Esthetic and Functional Outcomes of Superficial Parotidectomy Comparing Three Reconstruction Techniques: An Interventional Clinical Study

TL;DR

This study compares three reconstruction techniques after a parotidectomy surgery, finding that fat grafting provides the best aesthetic results and patient satisfaction after one year.

Contribution

The study introduces a comparative analysis of three specific reconstruction techniques for post-parotidectomy defects, highlighting the superior outcomes of en-block fat grafting.

Findings

The fat-graft group had the highest patient satisfaction scores at six and twelve months post-surgery.

Fat grafting showed significantly better outcomes compared to the sternocleidomastoid muscle flap and platelet-rich fibrin gel techniques.

Fat grafting resulted in minimal surgical site morbidity and a lower risk of Frey syndrome.

Abstract

Introduction
 Preauricular defect is one of the main concerns after superficial parotidectomy. Plastic surgeons have described many filling techniques to overcome the problem.

Objective
 To discuss three reconstruction techniques after superficial parotidectomy: partial-thickness, superiorly based sternocleidomastoid muscle flap; en-bloc fat graft; and platelet-rich fibrin gel, with a comparison of aesthetic and functional outcomes.

Methods
 The present study included 29 adult patients submitted to reconstruction after superficial parotidectomy by partial-thickness, superiorly based sternocleidomastoid muscle flap, en-bloc fat graft, and platelet-rich fibrin gel. A subjective evaluation of the facial nerve functions was conducted through a visual analog scale (VAS) with scores from 0 to 5, which was completed by the patient, a close relative, and 3 blinded staff members.

Results
 Regarding the VAS, in the comparison of the 3 groups at the sixth and twelfth postoperative months, the fat-graft group reported the highest mean values for satisfaction (3.4 ± 1.1 and 3.83 ± 0.97 respectively). The fat-graft group also showed highly significant differences when compared with the groups submitted to the sternocleidomastoid muscle flap (
p
 = 0.0001) and the platelet-rich fibrin gel techniques (
p
 = 0.016).

Conclusion
 Parotidectomy with immediate reconstruction of the surgical defect through an en-block fat graft provides better esthetic outcomes than sternocleidomastoid muscle flap and platelet-rich fibrin gel after one year. The patients submitted to the sternocleidomastoid muscle flap and fat-graft techniques reported minimal surgical site morbidity and a lower chance of developing Frey syndrome. The fat graft resulted in the best degree of cosmetic satisfaction, with minimal morbidity. Fat overcorrection is recommended.

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