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Fawzy A, Balbaa MA, Hagag M. Evaluation of functional and aesthetic outcomes of free dermal fat graft versus superficial musculoaponeurotic system flap after superficial parotidectomy: randomized clinical trial. BJS Open 2023; 7:7156603. [PMID: 37151084 PMCID: PMC10165060 DOI: 10.1093/bjsopen/zrac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Parotidectomy is the standard procedure for treatment of many parotid lesions; however, it has several drawbacks. Facial asymmetry and Frey's syndrome are the most annoying complications to patients. Insertion of interpositioning grafts into the parotidectomy bed can decrease these complications significantly. Free dermal fat graft (FDFG) and superficial musculoaponeurotic system (SMAS) flap have very promising results. This RCT aimed to compare these two techniques regarding functional and aesthetic outcomes. METHODS Between February 2016 and October 2021, adult patients undergoing superficial conservative parotidectomy in a single centre for a benign indication were randomized into two equal groups using a closed envelope method. In one group, FDFG was inserted at the parotidectomy bed, whereas, in the other group, SMAS flap was performed. Preoperative, operative, and postoperative data were recorded and analysed. The primary outcome was the development of Frey's syndrome. RESULTS Seventy-eight patients were randomized into two equal groups of 39 patients. There was no significant difference between the two groups regarding development of Frey's syndrome. There was no significant statistical difference between study groups regarding demographic data, co-morbidities, parotid pathologies, specimen volumes, total operating time, and postoperative complications. A tendency for over correction was observed in FDFG and under correction in SMAS flap. There was no statistically significant difference between the study groups regarding the patients' aesthetic satisfaction with the majority displaying excellent satisfaction with no poor results. CONCLUSION FDFG and SMAS flap are simple, rapid, and reliable procedures and are effective in improving both functional and aesthetic outcomes post-parotidectomy. They have comparable results; however, selection of either procedure can be determined according to patient and tumour characteristics. Registration number: NCT05452837 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Ahmed Fawzy
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
| | - M Ashraf Balbaa
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
| | - Mahmoud Hagag
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
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Stanford-Moore GB, Thompson EC, Gulati A, Carpenter P, Park A, Seth R, Knott PD. Outcomes of Vascularized Versus Nonvascularized Adipofascial Grafts for Parotidectomy Reconstruction. Facial Plast Surg Aesthet Med 2022; 25:232-237. [PMID: 35856681 DOI: 10.1089/fpsam.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Parotidectomy defects can leave patients with considerable functional and cosmetic deformities. We aim to compare the success rates and complications associated with vascularized versus nonvascularized adipofascial grafts for reconstruction, including flap failure, return to surgery, infection, and delay to adjuvant treatment. Methods: Retrospective case series of patients undergoing either adipofascial anterolateral thigh (AFALT) free tissue transfer or free fat transfer (FFT) after parotidectomy from January 2010 to January 2020. Group comparisons and logistic regression were used to determine predictors of outcome measures. Results: Seventy-six patients underwent AFALT reconstruction, and 73 patients underwent FFT reconstruction. Patients treated with AFALT reconstruction had more aggressive tumor characteristics and underwent more complex resections, most commonly radical parotidectomy (n = 55, 72.4%). Postoperative complications at both the donor and recipient sites were more common in the FFT group (N = 20, 27.4% in FFT vs. N = 11, 14.5% in AFALT, odds ratio = 0.45, 95% confidence interval = 0.20-1.02, p = 0.052). Conclusions: Although used in more advanced disease and in a more heavily treated wound bed, the AFALT free flap was safe and associated with fewer infectious complications than that offered by FFT.
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Affiliation(s)
- Gaelen B. Stanford-Moore
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Arushi Gulati
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
- UC San Francisco School of Medicine, San Francisco, California, USA
| | - Patrick Carpenter
- Department of Otolaryngology Head and Neck Surgery, Virginia Tech University, Blacksburg, Virginia, USA
- Carilion Clinic, Roanoake, Virginia
| | - Andrea Park
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rahul Seth
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - P. Daniel Knott
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
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3
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Linn YL, Khoo MSQ, Sultana R, Iyer NG, Dharmawan R. Comparison of the use of allogenic acellular dermal matrix on rates of Frey syndrome post parotidectomy: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:49-56. [PMID: 35431179 DOI: 10.1016/j.oooo.2021.12.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/02/2021] [Accepted: 12/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of acellular dermal matrix (ADM) use in reducing Frey syndrome (FS) rates in patients postparotidectomy. STUDY DESIGN We performed a systematic review and meta-analysis of existing literature comparing rates of FS with and without ADM use. RESULTS Eight studies were shortlisted for qualitative study, of which 7 compared rates of FS with and without the use of ADM. A total of 211 patients underwent parotidectomy with the use of ADM. Of these, mean patient age was 44.7 (SD ± 7.2); 89 of 159 were pleomorphic adenoma (55.9%), 29 of 159 with histological diagoses stated were Warthin's tumor (18.2%), and 159 of 211 were other histologic diagnoses (25.7%). Subjective and objective incidence rates for FS were 23 of 211 (10.9%) and 7 of 211 (3.3%), respectively. Patients in whom ADM barriers were used had significantly lower rates of subjective and objective FS (relative risk = 0.22; 95% confidence interval, 0.09-0.57; P = .002; and relative risk = 0.07; 95% confidence interval, 0.07-0.33; P < .001), respectively, compared to patients with no ADM. CONCLUSION The use of ADM was associated with lower FS rates compared to no ADM and should be considered in routine use to prevent this condition.
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Affiliation(s)
- Yun Le Linn
- Department of Head and Neck Surgery, National Cancer Centre Singapore, Singapore.
| | | | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Centre Singapore, Singapore; Duke NUS Medical School, Singapore
| | - Rena Dharmawan
- Department of Head and Neck Surgery, National Cancer Centre Singapore, Singapore; Duke NUS Medical School, Singapore
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Effectiveness of the Fibrinogen-Thrombin-Impregnated Collagen Patch in the Prevention of Postoperative Complications after Parotidectomy: A Single-Blinded, Randomized Controlled Study. J Clin Med 2022; 11:jcm11030746. [PMID: 35160200 PMCID: PMC8836986 DOI: 10.3390/jcm11030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/10/2022] Open
Abstract
We investigated whether a fibrinogen-thrombin collagen sponge patch reduces postoperative complications of parotid gland surgery. This single-blinded, randomized controlled study included 165 patients who underwent parotid surgery for benign tumors (2018–2019) at a tertiary center. Primary outcomes were postoperative drain amount, days until drain removal, and discharge. Patients were scheduled for follow-up at 1 and 4 weeks, and 3 months after surgery. Complications including surgical site infection, pain, seroma, sialocele, salivary fistula, facial nerve palsy, Frey’s syndrome with subjective symptoms, and facial asymmetry were analyzed. After identifying confounding variables, multivariate approaches were used. Histologic analysis was performed in a mouse model of salivary gland surgery. In total, 162 patients (77, fibrinogen-thrombin collagen patch group; 85, controls) were included, with no significant between-group differences other than resected tissue. Among postoperative total drain amount and days until drain removal and discharge, the only postoperative total drain was significantly lower in the patch group than in the control group in the adjusted model. Additionally, although validation through robust trials with longer follow-up is needed, we found the potential benefit of the fibrinogen patch on Frey’s syndrome and facial asymmetry. In conclusion, fibrinogen-thrombin-impregnated collagen patches in parotidectomy can reduce postoperative drainage and improve outcomes.
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Patel S, Ziai K, Lighthall JG, Walen SG. Biologics and acellular dermal matrices in head and neck reconstruction: A comprehensive review. Am J Otolaryngol 2022; 43:103233. [PMID: 34537508 DOI: 10.1016/j.amjoto.2021.103233] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Acellular dermal matrices (ADMs) have been studied extensively in the literature and have gained popularity for various reconstructive and aesthetic purposes. ADMs are composed of a basement membrane and acellular dermal layer of collagen and provide a platform for mucosal epithelization and neovascularization. Combining dermal collagen and essential growth factors allows ADMs to support adequate wound healing and bolster soft-tissue repairs. These dermal matrices can be derived from human cadaveric donor skin (allogenic) or mammalian donor sources (xenogeneic). These dermal substitutes provide the benefit of reducing or eliminating the need for autologous tissue grafts and subsequently minimize donor site morbidity. Many ADMs are currently available in the market, each with variations in processing, manufacturing, storage, preparation, and use. The literature validating ADMs in the head and neck for both cosmetic and reconstructive purposes is evolving rapidly. This review aims to provide an up-to-date and comprehensive overview of the principles of acellular dermal matrices (ADMs), the different types of ADMs, and evaluate common indications, techniques, and outcomes pertaining to select anatomic sites in the head and neck reconstruction.
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Affiliation(s)
- Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Scott G Walen
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
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Jain A, Rai A. Meta-Analysis to Evaluate the Efficacy of Sternocleidomastoid Muscle Flap as a Reconstruction Modality in Prevention of Frey's Syndrome Following Parotidectomy. J Maxillofac Oral Surg 2021; 20:310-318. [PMID: 33927502 PMCID: PMC8041995 DOI: 10.1007/s12663-020-01380-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND One of the commonest complications following parotidectomy is Frey's syndrome (FS). The use of sternocleidomastoid muscle (SCM) flap to prevent FS is controversial. Hence, this study has been designed to compare the effect of SCM flap with no reconstruction in prevention of FS following parotidectomy. METHODOLOGY An exhaustive literature search was conducted in July 2019. Studies focusing on sternocleidomastoid flap following parotidectomy were included in the meta-analysis. A random effects model was used to generate pooled estimates. Odds ratio with a 95% confidence interval was calculated for subjective symptoms and objective test. RESULTS A total of 125 studies were identified, out of which 17 studies were recruited in the meta-analysis. Sixteen studies were analyzed for the subjective symptoms, and ten were analyzed for the objective signs. There was no statistically significant difference in the occurrence of FS with the use of SCM flap on objective analysis. However, the subjective analysis showed a statistically significant reduction in FS following reconstruction with SCM flap after parotidectomy. CONCLUSION The present meta-analysis suggests that the use of SCM flap following parotidectomy has no effect in reducing the incidence of Frey's syndrome.
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Affiliation(s)
- Anuj Jain
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
| | - Anshul Rai
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
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Acellular dermal matrix for prevention of Frey's syndrome after superficial parotidectomy of benign tumors. Am J Otolaryngol 2021; 42:102893. [PMID: 33445038 DOI: 10.1016/j.amjoto.2020.102893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/27/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate: 1) the efficacy of acellular dermal matrix (ADM) to prevent Frey's syndrome (FS) after superficial parotidectomy of benign tumors. 2) the effect of different follow-up intervals on the incidence of FS. METHODS Fifty-five patients with benign parotid gland tumors underwent superficial parotidectomy were divided into two groups: Non-ADM group (n = 31, 56.3%) and ADM group (n = 24, 43.6%). The primary outcomes measure was the incidence of FS. The secondary outcomes were surgical site depression, infection, salivary sialocele, and salivary fistula. Subjective FS was evaluated using a clinical questionnaire submitted via WeChat at 3, 6, 12, 18, 24, and 32 months postoperatively. Objective FS was evaluated using Minor starch-iodine test at 6 and 12 months postoperatively. RESULTS There was a statistically significant difference in the incidence of subjective and objective FS when ADM compared with Non-ADM groups (P<0.05). The respective incidence of subjective FS at 3, 6, 12, 18, 24, and 32 months was 4.2%, 8.3%,20.8%, 20.8%, 20.8%, 20.8% in ADM group and 3.2%, 9.7%, 29%, 38.7%, 45.2% in Non-ADM group. The incidence of objective FS after 6 and 12 months was 4.2%, 8.3% in ADM group and 8.3% (2/24), 38.7% (12/31) in Non-ADM group respectively. Five patients in ADM group and 1 patient in Non-ADM group developed sialocele, and all patients resolved with conservative management. Surgical site depression was significantly higher in the Non-ADM group (15/31) compared with (5/24) in ADM (P=0.049). No cases of immune rejection, infection, hematoma, or salivary fistula were observed in ADM group. CONCLUSIONS The current study demonstrated that 1) ADM could reduce the incidence of FS in the patients undergoing superficial parotidectomy. 2) the peak onset of about 18 months appear to be acceptable follow-up for the development of FS.
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De Virgilio A, Costantino A, Russo E, Ferreli F, Pellini R, Petruzzi G, Zocchi J, Spriano G, Mercante G. Different Surgical Strategies in the Prevention of Frey Syndrome: A Systematic Review and Meta-analysis. Laryngoscope 2021; 131:1761-1768. [PMID: 33502015 DOI: 10.1002/lary.29414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/17/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS To define the best surgical technique able to reduce Frey syndrome (FS) incidence after parotidectomy. STUDY DESIGN Systematic review and network meta-analysis. METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were the incidence of subjective (clinical) and objective (positive starch-iodine test result) FS, respectively. RESULTS A total of 3830 patients with a median age of 50.35 years (n = 2323; IQR 44.25-54.18) were included for six interventions [temporoparietal fascia (TPFF), free fat graft (FFG), acellular dermal matrix (ADM), sternocleidomastoid muscle (SCM) flap, and superficial musculoaponeurotic system (SMAS) flap]. If compared to no treatment, the greatest reduction of subjective (clinical) FS incidence was measured for the TPFF (OR: 0.07, CI: 0.004-0.57), the ADM (OR: 0.09, CI: 0.02-0.35), and the FFG (OR: 0.11, CI: 0.03-0.42) techniques. However, a significant difference was measured also for the SCM flap (OR: 0.38, CI: 0.18-0.73) and for the SMAS flap (OR: 0.42, CI: 0.19-0.97). All treatments showed a significant reduction of the objective FS incidence if compared to no treatment (FFG, OR: 0.06, CI: 0.002-0.62; TPFF, OR: 0.07, CI: 0.01-0.33; ADM, OR: 0.11, CI: 0.03-0.44; SMAS, OR: 0.36, CI: 0.17-0.71; SCM, OR: 0.40, CI: 0.19-0.74). CONCLUSIONS TPFF, ADM, and FFG seem to be the best treatment strategies to prevent FS after parotidectomy. Further randomized controlled trials comparing these techniques should be conducted to define specific indications. Laryngoscope, 131:1761-1768, 2021.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
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Mashrah MA, Aldhohrah T, Abdelrehem A, Koraitim M, Wang L. What is the best method for prevention of postparotidectomy Frey syndrome? Network meta-analysis. Head Neck 2021; 43:1345-1358. [PMID: 33439485 DOI: 10.1002/hed.26597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/22/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Prevention of Frey syndrome (FS) after parotidectomy using an interposition barrier has long been gaining a wide popularity; however, there is no clear evidence regarding which preventive technique is more effective. The aim of this network meta-analysis (NMA) is to answer the question: What is the best method for prevention of FS after parotidectomy? METHODS A comprehensive search of the PubMed, Embase, SCOPUS, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of subjective Frey syndrome (SFS) and objective Frey syndrome (OFS). The Bayesian NMA accompanied with a random effects model and 95% credible intervals (CrIs) were calculated using GeMTC R package. RESULTS Thirty-four studies (n = 2987 patients) with five interventions, namely Alloderm (ADM), temporoparietal fascia (TPF), sternocleidomastoid muscle (SCM), superficial musculoaponeurotic system (SMAS), and free fat graft (FFG), were compared together and with no interposition barrier (NB). The results of NMA showed a statistically significant reduction in both SFS and OFS when ADM, TPF, SMAS, FFG, and SCM were compared with NB. No statistical differences were observed when comparing ADM, SCM, SMAS, FFG, and TPF. TPF ranked the best of all treatments (59.4%) and was associated with the least incidence of SFS; whereas ADM ranked the best of all treatments (61.1%) and was associated with the least incidence of OFS. CONCLUSIONS All interventions (TPF flap, ADM, FFG, SMAS, and SCM) were associated with a significant reduction in the incidence of FS when compared with NB. TPF and ADM showed the best outcome with the least incidence of SFS and OFS, respectively.
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Affiliation(s)
- Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Taghrid Aldhohrah
- Guanghua Stomatology Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Koraitim
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Liping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope 2020; 131:571-579. [PMID: 32678921 DOI: 10.1002/lary.28912] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report descriptive statistics for minor parotidectomy complications. METHODS A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
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Affiliation(s)
- Silvia Lambiel
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pavel Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.,Center for Otorhinolaryngology-Maxillofacial and Head and Neck Surgery, La Tour Hospital, La Tour Medical Group, Meyrin, Switzerland
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Ye L, Cao Y, Yang W, Wu F, Lin J, Li L, Li C. Graft interposition for preventing Frey's syndrome in patients undergoing parotidectomy. Cochrane Database Syst Rev 2019; 10:CD012323. [PMID: 31578708 PMCID: PMC6953270 DOI: 10.1002/14651858.cd012323.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Frey's syndrome is characterised by transient flushing and sometimes facial sweating in the area of the auriculotemporal nerve. It most commonly occurs after parotidectomy, but other causes may include submandibular gland surgery, mandibular condylar fracture, obstetric (forceps) trauma, sympathectomy and metabolic disease. Although the pathophysiology of Frey's syndrome remains controversial, the generally accepted hypothesis is that it occurs as the result of injury to the auriculotemporal nerve.There is currently no clear evidence to establish the efficacy and safety of the different methods used for the treatment of Frey's syndrome, therefore the prevention of this symptom during surgery is important. The main method used for prevention is the interposition of a graft between the skin flap and the parotid bed during surgery. Biomaterials, allograft or autograft can be used for this purpose. OBJECTIVES To evaluate the effects and safety of biomaterial, allograft or autograft interposition for the prevention of Frey's syndrome in patients undergoing parotidectomy, and to identify its effect on prevention and delayed occurrence. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Cochrane Register of Controlled Trials (CENTRAL; 2019, Issue 2); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 5 February 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) in patients with parotid disease (including tumours, inflammation, trauma etc.) undergoing parotidectomy with a minimal follow-up period of six months. We planned to include trials with interventions including biomaterial, allograft or autograft interposition alone or in combination with other surgical techniques. We included trials that compared any graft interposition and no graft interposition, or different graft interpositions. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcome measures were incidence rate of Frey's syndrome assessed clinically (Minor's starch-iodine test) and other complications (postoperative infection, subjective painful or restricted cervical movement, scar spread, rejection of the graft, complications related to the donor site such as accessory nerve injury and haematoma). Our secondary outcome measures were incidence rate of Frey's syndrome assessed by participants (by questionnaire) and sweating area assessed by Minor's starch-iodine test. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included three RCTs (124 participants), two of which we assessed as at high risk of bias and one at unclear risk of bias. All studies were hospital-based and recruited participants undergoing superficial parotidectomy. Most participants were diagnosed with benign lesions of the parotid gland. Participants were followed up for more than six months. The studies evaluated the two comparisons shown below:Sternocleidomastoid muscle flap versus no flapTwo studies assessed this comparison. Both assessed the effects of the sternocleidomastoid muscle flap procedure on the incidence rate of Frey's syndrome assessed clinically but neither showed a significant difference between groups (risk ratio (RR) 0.08, 95% confidence interval (CI) 0.00 to 1.23; 24 participants and RR 1.23, 95% CI 0.88 to 1.73; 36 participants; very low-certainty evidence). We did not pool the data due to the high heterogeneity (I² = 87%).One study found that the sternocleidomastoid muscle flap may result in little or no difference in other complications including haematoma (RR 2.18, 95% CI 0.09 to 50.16; 36 participants; low-certainty evidence), subjective painful or restricted cervical movement (RR 0.54, 95% CI 0.14 to 2.05; 36 participants; low-certainty evidence) and scar spread in the cervical region (RR 0.71, 95% CI 0.05 to 10.54; 36 participants; low-certainty evidence). Both studies reported the incidence rate of Frey's syndrome assessed by participants, with one reporting no events in either group and the other finding no evidence of a difference (RR 0.63, 95% CI 0.32 to 1.26; 36 participants; low-certainty evidence).Acellular dermal matrix versus no graftOnly one study assessed this comparison. Use of an acellular dermal matrix graft may result in little or no difference to the incidence rate of Frey's syndrome (assessed clinically) in comparison with the no graft group, but the evidence is very uncertain (RR 0.08, 95% CI 0.00 to 1.25; 30 participants; very low-certainty evidence).Acellular dermal matrix may slightly increase the wound infection rate compared with control (RR 17.00, 95% CI 1.02 to 282.67; 64 participants; low-certainty evidence). Acellular dermal matrix may result in little or no difference to the incidence of seromas or sialoceles (RR 2.33, 95% CI 0.66 to 8.23; 64 participants; low-certainty evidence). Acellular dermal matrix may result in little or no difference to the incidence rate of Frey's syndrome (assessed by participants) in comparison with the no graft group (RR 0.33, 95% CI 0.04 to 3.04; 64 participants; low-certainty evidence). AUTHORS' CONCLUSIONS The evidence for the effectiveness of graft interposition in preventing Frey's syndrome is of low or very low certainty. The use of acellular dermal matrix may be associated with an increase in the wound infection rate, and little or no difference in the incidence of seromas or sialoceles. Further studies are needed to draw reliable conclusions.
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Affiliation(s)
- Li Ye
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Yubin Cao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Wenbin Yang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Fanglong Wu
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of Oral and Maxillofacial SurgeryNo. 14, Section Three, Ren Min Nan RoadChengduChina610041
| | - Jie Lin
- West China Hospital of Stomatology, Sichuan UniversityDepartment of Oral Anaesthesiology and Intensive Care UnitNo 14, Section 3, South Renmin RoadChengduSichuanChina610041
| | - Longjiang Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
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Tork S, Jefferson RC, Janis JE. Acellular Dermal Matrices: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:173-184. [PMID: 31384233 DOI: 10.1055/s-0039-1693019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Modern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.
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Affiliation(s)
- Shahryar Tork
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Ryan C Jefferson
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey E Janis
- Department of Plastic Surgery, University Hospitals, Wexner Medical Center, Ohio State University, Columbus, Ohio
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Choi J, Park SI, Rha EY, Seo BF, Kwon H, Jung SN. Acellular dermal matrix (Insuregraf) in the prevention of Frey's syndrome and surgical site depression after parotidectomy. Arch Craniofac Surg 2019; 20:176-180. [PMID: 31256554 PMCID: PMC6615418 DOI: 10.7181/acfs.2019.00248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey's syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS The incidence of Frey's syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey's syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.
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Affiliation(s)
- Jangyoun Choi
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Song I Park
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Eun Young Rha
- Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bommie Florence Seo
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ho Kwon
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sung-No Jung
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Wang C, Wu D, Mao C, Lu M, Cai Z, Lai Y, Chen W. The preventive effect of decellularized pericardial patch against Frey's syndrome following the superficial parotidectomy. J Craniomaxillofac Surg 2019; 47:832-836. [PMID: 30738637 DOI: 10.1016/j.jcms.2019.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/19/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study aimed to investigate the feasibility of adopting the ThormalGEN surgical patch (a porcine decellularized pericardial patch) in the superficial parotidectomy to prevent postoperative Frey's syndrome in patients with benign parotid tumor. MATERIALS AND METHODS A total of 59 patients with benign parotid tumor undergoing superficial parotidectomy between April 2016 and January 2017 were enrolled, and divided into the ThormalGEN group (n = 37) and the control group (n = 22) based on their willingness to have the ThormalGEN surgical patch used in the superficial parotidectomy. At 6 months postoperation, the incidences of postoperative complications and Frey's syndrome were assessed by subjective assessment (patient self-assessment) and objective assessment (starch-iodine test), respectively. The risk factor of Frey's syndrome was analyzed by the multivariate logistic regression model. RESULTS The starch-iodine test, for objective assessment, showed that the ThormalGEN group had a significantly lower incidence of Frey's syndrome than the control group (8.11% vs. 40.91%, p = 006). However, in the patient self-assessment, there was no significant difference in the incidence of Frey's syndrome between groups (8.11% [3/37] vs. 13.64% [3/22], p = 0.4968). The incidences of postoperative complications were not significantly different between group (all p > 0.05). Two patients (5.41%) in the ThormalGEN group had salivary fistula. Multivariate logistic regression analysis showed that the ThormalGEN group had a significantly lower risk of Frey's syndrome than the control group (odds ratio = 0.11, 95% confidence interval = 0.02-0.51, p < 0.01). CONCLUSION These results suggest that the ThormalGEN surgical patch can effectively reduce the incidence of Frey's syndrome following superficial parotidectomy in patients with benign parotid tumor, and that this patch has a good safety and biocompatibility profile.
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Affiliation(s)
- Chengyong Wang
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Dong Wu
- The Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Chuanqing Mao
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Meng Lu
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Zhiyu Cai
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Yongzhen Lai
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Weihui Chen
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
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Wood CB, Netterville JL. Temporoparietal frey syndrome: An uncommon variant of a common syndrome. Laryngoscope 2018; 129:2071-2075. [PMID: 30570147 DOI: 10.1002/lary.27632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe a previously unreported variant of Frey syndrome. Gustatory sweating is a common complication of parotidectomy and typically directly overlies the surgical site or parotid bed. In some instances, the sweating may occur beyond the parotid bed or involve tissue that was undisturbed during the procedure. STUDY DESIGN Retrospective case series. METHODS All cases of temporoparietal Frey syndrome in a single surgeon's experience were reviewed. RESULTS Seven patients were found to have temporoparietal Frey syndrome. Three patients had concomitant first bite syndrome. Three patients had some form of reconstruction at time of surgery. The mean time to onset of symptoms was 11.5 months, with a range of 7 to 21 months. Four patients did not require any treatment for their symptoms, but two patients required intradermal Botox injections for symptomatic relief. DISCUSSION This study describes a previously unreported variant of Frey syndrome with symptoms occurring distal to the parotid gland. This likely develops either by regeneration of severed postganglionic fibers into sympathetic targets distally along the course of the auriculotemporal nerve or by regeneration into fibers of the sympathetic plexus traveling along the superficial temporal artery. LEVEL OF EVIDENCE Laryngoscope, 129:2071-2075, 2019.
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Affiliation(s)
- C Burton Wood
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Ghassemi A, Modabber A, Brzoska PO, Sababi M. Vascularised fatty tissue: its role in prevention of the symptoms of Frey syndrome after parotidectomy. Br J Oral Maxillofac Surg 2018; 56:877-880. [PMID: 30337163 DOI: 10.1016/j.bjoms.2018.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
Abstract
We studied 37 consecutive patients who had parotidectomies between 2008 and 2017 and who had vascular fat flaps inserted to replace the excised parotid tissue and prevent Frey syndrome. They were followed up for 1-9 years to check for the relevant symptoms. We studied 17 female and 20 male patients, mean age 52 (range 19-78) years. The flaps took a maximum of 17minutes to dissect. There was no donor site morbidity, the vascular fat flap was stable in all cases for up to nine years, and none of the patients complained of symptoms of Frey syndrome.
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Affiliation(s)
- A Ghassemi
- Oral and Maxillofacial Surgery, Teaching Hospital, Georg-August-University Göttingen, Klinikum-Lippe, Röntgenstr. 18, 32756 Detmold, Germany; Medical Faculty University RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - A Modabber
- Oral and Maxillofacial Surgery, University Hospital RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - P O Brzoska
- Department of Internal Medicine, St. Marien-Hospital, Hospitalstraße 44, 52353 Düren, Germany
| | - M Sababi
- Department of Hearing Disorders Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cuomo R, Grimaldi L, Brandi C, Sisti A, Nisi G. Vaginoplasty: What's New From 1946 to Date Commentary on: Vaginoplasty with Acellular Dermal Matrix after Radical Resection for Carcinoma of the Uterine Cervix. J INVEST SURG 2018; 32:186-188. [PMID: 29333882 DOI: 10.1080/08941939.2017.1411544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Roberto Cuomo
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Luca Grimaldi
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Cesare Brandi
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Andrea Sisti
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Giuseppe Nisi
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
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Wang Z, Huang J, Zeng A, Wu M, Wang X. Vaginoplasty with Acellular Dermal Matrix after Radical Resection for Carcinoma of the Uterine Cervix. J INVEST SURG 2018; 32:180-185. [PMID: 29303407 DOI: 10.1080/08941939.2017.1399177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Various methods are available for vaginoplasty, but many of them have the drawbacks including surgical complexity and postoperative pain at the donor site. We herein evaluated the outcomes of vaginoplasty using tissue-engineered biomaterial graft. This study included 16 early stage cervical cancer patients who received curative surgery in combination with radiotherapy. They underwent vaginoplasty with tissue-engineered biological material, acellular dermal matrix (ADM). After treatment, a vaginal dilator was advised to be used for 6 months to prevent contraction of vagina. The effectiveness of the treatment was evaluated by the anatomic changes of vagina before and after treatment, and the sexual outcomes at 12-month after treatment. The procedure was safe with no intra-operative complications reported. The mean operation time was 1.7 ± 0.3 hours, with 11/16 patients had blood loss < 50 mL during surgery. Generally, epithelialization was observed in 2-week after treatment. At the 1-year follow-up visit, the mean vaginal width was increased significantly from 1.31 ± 0.4 cm before surgery to 4.13 ± 0.43 cm after surgery (p = 0.034). The vaginal length was also increased from 5.97 ± 0.59 cm to 9.25 ± 0.66 cm (p < 0.001). Majority of the patients (12/16) reported satisfactory sexual life. The use of ADM in vaginoplasty was a safe and effective procedure that provided satisfactory sexual function for patients with vaginal abnormalities after cervical cancer treatment.
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Affiliation(s)
- Zhi Wang
- a Department of plastic and aesthetic surgery , Peking Union Medical College Hospital , Beijing , China
| | - Jiuzuo Huang
- a Department of plastic and aesthetic surgery , Peking Union Medical College Hospital , Beijing , China
| | - Ang Zeng
- a Department of plastic and aesthetic surgery , Peking Union Medical College Hospital , Beijing , China
| | - Ming Wu
- b Department of gynaecology and obstetrics , Peking Union Medical College Hospital , Beijing , China
| | - Xiaojun Wang
- a Department of plastic and aesthetic surgery , Peking Union Medical College Hospital , Beijing , China
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Reconstruction of parotidectomy and lateral skull base defects. Curr Opin Otolaryngol Head Neck Surg 2017; 25:431-438. [DOI: 10.1097/moo.0000000000000391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Byun JH, Lim JS, Lee HK. Mixed Tumor in Deep Lobe and Versatility of Acellular Dermal Matrix. Arch Craniofac Surg 2017; 18:132-136. [PMID: 28913321 PMCID: PMC5556895 DOI: 10.7181/acfs.2017.18.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 11/11/2022] Open
Abstract
Frey's syndrome and infra-auricular depressed deformities are the ones of the most common complications that can occur after total parotidectomy. We report 1 case of pleomorphic adenoma occurred in the deep lobe that obtained good results from using acellular dermal matrix (ADM) after total parotidectomy. A 24-year-old man visited the hospital with oval shape mass in right mandibular angle which of 4 cm in size was found in the deep lobe of right parotid gland from Magnetic resonance imaging scanning and a pleomorphic adenoma was suspected. A total parotidectomy was performed while preserving the facial nerve. The material known as ADM were placed in the depressed part from where the mass was removed, and the site was sutured. The surgery site was healed well without any complications such as Frey's syndrome or infra-auricular depressed deformities. The pathological result was confirmed as pleomorphic adenoma. In addition to these advantages, it does not have little potential of deformation by the gravity after the surgery, and there is no restraint on circulation, which makes fabrication free and each deformation into various shapes can be described as another advantage of the reconstruction using the ADM.
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Affiliation(s)
- Jin Hwan Byun
- Department of Plastic and Reconstructive Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jung Soo Lim
- Department of Plastic and Reconstructive Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hye Kyung Lee
- Department of Plastic and Reconstructive Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Zhang X, Liu Z, Yang Y, Yao Y, Tao Y. The clinical outcomes of vaginoplasty using tissue-engineered biomaterial mesh in patients with Mayer-Rokitansky-Küster-Hauser syndrome. Int J Surg 2017; 44:9-14. [DOI: 10.1016/j.ijsu.2017.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
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Tamplen M, Knott PD, Fritz MA, Seth R. Controversies in Parotid Defect Reconstruction. Facial Plast Surg Clin North Am 2016; 24:235-43. [DOI: 10.1016/j.fsc.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pham M, Eviston TJ, Clark JR. Reconstruction of limited parotidectomy defects using the dermofat graft. ANZ J Surg 2016; 87:E256-E260. [DOI: 10.1111/ans.13608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/20/2016] [Accepted: 03/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- My Pham
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
| | - Timothy J. Eviston
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
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Free abdominal fat transfer for partial and total parotidectomy defect reconstruction. Laryngoscope 2016; 126:2694-2698. [DOI: 10.1002/lary.26025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 03/06/2016] [Accepted: 03/16/2016] [Indexed: 11/07/2022]
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Irvine LE, Larian B, Azizzadeh B. Locoregional Parotid Reconstruction. Otolaryngol Clin North Am 2016; 49:435-46. [DOI: 10.1016/j.otc.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Effectiveness of platysma muscle flap in preventing Frey syndrome and depressive deformities after parotidectomy. J Plast Reconstr Aesthet Surg 2016; 69:663-72. [PMID: 26832076 DOI: 10.1016/j.bjps.2015.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/19/2015] [Accepted: 12/31/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Frey syndrome (FS) or depressive deformity (DD) occurring after parotidectomy significantly reduces a patient's quality of life. However, there seems to be no effective treatment strategy against these complications. In this study, we report our experience of using platysma muscle flap (PMF) to prevent the development of FS and DD after parotidectomy, and evaluate its effect subjectively and objectively. METHODS Superficial parotidectomy was performed for eight cases of parotid gland tumor, and a PMF was transferred to cover the site. The incidence of FS and DD were evaluated subjectively, using a questionnaire to the patients and board-certified reconstructive surgeons, and objectively, using Minor's starch-iodine test. RESULTS In seven patients, the defect could be completely covered with PMF, and none of them developed FS or obvious DD. However, in one patient, the defect could be only partially covered, and the patient developed complications in the exact site that the flap did not cover. Overall scores from the questionnaire were high in relation to both cosmetic and functional perspectives from most of the patients and all the surgeons. No patients had major postoperative complications requiring revision. CONCLUSIONS PMF can be useful to cover the defect and prevent complications after parotidectomy. PMF is relatively easy to perform with fewer complications; however, a complete coverage of the defect should be ensured to obtain optimal results.
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Autologous fat transfer: an aesthetic and functional refinement for parotidectomy. Surg Res Pract 2014; 2014:873453. [PMID: 25379564 PMCID: PMC4208499 DOI: 10.1155/2014/873453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/02/2013] [Accepted: 12/05/2013] [Indexed: 11/28/2022] Open
Abstract
Parotidectomy is a surgical procedure associated to functional (Frey's syndrome) as well as aesthetic (facial asymmetry) complications that can be very disturbing for the patient. Several procedures have been described to primarily avoid or secondarily reconstruct the facial defect and treat the neurological iatrogenic syndrome.
Autologous fat transfer was primarily used in 10 cases to avoid such complications. It is an easy technique widely used in cosmetic and reconstructive surgery. This technique gives very satisfying long-term results on the cosmetic as well as on the physiological point of view.
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Zhang B, Li J, Sarma D, Zhang F, Chen J. The use of heterogeneous acellular dermal matrix in the closure of hard palatal fistula. Int J Pediatr Otorhinolaryngol 2014; 78:75-8. [PMID: 24290949 DOI: 10.1016/j.ijporl.2013.10.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of closure of hard palatal fistula using Heal-All(®) Oral Biofilm, a heterogeneous acellular dermal matrix graft. PATIENTS AND METHODS Superior lip mucosal or myomucosal flap and buccal myomucosal flap were used in 20 patients (group 1) (2000-2005); whereas, heterogeneous acellular dermal matrix graft was performed in 18 patients (group 2) (2005-2013). The recurrence in the closed fistula and the obliteration of gingivolabial and gingivobuccal sulci were seen postoperatively with follow-up appointments at 1-3 months for all cases. RESULTS The recurrence rate of hard palatal fistula has been reduced from 25 to 11.1% with the use of heterogeneous acellular dermal matrix graft, and the rate of the obliteration of gingivolabial and gingivobuccal sulci has been decreased from 90 to 5.5%. CONCLUSIONS Closure of hard palatal fistula using Heal-All(®) Oral Biofilm graft is a useful method with high success rate. It is a day-case procedure especially to avoid dividing the pedical of the flap after follow-up, and the gingivolabial and gingivobuccal sulci do not need further procedures to deep with follow-up.
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Affiliation(s)
- Bo Zhang
- Department of Oral and Maxillofacial Surgery, Hunan Provincial people's Hospital, Changsha, PR China.
| | - Jian Li
- Department of Oral and Maxillofacial Surgery, Hunan Provincial people's Hospital, Changsha, PR China
| | - David Sarma
- Department of Oral and Maxillofacial Surgery, Hunan Provincial people's Hospital, Changsha, PR China
| | - Feng Zhang
- Department of Oral and Maxillofacial Surgery, Hunan Provincial people's Hospital, Changsha, PR China
| | - Jingjing Chen
- Department of Oral and Maxillofacial Surgery, Hunan Provincial people's Hospital, Changsha, PR China
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Interdisciplinary management of congenital infiltrating lipomatosis. Int J Pediatr Otorhinolaryngol 2013; 77:2071-4. [PMID: 24035641 DOI: 10.1016/j.ijporl.2013.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 11/22/2022]
Abstract
Congenital infiltrating lipomatosis is a benign yet locally invasive lipomatous tumor. Current treatment involves surgical excision and reconstruction of craniofacial deformity. Invasion of vital structures often makes complete resection problematic and recurrence is common. We present the case of a 15-year-old female patient with extensive congenital infiltrating lipomatosis involving the left face. A broad treatment algorithm was devised involving surgical resection as well as targeted chemotherapy. At 18 month follow-up the patient demonstrated improved facial symmetry without evidence of disease progression. Combining surgical and medical intervention may allow for a synergistic approach to controlling this rare disease.
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Systematic Evaluation on the Use of Acellular Dermis Matrix Graft in Prevention Frey Syndrome After Parotid Neoplasm Surgery. J Craniofac Surg 2013; 24:1526-9. [DOI: 10.1097/scs.0b013e31828dcdb3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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A Comparative Study of CG CryoDerm and AlloDerm in Direct-to-Implant Immediate Breast Reconstruction. Arch Plast Surg 2013; 40:374-9. [PMID: 23898434 PMCID: PMC3723998 DOI: 10.5999/aps.2013.40.4.374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/26/2013] [Accepted: 05/12/2013] [Indexed: 11/18/2022] Open
Abstract
Background To date, various types of acellular dermal matrix (ADM) have been developed for clinical use. AlloDerm is the most familiar type of ADM to most surgeons in breast reconstruction. It is prepared by freeze-drying. CG CryoDerm is the first form of ADM that requires no drying process. Therefore, theoretically, it has a higher degree of preservation of the dermal structures than AlloDerm. We conducted this study to compare the clinical course and postoperative outcomes of patients who underwent direct-to-implant breast reconstructions using AlloDerm and those who did using CG CryoDerm. Methods We performed a retrospective analysis of the medical records in a consecutive series of 50 patients who underwent direct-to-implant breast reconstruction using AlloDerm (n=31) or CryoDerm (n=19). We then compared the clinical course and postoperative outcomes of the two groups based on the overall incidence of complications and the duration of drainage. Results The mean follow-up period was 16 months. There were no significant differences in the overall incidence of complications (seroma, infection, skin flap necrosis, capsular contracture, and implant loss) between the two groups. Nor was there any significant difference in the duration of drainage. Conclusions CG CryoDerm has the merits of short preparation time and easy handling during surgery. Our results indicate that CG CryoDerm might be an alternative allograft material to AlloDerm in direct-to-implant breast reconstruction.
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Free fat grafting in superficial parotid surgery to prevent Frey's syndrome and improve aesthetic outcome. The Journal of Laryngology & Otology 2013; 128 Suppl 1:S44-9. [DOI: 10.1017/s0022215113001394] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Frey's syndrome and cosmesis are important considerations in parotid surgery. Placement of an interpositional barrier can prevent these complications; however, surgical technique and efficacy remain controversial.Methods:A prospective case series was collected comprising all patients undergoing primary superficial parotidectomy for benign pathology with abdominal free fat grafting between June 2007 and December 2010, performed by a single surgeon. A survey was also distributed to otorhinolaryngology consultants across Australia to assess current practice.Results:Twenty-eight patients were included. No patient had clinical symptoms of Frey's syndrome. Seventy-five per cent of patients were completely satisfied with their aesthetic outcome, 18 per cent scored 4/5 and the remaining 7 per cent (2 patients) scored 3/5. The survey revealed that 79 per cent of respondents did not use interpositional grafts.Conclusion:Abdominal free fat is ideal for grafting as it is an effective, safe, simple, accessible, fast and inexpensive method of providing an interpositional graft.
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Zhu L, Zhou H, Sun Z, Lou W, Lang J. Anatomic and Sexual Outcomes after Vaginoplasty Using Tissue‐Engineered Biomaterial Graft in Patients with Mayer‐Rokitansky‐Küster‐Hauser Syndrome: A New Minimally Invasive and Effective Surgery. J Sex Med 2013; 10:1652-8. [DOI: 10.1111/jsm.12143] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Durgut O, Basut O, Demir UL, Özmen ÖA, Kasapoglu F, Coskun H. Association between skin flap thickness and Frey's syndrome in parotid surgery. Head Neck 2013; 35:1781-6. [DOI: 10.1002/hed.23233] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Osman Durgut
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Oguz Basut
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Uygar Levent Demir
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Ömer A. Özmen
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Fikret Kasapoglu
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Hakan Coskun
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
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Winstead JM, Olson GT, Frodel JL. Reconstruction of periparotid defects using temporoparietal fascia flap with layered acellular human dermal allograft. Craniomaxillofac Trauma Reconstr 2013; 5:19-24. [PMID: 23450141 DOI: 10.1055/s-0031-1300959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 11/07/2011] [Indexed: 10/14/2022] Open
Abstract
Excision of lesions in the periparotid area can leave a sizable concavity of the preauricular area with skeletonization of the mandible. To achieve the bulk necessary to fill this defect, we propose using a composite graft. Acellular human dermal allograft provides the thickness of the graft, and the temporoparietal fascia flap provides blood supply to the dermal graft. Our hypothesis is that vascularization of the graft will promote greater ingrowth of native tissue and prevent breakdown and absorption of the graft. Four representative patients are described.
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A Systematic Review of Acelluar Dermal Matrices in Head and Neck Reconstruction. Plast Reconstr Surg 2012; 130:35S-43S. [DOI: 10.1097/prs.0b013e31825eff7a] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shi LJ, Wang Y, Yang C, Jiang WW. Application of acellular dermal matrix in reconstruction of oral mucosal defects in 36 cases. J Oral Maxillofac Surg 2012; 70:e586-91. [PMID: 22921754 DOI: 10.1016/j.joms.2012.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 05/09/2012] [Accepted: 07/11/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE Artificial grafts have been investigated for use in the repair of oral mucosal defects. The aim of this retrospective study was to present the outcomes of the use of acellular dermal matrix (ADM) grafts to repair oral mucosal defects. MATERIALS AND METHODS Data from 36 patients with oral mucosal defects reconstructed with ADM grafts from 2003 through 2009 were reviewed. All patients were followed-up for at least 6 months to observe the graft repair, wound-healing time, contracture, color, infection, pain, immunologic reaction, texture of the graft, and clinical course. Graft success was defined as the ADM graft being replaced by new mucosa-like tissue and the oral mucosal defect being covered with the new mucosa-like tissue. Any evidence of incomplete graft re-epithelialization or graft sloughing was considered a graft failure (complete or incomplete). RESULTS Of the 36 cases, 34 grafts (94.4%) were successfully replaced with new mucosa-like tissues and only 2 grafts (5.6%) failed. No complaints such as pain, immunologic reaction, or infection were observed during the follow-up. Mild graft contraction occurred in 7 patients with lip or buccal defects, especially at approximately 3 to 5 weeks after the reconstructive surgery. CONCLUSIONS The ADM grafts for oral mucosal defects were safe and effective. The present data support the clinical application of ADM grafts in reconstructing oral mucosal defects caused by various oral diseases.
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Affiliation(s)
- Lin-Jun Shi
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Militsakh ON, Sanderson JA, Lin D, Wax MK. Rehabilitation of a parotidectomy patient-A systematic approach. Head Neck 2012; 35:1349-61. [DOI: 10.1002/hed.23095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/10/2022] Open
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Graft for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg 2012; 71:419-27. [PMID: 22884117 DOI: 10.1016/j.joms.2012.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/27/2012] [Accepted: 06/08/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To detect the effect and safety of different types of grafts for the prevention of Frey syndrome after parotidectomy. MATERIALS AND METHODS The following data bases were searched electronically: MEDLINE (using OVID, from 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, issue 2, 2011), EMBASE (available from: http://embase.com, 1984 to July 2011), World Health Organization International Clinical Trials Registry Platform (July 2011), Chinese BioMedical Literature Database (1978 to July 2011), and the China National Knowledge Infrastructure (1994 to July 2011). The relevant journals and reference lists of the included studies were manually searched for randomized controlled trials studying the effect and safety of different types of grafts for preventing Frey syndrome after parotidectomy. The risk of bias assessment using Cochrane Collaboration's tool and data extraction was independently performed by 2 reviewers. The meta-analysis was performed using Review Manager, version 5.1. RESULTS A total of 14 randomized clinical trials and 1,098 participants were included. All had an unclear risk of bias. The meta-analysis results showed that the use of an acellular dermis matrix can reduce by 82% the risk of Frey syndrome compared with the no-graft group using an objective assessment (relative risk [RR] 0.18, 95% confidence interval [CI] 0.12 to 0.26; P < .00001; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] quality of evidence: high). The acellular dermis matrix can also reduce by 90% the risk of Frey syndrome compared with the no-graft group using a subjective assessment (RR 0.10, 95% CI 0.05 to 0.22; P < .00001; GRADE quality of evidence: high). The muscle flaps can reduce by 81% the risk of Frey syndrome compared with the no-graft group (RR 0.19, 95% CI 0.13 to 0.27; P < .00001; GRADE quality of evidence: high). No statistically significant difference was found between the acellular dermal matrix and muscle flap groups (RR 0.73, 95% CI 0.15 to 3.53, P = .70; GRADE quality of evidence: low). No serious adverse events were reported. CONCLUSIONS The present clinical evidence suggests that grafts are effective in preventing Frey syndrome after parotidectomy. More randomized clinical trials are needed to confirm our conclusions and prove the safety of the grafts.
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Luo W, Zheng X, Chen L, Jing W, Tang W, Long J, Tian W, Liu L. The use of human acellular dermal matrix in the prevention of infra-auricular depressed deformities and Frey's syndrome following total parotidectomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e9-13. [PMID: 22769423 DOI: 10.1016/j.oooo.2011.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 08/23/2011] [Accepted: 08/31/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to explore whether human acellular dermal matrix (ADM) implantation could prevent infra-auricular depressed deformities and Frey's syndrome following total parotidectomy. METHODS We analyzed 41 cases of total parotidectomy (control group) and 29 cases of simultaneous ADM implantation following total parotidectomy (ADM group) for infra-auricular depressed deformities and the presence of gustatory flushing or sweating. The follow-up periods ranged from 6 months to 7 years. RESULTS Facial contours and bilateral symmetry improved after surgery in the ADM group. In the control group, an infra-auricular depressed deformity was evident in all 41 cases. Frey's syndrome was recorded in 1 patient (3.4%) from the ADM group and 14 patients (34.1%) from the control group. No cases of immune rejection, infection, hematoma, or salivary fistula were observed in either group. CONCLUSIONS The use of ADM could reduce postoperative facial contour deformities and Frey's syndrome following total parotidectomy.
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Affiliation(s)
- Wen Luo
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Grzybowski A, Sak J. Lucja Frey (1889–1942): life destroyed by the Holocaust--on the 70th anniversary of her death. Clin Dermatol 2012; 30:355-9. [PMID: 22641864 DOI: 10.1016/j.clindermatol.2011.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lucja Frey was the first to explain the pathogenesis of the auriculotemporal syndrome, and the syndrome is recognized today as the Frey syndrome. Patients with this disease are subjected to paroxysmal paraesthesia of half of the face combined with sweating and redness. This syndrome can be found in the differential diagnosis of contemporary dermatology. Among others, it is differentiated from food allergies. The life and scientific career of Lucja Frey was brutally interrupted by the tragic times of the Holocaust.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland.
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Nadershah M, Salama A. Removal of Parotid, Submandibular, and Sublingual Glands. Oral Maxillofac Surg Clin North Am 2012; 24:295-305, x. [DOI: 10.1016/j.coms.2012.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Athavale SM, Rangarajan S, Dharamsi L, Wentz S, Phillips S, McRackan T, Yarbrough WG. AlloDerm and DermaMatrix implants for parotidectomy reconstruction: A histologic study in the rat model. Head Neck 2012; 35:242-9. [DOI: 10.1002/hed.22952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/12/2022] Open
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Zeng XT, Tang XJ, Wang XJ, Li MZ, Guo Y, Huang W, Niu YM, Leng WD. AlloDerm implants for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis. Mol Med Rep 2012; 5:974-80. [PMID: 22266670 PMCID: PMC3493056 DOI: 10.3892/mmr.2012.762] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/18/2012] [Indexed: 11/05/2022] Open
Abstract
Although Frey syndrome is not life-threatening, it is identified as the most serious and widely recognized sequela of parotidectomy and has significant potential negative social and psychological implications. Several studies have investigated whether AlloDerm® implants prevent Frey syndrome effectively and safely, however, the conclusions are inconsistent. We aimed to evaluate the precise effectiveness of AlloDerm implants for preventing Frey syndrome after parotidectomy, using a systematic review and meta-analysis. We searched randomized and quis-randomized controlled trials in which AlloDerm implants were compared to blank controls for preventing Frey syndrome after parotidectomy, from the PubMed, Embase, the Cochrane Library and the ISI Web of Knowledge databases, without any language restriction. Two reviewers independently searched, identified, extracted data and assessed methodological quality. Relative risks with 95% confidence intervals were calculated and pooled. Five articles involving 409 patients met the inclusion criteria. Meta-analyses showed a significant 85% relative risk reduction in objective incidence (RR=0.15, 95% CI 0.08-0.30; P<0.00001) and 68% in subjective incidence (RR=0.32, 95% CI 0.19-0.57; P<0.00001) of Frey syndrome with AlloDerm implants; there was a significant 91% relative risk reduction in salivary fistula (RR=0.09, 95% CI 0.01-0.66; P=0.02); there was no statistical significance for the incidence of facial nerve paralysis (RR=0.96, 95% CI 0.84-1.09; P=0.51); there was no statistical significance for the incidence of seroma/sialocele (RR=1.36, 95% CI 0.66-2.80; P=0.40); there was a trend for a small effect in improving facial contour. Adverse events related to AlloDerm implants were not found. There is evidence that AlloDerm reduces the incidence of Frey syndrome effectively and safely, and also has the potential to improve facial contour and decrease salivary fistula. However, it is unclear whether AlloDerm implants improve facial contour and decrease other complications. Thus, further controlled evaluative studies incorporating more precise measures are required.
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Affiliation(s)
- Xian-Tao Zeng
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, PR China
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The use of AlloDerm in postmastectomy alloplastic breast reconstruction: part I. A systematic review. Plast Reconstr Surg 2011; 127:2232-2244. [PMID: 21617458 DOI: 10.1097/prs.0b013e3182131c56] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postmastectomy alloplastic breast reconstruction is a common procedure that continues to evolve. Increasingly, AlloDerm is being used in both direct-to-implant and two-stage breast reconstruction. The objective of this systematic review was to summarize the outcomes from studies describing this use of AlloDerm, and to compare outcomes to those from studies reviewing non-AlloDerm alloplastic reconstruction. METHODS A computerized search was performed across multiple databases. Studies involving patients undergoing alloplastic breast reconstruction with AlloDerm were included. A systematic review was performed to include randomized controlled trials, comparative observational studies, noncomparative observational studies, and case series. RESULTS A systematic review of the literature revealed 14 studies that satisfied inclusion criteria. Both acute and long-term complication rates were obtained. No objective validated outcomes were reported. Ninety-three percent of included studies were level IV evidence. Complication rates were as follows: infection, 0 to 11 percent; hematoma, 0 to 6.7 percent; seroma, 0 to 9 percent; partial flap necrosis, 0 to 25 percent; implant exposure with removal, 0 to 14 percent; implant exposure with salvage, 0 to 4 percent; capsular contracture, 0 to 8 percent; and rippling, 0 to 6 percent. No study included a cost analysis. CONCLUSIONS Complications using AlloDerm are comparable to those of non-AlloDerm alloplastic reconstructions. AlloDerm appears to confer a low rate of capsular contracture. A formal analysis is required to determine AlloDerm's cost effectiveness in use for direct-to-implant reconstructions. In addition, a randomized controlled trial comparing AlloDerm use to conventional two-stage reconstruction is currently absent from the literature.
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Zhi K, Ren W, Gao L, Zhao L, Huang S, Li J, Guo F. Face-lift incision combined with sternomastoid muscular flap in parotidectomy. Aesthetic Plast Surg 2011; 35:558-62. [PMID: 21403992 DOI: 10.1007/s00266-011-9663-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND To improve the aesthetic outcome of a traditional parotidectomy, this study used a face-lift incision combined with a sternomastoid muscular (SCM) flap and compared the classical method with these techniques from the patient's perspective. METHODS Between 2005 and 2007, 38 patients with benign parotid disease underwent surgery. The patients were retrospectively assigned to two groups according to the surgical technique used. Parotidectomy was performed using a combined face-lift incision and SCM flap for 18 patients (modified group). Another 20 patients received classical parotidectomy (Blair incision without reconstruction) (classical group). The patients were followed up every 3 months for 3 years. During the follow-up period, the patients were specifically asked about their satisfaction with their postoperative appearance. RESULTS During the follow-up period, all the patients in the group that had the face-lift incision and SCM flap were satisfied with the aesthetic outcome, and the depression deformity was considerably less. Nine patients in the classical group were not satisfied with the aesthetic outcome. CONCLUSION The face-lift incision and SCM flap technique can be performed safely with satisfactory cosmetic and functional results. It results in improved patient satisfaction without additional risk of complications.
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Affiliation(s)
- Keqian Zhi
- Department of Oral and Maxillofacial Surgery/Oncological Head and Neck Surgery, Stomatological Hospital, Xi'an Jiaotong University, Number 98, Xiwu Road, Xi'an, ShaanXi 710004, China.
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Complications of alloderm and dermamatrix for parotidectomy reconstruction. Head Neck 2011; 34:88-93. [DOI: 10.1002/hed.21684] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/04/2010] [Accepted: 10/22/2010] [Indexed: 11/07/2022] Open
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Sanabria A, Kowalski LP, Bradley PJ, Hartl DM, Bradford CR, de Bree R, Rinaldo A, Ferlito A. Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: A systematic review. Head Neck 2011; 34:589-98. [DOI: 10.1002/hed.21722] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2010] [Indexed: 11/09/2022] Open
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