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

Askar, Sherif Mohammad; Mohamed, Abd ElRaof Said; Oraby, Tamer; Khaled, Ibrahim; Megahed, Mahmoud; Awad, Ali

doi:10.1055/s-0044-1788911

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Original Research • Int Arch Otorhinolaryngol. 29 (2) • 2025 • https://doi.org/10.1055/s-0044-1788911 linkcopy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords
superficial parotidectomy; sternomastoid muscle flap; fat graft

Degree	Appearance
5	Normal appearance, symmetrical to the opposite side
4	Minimal asymmetry, barely noticeable from a short distance
3	Mild asymmetry, noticeable but with no disfigurement
2	Moderate asymmetry, mainly in the preauricular area, is apparent
1	Severe asymmetry, with a deep preauricular and retromandibular groove
0	Severe asymmetry, with a deep preauricular, retromandibular groove, and an obvious scar

Variables	Study groups (N = 29)			f	p	Post-hoc test
Variables	SCF	PRF	Fat graft	f	p	Post-hoc test
Cosmetic satisfaction of patients at 6 months	1.6 ± 1.1	2.2 ± 0.7	3.4 ± 1.1	8.1	0.002	(0.21)* (0.0001) (0.016)*
Cosmetic satisfaction of patients at 12 months	3.3 ± 0.9	3 ± 0.87	3.8 ± 0.97	1.7	0.205	−
Paired t; P1	5.2; 0.0001	5.3; 0.001	1.2; 0.28
Cosmetic satisfaction of relatives at 6 months	2.6 ± 0.67	2.8 ± 0.7	3.9 ± 1.2	6.1	0.007	(0.72)* (0.003) (0.01)*
Cosmetic satisfaction of relativeS at 12 months	3.9 ± 0.54	3.4 ± 0.88	4.2 ± 1.2	1.7	0.196	−
Paired t; P1	6.5 0.0001	4 0.004	1.4 0.19
Experts score at 6 months	3.8 ± 0.37	2.7 ± 0.5	4.2 ± 0.41	31.1	0.0001	(0.0001)* (0.068) 0.0001)*
Experts score 12 months	4 ± 0.35	2.9 ± 0.46	4.4 ± 0.46	29.2	0.0001	(0.0001)* (0.03) (0.0001)*
Paired t; P1	1.84 0.096	5.3 0.001	4 0.001
Total score at 6 months	3.1 ± 0.14	2.6 ± 0.33	3.97 ± 0.35	46.2	0.0001	(0001)* (0.0001) 0.0001)*
Total score at 12 months	3.8 ± 0.34	3 ± 0.37	4.2 ± 0.31	28.5	0.0001	(0.0001)* (0.01) (0.0001)*
Paired t; P1	6.3; 0.0001	10; 0.0001	4; 0.004

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[TFN1] Abbreviations: f, analysis of variance (ANOVA); PRF, platelet-rich fibrin gel; SCF, partial-thickness sternocleidomastoid muscle flap; VAS-f, Visual Analog Scale.

[TFN2] Notes: Data: expressed as mean ± standard deviation values; P: comparison among the three groups; P1: comparison within each group;

[TFN3] ^*
p-values for the comparison between the SCF and fat-graft groups;

[TFN4] ^**
p-values for the comparison between the PRF and fat-graft groups;

[TFN5] ^***
p-values for the comparison between the SCF and PRF groups; p < 0.05: significant; p < 0.001: highly significant.