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Plastic and Reconstructive Surgery Nov 2012The use of acellular dermal matrices has been well described in the scientific literature since the early 1990 s and has been utilized for multiple applications in the... (Review)
Review
BACKGROUND
The use of acellular dermal matrices has been well described in the scientific literature since the early 1990 s and has been utilized for multiple applications in the head and neck for both aesthetic and reconstructive efforts.
METHODS
After systematically searching the PubMed database and following further refinement (based on the authors' inclusion and exclusion criteria), the authors identified 30 studies that provided information about patients who had undergone head and neck reconstruction with the use of acellular dermal matrix. Studies had to report quantifiable objective results in patients who were older than 1 year and younger than 90 years. The authors excluded single case reports, studies with fewer than 10 patients, and studies not published in English.
RESULTS
The optimal material used as an implant for reconstruction possesses the following properties: facilitation of vascular ingrowth, decreased propensity to incite inflammation, biologic inertness, resistance to infection, and ease of handling. Acellular dermal matrix possesses many of these properties and is utilized in reconstructing nasal soft tissue and skeletal support, tympanic membrane, periorbital soft tissue, extraoral and intraoral defects, oropharyngeal defects, dura mater, and soft-tissue deficits from parotidectomy. Furthermore, it is used to assist in preventing Frey syndrome following parotidectomy and surgical treatment of facial paralysis.
CONCLUSIONS
Use of acellular dermal matrix for head and neck reconstruction has expanded exponentially and is validated in many studies. Further prospective randomized control trials are warranted to further investigate the efficacy of acellular dermal matrix in head and neck reconstruction.
Topics: Absorbable Implants; Acellular Dermis; Collagen; Ear; Esthetics; Face; Head; Humans; Neck; Ophthalmologic Surgical Procedures; Oral Surgical Procedures; Parotid Gland; Postoperative Complications; Plastic Surgery Procedures; Rhinoplasty; Treatment Outcome
PubMed: 23096983
DOI: 10.1097/PRS.0b013e31825eff7a -
Journal of Oral and Maxillofacial... Feb 2013To detect the effect and safety of different types of grafts for the prevention of Frey syndrome after parotidectomy. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To detect the effect and safety of different types of grafts for the prevention of Frey syndrome after parotidectomy.
MATERIALS AND METHODS
The following data bases were searched electronically: MEDLINE (using OVID, from 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, issue 2, 2011), EMBASE (available from: http://embase.com, 1984 to July 2011), World Health Organization International Clinical Trials Registry Platform (July 2011), Chinese BioMedical Literature Database (1978 to July 2011), and the China National Knowledge Infrastructure (1994 to July 2011). The relevant journals and reference lists of the included studies were manually searched for randomized controlled trials studying the effect and safety of different types of grafts for preventing Frey syndrome after parotidectomy. The risk of bias assessment using Cochrane Collaboration's tool and data extraction was independently performed by 2 reviewers. The meta-analysis was performed using Review Manager, version 5.1.
RESULTS
A total of 14 randomized clinical trials and 1,098 participants were included. All had an unclear risk of bias. The meta-analysis results showed that the use of an acellular dermis matrix can reduce by 82% the risk of Frey syndrome compared with the no-graft group using an objective assessment (relative risk [RR] 0.18, 95% confidence interval [CI] 0.12 to 0.26; P < .00001; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] quality of evidence: high). The acellular dermis matrix can also reduce by 90% the risk of Frey syndrome compared with the no-graft group using a subjective assessment (RR 0.10, 95% CI 0.05 to 0.22; P < .00001; GRADE quality of evidence: high). The muscle flaps can reduce by 81% the risk of Frey syndrome compared with the no-graft group (RR 0.19, 95% CI 0.13 to 0.27; P < .00001; GRADE quality of evidence: high). No statistically significant difference was found between the acellular dermal matrix and muscle flap groups (RR 0.73, 95% CI 0.15 to 3.53, P = .70; GRADE quality of evidence: low). No serious adverse events were reported.
CONCLUSIONS
The present clinical evidence suggests that grafts are effective in preventing Frey syndrome after parotidectomy. More randomized clinical trials are needed to confirm our conclusions and prove the safety of the grafts.
Topics: Acellular Dermis; Bias; Humans; Muscle, Skeletal; Parotid Gland; Postoperative Complications; Randomized Controlled Trials as Topic; Risk Factors; Skin Transplantation; Surgical Flaps; Sweating, Gustatory
PubMed: 22884117
DOI: 10.1016/j.joms.2012.06.007 -
The Laryngoscope Sep 2012Recent studies suggest that extracapsular dissection (ECD) is an option for the resection of certain benign parotid tumors. This study investigates complication rates... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES/HYPOTHESIS
Recent studies suggest that extracapsular dissection (ECD) is an option for the resection of certain benign parotid tumors. This study investigates complication rates and effectiveness of ECD versus superficial parotidectomy (SP) for the treatment of primary benign parotid neoplasms.
STUDY DESIGN
Systematic literature review with meta-analysis.
METHODS
Studies available for inclusion evaluated the complications and effectiveness of ECD and SP as surgical techniques for the treatment of solitary, benign parotid tumors. An Ovid/Medline search revealed nine articles that met inclusion criteria. A critical review and meta-analysis of these articles was performed.
RESULTS
The included studies evaluated a total of 1,882 patients. There was no observed difference in tumor recurrence between the ECD and SP groups (odds ratio [OR], 0.557; 95% confidence interval [CI], 0.271-1.147). There was a significantly lower rate of transient facial nerve paresis (OR, 0.256; 95% CI, 0.174-0.377) in the ECD group (59 of 741; 8.0%) compared to the SP group (81 of 397; 20.4%); however, there was no observed difference in permanent facial paralysis between the ECD and SP groups (OR, 0.878; 95% CI, 0.282-2.730). Frey's syndrome was less often observed (OR, 0.117; 95% CI, 0.071-0.191) after ECD (27 of 602; 4.5%) compared to SP (75 of 287; 26.1%).
CONCLUSIONS
This systematic review with meta-analysis suggests that ECD has a similar recurrence rate as SP with fewer postoperative complications. ECD may be considered an alternative surgical modality for select benign parotid neoplasms.
Topics: Cohort Studies; Disease-Free Survival; Dissection; Female; Follow-Up Studies; Humans; Male; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Risk Assessment; Surgical Procedures, Operative; Survival Analysis; Treatment Outcome
PubMed: 22753318
DOI: 10.1002/lary.23396 -
Molecular Medicine Reports Apr 2012Although Frey syndrome is not life-threatening, it is identified as the most serious and widely recognized sequela of parotidectomy and has significant potential... (Meta-Analysis)
Meta-Analysis Review
Although Frey syndrome is not life-threatening, it is identified as the most serious and widely recognized sequela of parotidectomy and has significant potential negative social and psychological implications. Several studies have investigated whether AlloDerm® implants prevent Frey syndrome effectively and safely, however, the conclusions are inconsistent. We aimed to evaluate the precise effectiveness of AlloDerm implants for preventing Frey syndrome after parotidectomy, using a systematic review and meta-analysis. We searched randomized and quis-randomized controlled trials in which AlloDerm implants were compared to blank controls for preventing Frey syndrome after parotidectomy, from the PubMed, Embase, the Cochrane Library and the ISI Web of Knowledge databases, without any language restriction. Two reviewers independently searched, identified, extracted data and assessed methodological quality. Relative risks with 95% confidence intervals were calculated and pooled. Five articles involving 409 patients met the inclusion criteria. Meta-analyses showed a significant 85% relative risk reduction in objective incidence (RR=0.15, 95% CI 0.08-0.30; P<0.00001) and 68% in subjective incidence (RR=0.32, 95% CI 0.19-0.57; P<0.00001) of Frey syndrome with AlloDerm implants; there was a significant 91% relative risk reduction in salivary fistula (RR=0.09, 95% CI 0.01-0.66; P=0.02); there was no statistical significance for the incidence of facial nerve paralysis (RR=0.96, 95% CI 0.84-1.09; P=0.51); there was no statistical significance for the incidence of seroma/sialocele (RR=1.36, 95% CI 0.66-2.80; P=0.40); there was a trend for a small effect in improving facial contour. Adverse events related to AlloDerm implants were not found. There is evidence that AlloDerm reduces the incidence of Frey syndrome effectively and safely, and also has the potential to improve facial contour and decrease salivary fistula. However, it is unclear whether AlloDerm implants improve facial contour and decrease other complications. Thus, further controlled evaluative studies incorporating more precise measures are required.
Topics: Collagen; Humans; Parotid Gland; Prostheses and Implants; Sweating, Gustatory
PubMed: 22266670
DOI: 10.3892/mmr.2012.762 -
Head & Neck Apr 2012Parotidectomy is a common procedure and Frey's syndrome (gustatory sweating) is a common side effect. The current literature was assessed concerning the effectiveness of... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Controlled Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Male; Muscle, Skeletal; Parotid Gland; Postoperative Complications; Primary Prevention; Randomized Controlled Trials as Topic; Risk Assessment; Surgical Flaps; Surgical Procedures, Operative; Sweating, Gustatory; Treatment Outcome
PubMed: 21472880
DOI: 10.1002/hed.21722