The superficial musculoaponeurotic system flap in the prevention of Frey syndrome: A meta-analysis

Laryngoscope. 2016 Jul;126(7):1581-4. doi: 10.1002/lary.25895. Epub 2016 Feb 24.


Objectives/hypothesis: Evaluate the difference of the incidence in clinical Frey syndrome in studies comparing classical parotidectomy and parotidectomy with superficial musculoaponeurotic system (SMAS) flap elevation and suturing through meta-analysis methodology.

Study design: Meta-analysis of controlled studies with and without SMAS flap.

Methods: Database search with the following key word combination: "Frey syndrome" and "SMAS."

Inclusion criteria: parotidectomy, SMAS flap and control groups, minimal follow-up of 1 year. The outcome was the presence of clinical Frey syndrome.

Results: Eleven studies, mostly retrospective and not randomized. According to the fixed-effect model, SMAS technique is associated with a decrease of clinical Frey syndrome with an odds ratio (OR) of 0.42 (confidence interval [CI] 0.32-0.56). With the random-effect model, the difference remains significant (P = 0.006) with an OR of 0.25 (CI 0.09-0.66). The heterogeneity index I(2) is very high (85%).

Conclusion: The use of SMAS flap and suturing is associated with a decreased incidence of Frey syndrome. Laryngoscope, 126:1581-1584, 2016.

Keywords: Frey syndrome; Parotidectomy; SMAS; gustatory sweating; meta-analysis; prevention.

Publication types

  • Meta-Analysis

MeSH terms

  • Clinical Studies as Topic
  • Humans
  • Parotid Diseases / surgery
  • Parotid Region / surgery
  • Plastic Surgery Procedures / methods*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Superficial Musculoaponeurotic System / transplantation*
  • Surgical Flaps / surgery*
  • Sweating, Gustatory / etiology
  • Sweating, Gustatory / prevention & control*