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Fig. 2. Results of the network meta-analysis concerning clinical (subjective) Frey syndrome prevention. (A) network plot of included interven tions. Circles are weighted according to the number of studies, including the intervention, and lines are weighted according to the number of studies comparing the two connected techniques. (B) absolute risk of clinical (subjective) Frey syndrome incidence for each intervention. [Color fi gure can be viewed in the online issue, which is available at www.laryngoscope.com.]

TABLE I. League Table Showing Comparative Effectiveness of Analyzed Interventions in Network Meta-analysis Concerning Clinical (Subjective) Frey Syndrome Prevention. TPFF 1.33 (0.12, 26.80) ADM 1.60 (0.15, 31.89) 1.21 (0.20, 7.16) FFG 5.38 (0.60, 92.14) 4.08 (0.97, 17.74) 3.39 (0.81, 14.21) SCM 6.13 (0.68, 106.10) 4.64 (1.01, 21.17) * 3.87 (0.86, 16.81) 1.13 (0.42, 3.08) SMAS 14.37 (1.75, 233.90) * 10.95 (2.87, 43.29) * 9.11 (2.35, 35.30) * 2.67 (1.37, 5.42) * 2.38 (1.03, 5.29) * None Different treatments are reported in order of clinical (subjective) Frey syndrome prevention ranking. Comparisons should be read from left to right. The esti mate is located at the intersection of the column-de fi ning treatment and the row-de fi ning treatment. Data are reported as OR with 95% CI. An OR value greater than 1 favors the column-de fi ning treatment. * P value statistically signi fi cant.

total of 56 studies 6,8,13,19 – 24,37 – 83 were included in the quali tative and quantitative synthesis. The reasons behind the exclusions of 45 studies are shown in Figure 1. Study ’ s general characteristics are shown in Supporting Table 1. A total of 3830 patients with a median age of 50.35 years (n = 2323; IQR 44.25 – 54.18) were included for six different interventions and 96 treatment arms. A median follow-up of 24 months (n = 2401; IQR 16 – 36.9) was reported by 40 studies. The median follow-up for each intervention is shown in Supporting Table 2. The extent of parotid surgery was reported by 44 studies (n = 2913). The majority of patients (n = 2161; 74.2%) underwent a super fi cial/partial parotidectomy, while only 752 (25.8%) patients were treated with a total/ subtotal parotidectomy. Histopathologic nature of the parotid tumor was reported by 44 studies (n = 2527), with a predominance of benign lesions (n = 2304; 91.2%) com pared to malignant tumors (n = 223; 8.8%).

or retrospective 13,38,39,41,42,44,48,49,51,53 – 55,57,58,61 – 67,70,72,74,75,78,82,83 (n = 2301, 60.1%) non-randomized studies. In particular, 12 prospective (n = 349, 9.1%) and seven retro spective (n = 378, 9.9%) single-arm studies were included, while 22 retrospective case – control (n = 1923, 50.2%) and eight prospective non-randomized studies (n = 890, 23.2%) ful fi lled the abovementioned eligibility criteria. On the other hand, only a minority of patients (n = 290, 7.6%) were enrolled in seven RCTs. 6,19 – 24 MINORS criteria showed an overall mean score of 10.8 ± 1.4 in non-comparative studies (maximum of 16), while a mean score of 15.5 ± 1.8 was measured in compar ative studies (maximum of 24). MINORS scores of indi vidual studies are shown in Supporting Table 3. The methodological quality of included randomized trials is summarized in Supporting Figure 1. Some con cerns of reporting bias were raised for all included RCTs. Five RCTs (n = 224) showed some concerns also for selec tion bias. However, no high risk of bias was highlighted in the included RCTs. The funnel plots generated for the meta-analyses of each intervention are shown in Supporting Figure 2. Egger ’ s regression test showed a symmetric distribution of the points in all funnel plots (ADM, Intercept = 0.36,

Methodological quality and risk of bias of included studies The majority of included studies were prospec tive 37,40,43,45 – 47,50,52,56,59,60,68,69,71,73,76,77,79 – 81 (n = 1239, 32.3%)

Laryngoscope 131: August 2021

De Virgilio et al.: Surgical prevention of Frey syndrome

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