Department of Oral and Maxillofacial Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece.
ENT Department, Theagenio Cancer Hospital, Thessaloniki, Greece.
Ann Otol Rhinol Laryngol. 2021 Sep;130(9):1036-1043. doi: 10.1177/0003489421990185. Epub 2021 Feb 6.
Frey's syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence.
We conducted a 20-year retrospective study including the patients who had undergone "formal" (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions.
We included patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of sites that were reconstructed with a SMAS flap, and (2) Group B, comprised sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey's syndrome was found after the use of dermal collagen interpositional barrier ( = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor's test was positive at an incidence of 59.09% in Group A and 21.87% in Group B ( = .004, 95% CI). Severe Frey's syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B ( = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey's syndrome in the compared groups.
Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey's syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.
Frey 综合征是腮腺手术的一种常见并发症；通过在腮腺暴露的实质床和覆盖皮瓣之间放置一种间隔物，可以预防该综合征。本研究的目的是回顾性评估使用和不使用猪真皮胶原移植物（PDCG）预防该综合征发生的临床效果。
我们进行了一项为期 20 年的回顾性研究，纳入了因良性病变行“常规”（浅、全或次全）腮腺切除术的患者。纳入标准还包括：（i）定期监测与综合征相关的临床症状，（ii）进行 Minor 淀粉-碘试验检查。根据 Luna-Ortiz 分级评分系统，回顾性评估诊断出的综合征的严重程度。为了评估手术部位分离程度方面的组间差异，我们使用可用的尺寸估计肿瘤和组织学标本的体积。
我们纳入了 76 例行常规腮腺手术的患者。手术部位分为 2 组：（1）A 组由接受 SMAS 皮瓣重建的部位组成，（2）B 组由额外应用 PDCG 作为人工预防屏障的部位组成。在平均 26.3 个月的随访中，使用真皮胶原间隔物后 Frey 综合征的临床诊断发生率显著降低（ = .031）。具体来说，A 组主观症状的发生率为 31.8%，B 组为 6.7%。A 组 Minor 试验阳性的发生率为 59.09%，B 组为 21.87%（ = .004，95%CI）。A 组中有 31.82%的患者出现严重 Frey 综合征，B 组中有 3.12%的患者出现严重 Frey 综合征（ = .002，95%CI）。由于切除的肿瘤和切除的组织学标本体积之间没有统计学显著差异，因此在比较组中，手术分离程度并未证明会影响 Frey 综合征的发生。
猪真皮胶原是一种安全、实用且有用的腮腺重建方法，因为当需要切除更多的腺组织时，它似乎有助于预防 Frey 综合征。需要进行更多具有更大样本量的随机对照研究，以更好地评估 PDCG 在腮腺手术中的应用。
