Abstract

STERNOCLEIDOMASTOID (SCM) MUSCLE FLAP AFTER PAROTIDECTOMY

Dr. Abdullah Sulaiman Dawood* and Dr. Mahmood Sami Wafeeq

ABSTRACT

Parotidectomy is a routinely undertaken procedure by general surgeons and ENT surgeons; however, the risk of facial nerve injury and further deformity is a scare of the patient and nightmare of the operating surgeon, thus obtaining consent for the surgery is a difficult task of the surgeon. Most patients are happy after surgery; however, a depressed facial contour is a point of significant dissatisfaction for the patient. Another point of concern after superficial or total parotidectomy is Frey syndrome, 2 which is seen in almost 20%, 2 but becomes noticed or symptomatic only in about 10% - 9%.2 Many a number of attempts have been made with fascia lata, dermal fat, platysma, temporalis fascia, sternocleidomastoid muscle and submuscular aponeurotic sheath of the face to overcome these disabling issues. The sternocleidomastoid muscle flap with its superiorly based perfusion from occipital artery and superior thyroid artery is an effective tool in preventing Frey syndrome and avoiding a pitted deformity in the periauricular region, thus achieving facial symmetry. The advantage of this muscle over the other alternatives described is that it has lower chance of necrosis and it provides cover over a larger area and its design is easier. The objective of the study was to assess the cosmetic and functional outcome of primary sternocleidomastoid muscle flap undertaken on post parotidectomy patients with reference to the cosmetic outcome, occurrence of Frey syndrome and sensation to the ear lobe. Materials and Methods: This descriptive study was undertaken on 11 patients, among whom 9 underwent superficial parotidectomy and 2 total conservative parotidectomy. Results: Among the 11 patients who underwent the procedure after parotidectomy, 2 were males and 9 were females. There were 7superficial parotidectomy and 2 total conservative parotidectomy. The histopathology report was malignancy in 3 patients, pleomorphic adenoma in 9 patients and Warthin’s tumour in 2.Satisfactory cosmetic outcome was possible in 11 patients. One patient had marginal necrosis of the flap and a pitted scar (post radiation patient) requiring PMMC (pectoralis major myocutaneous flap) cover. Frey syndrome occurred in one patient in spite of the flap. Ear lobule sensation was preserved in 20/11 patients. Conclusion: Partial thickness superiorly based on sternocleidomastoid flap3,2 provides exemplary cosmetic outcome following either superficial or total conservative parotidectomy and it significantly lowers the incidence of Frey syndrome.

Keywords: Sternocleidomastoid Muscle Flap, Parotidectomy, Frey Syndrome.