Prevention of Frey syndrome in parotid gland surgery.

Abstract

Objective: This study discusses the anatomy and surgical techniques for the prevention of Frey syndrome. By performing only a partial superficial parotidectomy, we probably preserve the connection between the auriculotemporal nerve and the facial nerve. By suturing the remainder of the parotid gland tissue and the superficial musculoaponeurotic system (SMAS) back to the sternocleidomastoid muscle, an interposition is made. Furthermore, by extending the incision not too far cranially, the auriculotemporal nerve cutaneous branch is spared. We also tried to preserve part of the great auricular nerve (GAN).

Design: Descriptive study.

Setting: One main institute (a tertiary referral centre) and one affiliated secondary centre.

Methods: Patients operated on for parotid gland tumours in our hospitals during the last 3 years underwent starch-iodine testing after at least 1 year of follow-up.

Main outcome measures: The number of patients developing Frey syndrome. We hypothetically explored the importance of preserving both the auriculotemporal and the great auricular nerve.

Results: Eighty-one patients were operated on for a parotid gland tumour. Forty-five (56%) of these patients could be followed up for more than 1 year. Four patients had a positive starch-iodine test. Two of these underwent revision surgery and had symptoms already before our procedure. About half of the patients had a SMAS interposition performed. All four patients with Frey syndrome did not have a SMAS interposition.

Conclusion: We advocate our technique in primary benign tumours. Further research to clarify the parasympathetic and sympathetic function of the great auricular nerve and the cutaneous branch of the auriculotemporal nerve is necessary.