Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: a systematic review

Head Neck. 2012 Apr;34(4):589-98. doi: 10.1002/hed.21722. Epub 2011 Apr 5.


Background: Parotidectomy is a common procedure and Frey's syndrome (gustatory sweating) is a common side effect. The current literature was assessed concerning the effectiveness of the sternocleidomastoid muscle (SCM) flap to prevent Frey's syndrome after parotidectomy.

Methods: A bibliography search was conducted for studies published between 1966 and 2010 and included randomized controlled trials (RCTs) or cohort studies with patients undergoing parotidectomy with facial nerve preservation. The outcome measures of particular interest were the incidence of Frey's syndrome and cosmetic impairment.

Results: In all, 12 studies were selected (1 meta-analysis of all interventions to prevent Frey's syndrome, 2 RCTs, and 9 cohort studies). The trials were too heterogeneous to perform a meta-analysis on the effect of the SCM flap. The results reported by the authors of each study suggest an objective decrease in Frey's syndrome when the SCM flap was used, but there was no difference in the patients' subjective reporting of symptoms. However, this conclusion is prone to the biases inherent in these studies, and thus overall it is impossible to make any recommendation.

Conclusion: Current reported evidence is inconclusive as to the use of SCM muscle flap as an intervention to prevent Frey's syndrome following parotid surgery.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Controlled Clinical Trials as Topic
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Muscle, Skeletal / surgery
  • Muscle, Skeletal / transplantation*
  • Parotid Gland / physiopathology
  • Parotid Gland / surgery*
  • Postoperative Complications / prevention & control
  • Primary Prevention / methods
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Surgical Flaps / blood supply*
  • Surgical Procedures, Operative / adverse effects*
  • Surgical Procedures, Operative / methods
  • Sweating, Gustatory / etiology
  • Sweating, Gustatory / prevention & control*
  • Treatment Outcome