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Revista Española de Cirugía Oral y Maxilofacial

versión On-line ISSN 2173-9161versión impresa ISSN 1130-0558

Rev Esp Cirug Oral y Maxilofac vol.28 no.3 Madrid may./jun. 2006




SMAS flap for the prevention of Frey’s syndrome

Colgajo de SMAS en la prevención del síndrome de Frey



In this paper the authors discuss a subject of great interest that continues being the object of controversy. Frey’s syndrome is a very common sequelae that can occur after a parotidectomy, but it has also been described after surgery of the submaxillary gland or after cervical dissection.1 Despite appearing frequently, in most cases this complication is not of great clinical transcendence. Consequently, it tends not to require treatment although currently botulinum toxin is being used and good results have been reported.2

Numerous methods have been described with the aim of preventing the appearance of Frey’s syndrome after a parotidectomy. Of these, the insertion of various materials such as lyophilized duramater or acellular dermis3 stand out, as well as regional flaps such as the sternocleidomastoid muscle or temporoparietal fascia flaps. Perhaps the paper we are discussing would have been more complete had these methods been discussed in relation to the superficial musculoaponeurotic system (SMAS) flap, the object of the study. The authors present their results in a series of 81 cases of parotidectomy. The series is extensive, although heterogeneous groups are included, some scant in numbers such as the group of patients with total non-conservative parotidectomies. The largest group is the conservative superficial parotidectomy group (68%). The authors diagnosed Frey’s syndrome in a rigorous manner. Of the total in the series, the syndrome was identified in 13 cases. The analysis of the results shows that a SMAS flap was not carried out in 16 of the interventions, while in 65 cases the flap was prepared. Frey’s syndrome was diagnosed in the postoperative period in 9 out of the 65 cases undergoing this technique (13%), while the syndrome was identified in 4 out of the 16 cases that did not receive a SMAS flap (25%). The authors do not carry out a statistical comparison, probably as a result of the size of the second sample group, although the difference is clear. In any event, carrying out a SMAS flap does apparently reduce the appearance of Frey’s syndrome, but it does not prevent it completely. In our opinion, the SMAS flap is a simple technique that has other advantages. Its good aesthetic results stand out, as the depression that arises after the intervention in the operated area is avoided. These results can be excellent, especially when the SMAS flap is carried out using a rhytidectomy-type approach in cases of tumors that are fundamentally benign.4,5

We believe, in conclusion, that the paper discussed provides the authors’ experience on a subject of interest and the subject of controversy. We share their opinion as to the SMAS flap being a complementary method of first choice in cases of parotidectomy, providing this is indicated from an oncological point of view.



1. Bonanno PC, Casson PR. Frey's síndrome: a presentable phenomenon. Plast Reconstr Surg 1992;89:452-6.        [ Links ]

2. Arad-Cohen A, Blitzer A. Botulinum toxin treatment for symptomatic Frey's síndrome. Otolaryngol Head Neck Surg 2000;122:237-40.        [ Links ]

3. Govindaraj S, Cohen M, Genden E, Constantino P, Urken M. The use of acellular dermis in the prevention of Frey's syndrome. Laryngoscope 2001;111:1993- 8.        [ Links ]

4. Bozzetti A, Biglioli F, Salvato G, Brusati R. Technical refinements in surgical treatment of benign parotid tumors. J Cranio-Maxillofac Surg 1999;27:289-93.        [ Links ]

5. Honig J. Facelift approach with a hybrid SMAS rotation advancement flap in parotidectomy for prevention of scars and contour deficiency affecting the neck and sweat secretion of the cheek. J Craniofacial Surg 2004;15:797-803.        [ Links ]

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