Assessment of functional outcome after parotidectomy reconstruction

Jitendra Kumar, Sunil Kumar, H. P. Singh, Veerendra Verma, Anupam Mishra


Background: Total or superficial parotidectomy, when a reconstructive technique is not used, usually leads to Frey’s syndrome, preauricular and retromandibular depression. These together with the scar from a classic or modified Blair incision limit the final aesthetic outcome. The superiorly based sternocleidomastoid muscle (SCM) flap or superficial musculo-aponeurotic system (SMAS) flap can be used for reconstruction of the defect to achieve better facial contour restoration. The aim and objective of the study was to evaluate the functional and cosmetic outcome of patients after reconstruction in parotid surgeries.

Methods: This study was done in the department of Otorhinolaryngology & Head-Neck Surgery. Total number of patients with parotid tumours were 24 in each group namely- Group A: Patients undergoing parotid surgery without reconstruction. Group B: Patients undergoing parotid surgery with reconstruction using superiorly based sternocleidomastoid muscle flap. All patients were followed and analyzed on 6 weeks, 6 months and 1 year postoperatively on the basis of patient’s satisfaction, cosmesis, subjective Frey’s syndrome, retromandibular and pre-auricular depression using visual analogue scale.  

Results: In Group A, subjective Frey’s syndrome was present in 8.3% patients from 6 month to 1 year. In contrast, in Group B, it remain absent in all patients at all periods. In Group A, preauricular depression was present in 79.2% patients in immediate postop and 95.8% patients from 6 week to 1 year. In contrast, in Group B, it was present in only 4.2% patients at all periods. In Group A, retromandibular depression was present in 70.8% patients while in Group B, it was absent in all patients.

Conclusions: The superiorly based SCM flap for reconstruction of defect following superficial or total parotidectomy improves the final outcome in terms of the facial deformity (pre-auricular, retro-auricular depression) and lowers the incidence of Frey’s syndrome.


Parotidectomy, Sternocleidomastoid flap, Functional outcome

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Hodgkinson DJ, Woods JE. The influence of facial-nerve sacrifice in surgery of malignant parotid tumors. J Surg Oncol. 1976;8:425-32.

Chung EJ, Lee SH, Baek SH, Kwon KH, Chang YJ, Rho YS. Oncological and functional results after the surgical treatment of parotid cancer. Int J Oral Maxillofac Surg. 2015;44:16-22.

Durgut O, Basut O, Demir UL, Demir UL, Ozmen OA, Kasapoglu F, Coskun H. Association between skin flap thickness and Frey's syndrome in parotid surgery. Head Neck. 2013;35:1781-6.

Sanabria A, Kowalski LP, Bradley PJ, Hartl DM, Bradford CR, de Bree R, et al. Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidetomy: a systematic review. Head Neck. 2012;34:598–8.

Curry JM, Fisher KW, Heffelfinger RN, Rosen MR, Keane WM. Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Laryngoscope 2008;118(2):210-5.

Barberá R, Castillo F, D'Oleo C, Benítez S, Cobeta I. Superficial musculoaponeurotic system flap in partial parotidectomy and clinical and subclinical Frey's syndrome. Cosmesis and quality of life. Head Neck. 2014;36:130-6.

Cesteleyen L, Helman J, King S, Van de Vyvere G. Temporoparietal fascia flaps and superficial muscoloaponeurotic system plication in parotid surgery reduces Frey's syndrome. J Oral Maxillofac Surg. 2002;60:1284–97.

Nofal AA, Mohamed M. Sternocleido mastoid Muscle Flap after Parotidectomy. Int Arch Otorhino-laryngol. 2015;19(4):319-24.

Gooden EA, Gullane PJ, Irish J, Katz M, Carroll C. Role of the sternocleidomastoid muscle flap preventing Frey’s syndrome and maintaining facial contour following superficial parotidectomy. J Otolaryngol. 2001;30:98-101.