The use of the SMAS to close Mohs defects invading the parotid gland

BACKGROUND. Plastic surgery literature reports the use of the superficial m usculoaponeurotic system (SMAS) in reconstruction after parotidectomies to prevent the complications of Frey's Syndrome and fistula formation. However , there is scant information in the dermatologic literature regarding the u se of the SMAS when closing Mohs defects overlying the parotid gland. OBJECTIVE. Our purpose is to introduce to the dermatologic surgery literatu re the need for plication of the SMAS prior to closure of the overlying tis sues when repairing surgical defects which invade the integrity of the paro tid gland. METHODS. We describe a patient with a large basal cell carcinoma located in the right preauricular region. Using text and photographs, we detail our c losure of this large defect which invaded the parotid gland. RESULTS. Closure of the SMAS over the parotid gland before suturing the ove rlying tissues provided our patient with an excellent functional ann cosmet ic result, without the formation of a fistula, sialocele, or Frey's Syndrom e. CONCLUSION. We propose that the essential first step in the ideal closure o f surgical wounds which penetrate the parotid gland involves the isolation and plication of the SMAS. This will create a barrier to the accumulation o f parotid secretions which, in turn, may lead to the development of a sialo cele and fistula formation. Such a barrier will also prevent the formation of Frey's Syndrome. Furthermore, plication of the SMAS serves to improve co smesis by contributing soft tissue bulk to the wound and avoiding a concave deformity. (C) 1998 by the American Society for Dermatologic Surgery, Inc.