What is the experience in using a superficial muscoloaponeurotic system (SMAS)-platysma flap in facial-aesthetic parotid surgery for benign parotid neoplasms?
Background: The surgical management of benign parotid neoplasms has evolved from oncologic safety alone to an operation that is focused on limited visible incisions, facial contour restoration, prevention of Frey syndrome, and preservation of facial motor and sensory function. Although several approaches and reconstructive techniques have been described, most have shortcomings.
Explore this issue:December 2011
Study design: Observation/surgical technique.
Setting: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, William Beaumont Hospital, Troy, Mich.; Department of Otolaryngology-Facial Plastic Surgery, Henry Ford Macomb Hospital, Warren, Mich.
Synopsis: The approach described in this article utilized a double-layer SMAS-platysma flap that selectively allowed targeted myofascial cuts in more than 150 cases of benign parotid neoplasms during the last 10 years. There were no cases of clinically significant Frey syndrome. Two cases of marginal nerve paresis spontaneously resolved within several months. No cases of post-operative hematoma, wound infection, salivary fistula or hypertrophic scar formation were noted, and patient satisfaction relating to scar appearance and facial contour was uniformly high. The authors said the disadvantages of this technique relate to its inability to provide sufficient volume replacement in patients with full, round faces or thick parotid glands.
Bottom line: The application of an SMAS-platysma flap can alleviate the depression in the retromandibular region following superficial parotidectomy for moderately sized neoplasms and has been shown to help prevent post-parotidectomy sequelae of Frey syndrome.
Citation: Arden RL, Miguel GS. Aesthetic parotid surgery: evolution of a technique. Laryngoscope. 2011;121(12):2581-2585.
—Reviewed by Sue Pondrom