The use of acellular dermis in the prevention of Frey's syndrome

Educational Objective. At the conclusion of this presentation, the particip ant should be able to discuss the indications and advantages of using acell ular dermis in the prevention of post-parotidectomy gustatory sweating (Fre y's Syndrome). Introduction: Gustatory sweating is a common postoperative p roblem and a challenge to treat. The purpose of this study was to evaluate the role of acellular dermis in preventing post-parotidectomy gustatory swe ating. Methods: Sixty-four patients were randomly assigned to two groups. G roup I consisted of 32 patients who underwent a superficial lobe parotidect omy. Group II consisted of 32 patients who underwent a superficial lobe par otidectomy and underwent intraoperative placement of acellular dermis withi n the parotid bed, between the skin flap and the remaining parotid tissue. The implanted volume of acellular dermis was determined by the amount requi red to aesthetically restore lateral facial contour. All 64 patients were e valuated for gustatory sweating by identical phone and mail questionnaires. Thirty randomly chosen patients (group I = 15, group II = 15) were evaluat ed using a modified Minor's Starch-Iodine Test (MSIT). In all 30 patients, the MSIT was administered to both sides of the face. Results. The responses to questionnaires (N = 64) demonstrated the subjective presence of gustato ry sweating in 3 of 32 patients (9.3%) in group I, whereas group II demonst rated a subjective incidence in I of 32 patients (3.1%). The objective inci dence determined by those who underwent the MSIT (n = 30) revealed a 40%, ( 6) and 0% incidence of Frey's Syndrome in groups I and II, respectively. Th e complication rate in group I was 9% (3 seromas) and in group II it was 25 % (7 seromas and 1 wound infection). Conclusions. Acellular dermis appears to be an effective method for preventing post-parotidectomy gustatory sweat ing, despite its higher complication rate.