Wille-Bischofberger Andrea, Rajan Gunesh P, Linder Thomas E, Schmid Stephan
Zürich and Luzern, Switzerland; and Fremantle, Australia From the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zürich; Otolaryngology, Head and Neck Surgery Unit, Ear Sciences Center, Lions Ear and Hearing Institute, University of Western Australia; and Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Luzern.
Plast Reconstr Surg. 2007 Nov;120(6):1519-1523. doi: 10.1097/01.prs.0000282036.04717.1d.
Clinical observations indicate that creation of the superficial musculoaponeurotic system (SMAS) flap during parotid surgery decreases postoperative gustatory sweating (Frey's syndrome) and improves cosmesis after surgery.
On the basis of their previous study with 23 patients where no SMAS flap was used, the authors performed a prospective, long-term study of 6(1/2) years in 25 patients, using the SMAS flap, and compared these results with the postoperative results of their initial study. Twenty-two patients of the SMAS flap group were available for reassessment of gustatory sweating and symptoms. The Minor starch test was used to document the extent and intensity of postoperative sweating. Satisfaction with postoperative cosmetic results was assessed through a semiquantitative questionnaire as used in the previous study.
The incidence of symptomatic Frey's syndrome was significantly higher in the no-SMAS flap group after 23 months (43 percent versus 0 percent; p = 0.003). The surface extent of Frey's syndrome after 23 months was significantly reduced in the SMAS flap group (p = 0.006). At final follow-up, the incidence and extent of symptomatic Frey's syndrome showed no significant differences between the two groups (41 percent versus 56 percent; p = 0.42). The rate of satisfactory cosmetic results was significantly higher in the SMAS flap group (96 percent versus 35 percent; p < 0.05).
Creation of the SMAS flap in parotid surgery for benign lesions delays the onset and reduces the intensity and extent, but does not prevent the occurrence, of Frey's syndrome. It reliably improves the cosmetic results by reducing the retromandibular depression after parotid surgery.
临床观察表明，腮腺手术中制作表浅肌肉腱膜系统（SMAS）皮瓣可减少术后味觉性出汗（弗雷综合征）并改善术后美容效果。
基于之前对23例未使用SMAS皮瓣患者的研究，作者对25例使用SMAS皮瓣的患者进行了为期6.5年的前瞻性长期研究，并将这些结果与他们最初研究的术后结果进行比较。SMAS皮瓣组的22例患者可重新评估味觉性出汗和症状。使用Minor淀粉试验记录术后出汗的程度和强度。通过与之前研究相同的半定量问卷评估对术后美容效果的满意度。
23个月后，未使用SMAS皮瓣组有症状的弗雷综合征发生率显著更高（43%对0%；p = 0.003）。23个月后，SMAS皮瓣组弗雷综合征的表面范围显著减小（p = 0.006）。在最终随访时，两组之间有症状的弗雷综合征的发生率和范围无显著差异（41%对56%；p = 0.42）。SMAS皮瓣组美容效果满意的比例显著更高（96%对35%；p < 0.05）。
在腮腺良性病变手术中制作SMAS皮瓣可延迟弗雷综合征的发作并降低其强度和范围，但不能预防其发生。它通过减少腮腺手术后下颌后凹陷可靠地改善了美容效果。
