Partial-thickness sternomastoid rotational flap in parotid surgery: the functional and esthetic outcomes

Abstract

Author(s): Norhafiza Mat Lazim*, Nurul Farahiyah Abdullah, Zulkifli Yusof, Baharudin Abdullah

Introduction: Majority of parotid tumor requires parotid surgery and complications following parotidectomy are multiple namely facial nerve paresis, Frey’s syndrome, retromandibular depression and hypoesthesia of ear lobule. Parotidectomy with sternomastoid (SCM) flap may play significant roles in preventing these complications. Objectives: The objectives of this study were to compare the occurrence of Frey’s syndrome, esthetic outcome, facial nerve paresis and ear lobe paresthesia between the two groups, parotidectomy with sternomastoid flap and parotidectomy without sternomastoid flap. Methodology: This was a comparative cross-sectional study performed at Hospital Universiti Sains Malaysia and Hospital Sultanah Bahiyah from June 2016 until October 2018, after ethical committee approval (USM/JEPeM/17020092). The patient was recruited prospectively for the SCM flap group and retrospectively for non-flap group. Frey’s syndrome was evaluated both subjectively and objectively by patient’s complaint assessment and Minor Starch Iodine test. Evaluation of esthetic outcome was conducted using Visual Analog Score (VAS). In addition, assessment of facial nerve was performed by using the House-Brackmann grading system, whereas hypoesthesia of ear lobe numbness was evaluated by patient complaints documentation. All data were entered and analyzed using the software IBM SPSS version 24. Descriptive analysis and Pearson's Chi-square test were used in analyzing the obtained data. Results: Occurrence of Frey’s syndrome in parotidectomy without SCM flap was higher compared to parotidectomy with SCM flap group. Results showed that 13 patients (72.2%) in the non-SCM flap group had Frey’s syndrome whereas only 2 patients (11.8%) in SCM flap group had the syndrome. The aesthetic result showed that patients with parotidectomy with SCM flap had lower mean score of 1.21 (SD=0.36) at day 14, 0.06 (SD=0.24) at day 30 and 0.03 (SD=0.12) at day 60 respectively. Both outcomes were statistically significant (p<0.05). While incidence of facial nerve palsy and cervical/ear lobe numbness were the same in the two studied groups. Conclusion: There was a significant difference in Frey’s syndrome and aesthetic outcomes of the parotidectomy with SCM flap compared to those without SCM flap. Partial-thickness sternomastoid flap should be routinely practiced especially in young patients with benign big tumor going for parotidectomy.

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