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The Role of SMAS Flap in Preventing Frey’s Syndrome Following Standard Superficial Parotidectomy


Apichai Angspatt MD*,
Theera Yangyuen MD*, Sirachai Jindarak MD*,
Prayuth Chokrungvaranont MD*, Pichit Siriwan MD*
* Division of Plastic and Reconstructive Surgery, Department of Surgery,
King Chulalongkorn Memorial Hospital


Between 1992 and 2002, 46 patients who underwent standard superficial parotidectomy with a
superficial muscoloaponeurotic system (SMAS) preservation technique were included in a retrospective
study. Twenty-six patients were evaluated by questionnaire for subjective symptoms of gustatory sweating
and flushing as well as satisfaction with the aesthetic appearance of their cheek. Six of twenty-six patients
(23.1 %) complained of symptoms of Frey’s syndrome. Seven of twenty-six patients (26.9%) demonstrated a
positive Minor’s starch iodine test. By this technique the incidence of Frey’s syndrome is substantially
reduced from 48% by subjective review and 72% by objective measurement reported in the previous study by
the same group of surgeons without using the SMAS preservation technique. This study supports the role of
the SMAS flap in preventing Frey’s syndrome following standard superficial parotidectomy.

Keyword : Keywords : Frey’s syndrome, SMAS flap (superficial musculoaponeurotic system), Standard superficial

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