial lobe of the parotid gland and to reduce formation of postoperative fistula. STUDY DESIGN: During surgery in each of 32 patients with benign tumor in the superficial lobe of the parotid gland, a fascia flap was raised from beneath the ear lobe, placed in its original position, and firmly sutured after regional resection of the tumor. The results were compared with those in a control group of 30 patients, whose operations were the same as those of the experimental group except for the fact that the fascia overlying the tumor was excised with the tumor in the controls. RESULTS: The wounds of the 32 patients repaired with the fascia flap healed well without any complication. Among the 30 patients in the control group, fistula occurred in 4 patients (13.3%). The difference was significant when the 2 groups were compared (chi2 test: P = .049 , P < .05). CONCLUSIONS: Use of a parotid fascia flap in partial parotidectomy for benign tumors in the superficial lobe holds promise for the prevention of postoperative fistula formation.