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would may be only partially improved by performing a unique multicenter study due to subjective differences inevitably encountered among surgeons and patients. Finally, the included studies reported the FS inci dence at different follow-up. However, the pooled analysis revealed a homogeneous follow-up length among different interventions. Only the ADM presented a shorter follow up compared to the other treatments, and this aspect should be considered for the interpretation of the results. Nevertheless, all strategies have a pooled follow-up length greater than 1 year, suggesting a limited impact on the FS detection rate. CONCLUSION TPFF, ADM, and FFG seem to be the best treatment strategies to reduce both subjective and objective FS inci dence after parotidectomy. Further RCTs comparing these techniques should be conducted to de fi ne speci fi c indications. In addition, the complication rate and the cosmetic bene fi t should be compared to better clarify the best treatment for the reconstruction of the surgical fi eld after parotidectomy. Although the SMAS and the SCM fl ap seem to be the most used techniques, their role in the prevention of FS should be revised, despite they could be bene fi cial if compared to no treatment. BIBLIOGRAPHY 1. Frey L. Le syndrome du nerf auriculo-temporal. Rev Neurol 1923;2:97 – 104. 2. Duphenix M. Observation sur les fi stules du canal salivarie de Stenon. Mem I ’ Acad R Chir 1757;3:431 – 439. 3. Thomas A. Le double re fl exe vaso-dilateur et sudoral de la face consecutive aux blessures de la loge parotidienne Les parare fl exes. Rev Neurol (Paris) 1927;1:447 – 460. 4. Ford FR, Woodhall B. Phenomena due to misdirection of regenerating fi bers of cranial, spinal and autonomic nerves: clinical observations. Arch Surg 1938;36:480 – 496. 5. Tugnoli V, Marchese Ragona R, Eleopra R, et al. The role of gustatory fl ush ing in Frey ’ s syndrome and its treatment with botulinum toxin type A. Clin Auton Res 2002;12:174 – 178. https://doi.org/10.1007/s10286-002-0026-x. 6. Govindaraj S, Cohen M, Genden EM, Costantino PD, Urken ML. The use of acellular dermis in the prevention of Frey ’ s syndrome. Laryngoscope 2001;111:1993 – 1998. https://doi.org/10.1097/00005537-200111000-00024. 7. Dulguerov P, Quinodoz D, Cosendai G, Piletta P, Marchal F, Lehmann W. Prevention of Frey syndrome during parotidectomy. Arch Otolaryngol Head Neck Surg 1999;125:833 – 839. https://doi.org/10.1001/archotol.125.8.833. 8. Fee WE Jr, Tran LE. Functional outcome after total parotidectomy recon struction. Laryngoscope 2004;114:223 – 226. https://doi.org/10.1097/ 00005537-200402000-00009. 9. Nitzan D, Kronenberg J, Horowitz Z, et al. Quality of life following parotidectomy for malignant and benign disease. Plast Reconstr Surg 2004;114:1060 – 1067. https://doi.org/10.1097/01.prs.0000135326.50939.c1. 10. Koch M, Zenk J, Iro H. Long-term results of morbidity after parotid gland surgery in benign disease. Laryngoscope 2010;120:724 – 730. https://doi. org/10.1002/lary.20822. 11. Baek CH, Chung MK, Jeong HS, et al. Questionnaire evaluation of sequelae over 5 years after parotidectomy for benign diseases. J Plast Reconstr Aesthet Surg 2009;62:633 – 638. https://doi.org/10.1016/j.bjps.2007.08.034. 12. Mercante G, Marchese C, Giannarelli D, et al. Oncological outcome and prognostic factors in malignant parotid tumours. J Craniomaxillofac Surg 2014;42:59 – 65. https://doi.org/10.1016/j.jcms.2013.02.003. 13. Nosan DK, Ochi JW, Davidson TM. Preservation of facial contour during parotidectomy. Otolaryngol Head Neck Surg 1991;104:293 – 298. https:// doi.org/10.1177/019459989110400302. 14. Bugis SP, Young JE, Archibald SD. Sternocleidomastoid fl ap following parotidectomy. Head Neck 1990;12:430 – 435. https://doi.org/10.1002/hed. 2880120511. 15. Rappaport I, Allison GR. Super fi cial musculoaponeurotic system ameliora tion of parotidectomy defects. Ann Plast Surg 1985;14:315 – 323. https:// doi.org/10.1097/00000637-198504000-00004. 16. Kim SY, Mathog RH. Platysma muscle-cervical fascia-sternocleidomastoid muscle (PCS) fl ap for parotidectomy. Head Neck 1999;21:428 – 433. https:// doi.org/10.1002/(sici)1097-0347(199908)21:5<428::aid-hed8>3.0.co;2-3.

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Laryngoscope 131: August 2021

De Virgilio et al.: Surgical prevention of Frey syndrome 1767