Süperfisiyal parotidektomi yapılan hastalarda sternokleidomastoid kas flebinin frey sendromu üzerindeki etkisinin galvanik deri cevapları ile değerlendirilmesi
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Date
2011
Authors
Demirci, Uğur
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Publisher
Uludağ Üniversitesi
Abstract
Süperfisiyal parotidektomi sonrası en sık görülen komplikasyonlardan biri Frey Sendromu'dur. Frey Sendromu oluşumunu engellemek için birçok cerrahi yöntem tanımlanmıştır. Sternokleidomastoid (SKM) kas flebi uygulaması bu yöntemler arasında basit, güvenli ve etkin olması özellikleriyle sık kullanılmaktadır. Çalışmamızda çıkarılan parotis dokusu yerine SKM kas flebi çevrilmiştir. Frey Sendromu tanısında objektif yöntem olarak genellikle Minor'ün nişasta-iyot testi kullanılmaktadır. Bu testin semptomatik olmayan hastalarda da büyük oranda pozitif sonuç vermesi daha özgül bir test kullanılmasını gerekli kılmaktadır. Bu amaçla çalışmamızda galvanik deri cevapları testi (GDC) kullanılmıştır. Çalışmamızın amacı süperfisiyal parotidektomi yapılan hastalarda SKM kas flebi kullanılmasının Frey Sendromu ve GDC ölçümleri üzerindeki etkisini araştırmaktır.Çalışmamızda benign hastalıklar nedeniyle süperfisiyal parotidektomi yapılan 22 flepli ve 21 flepsiz hasta değerlendirildi. Hastaların preoperatif sağ ve sol parotis lojuna uyan bölgedeki cilt üzerinden GDC'ları ölçüldü. Postoperatif 6. ayda yine her iki tarafın GDC'ları ölçüldü. Opere edilmemiş taraf kontrol grubu olarak kabul edildi.Hastaların 4'ünde (%9,3) Frey Sendromu bulguları vardı. Bu hastaların hepsi flepsiz gruptaydı. Flepsiz hastalar içinde Frey Sendromu oranı %19 olarak hesaplandı. Flepli hastalarda postoperatif opere ve sağlam taraflardan elde edilen GDC ölçümleri arasında fark saptanmadı. Flepsiz hastalarda postoperatif opere tarafta sağlam tarafa göre GDC değerlerinin daha yüksek olduğu saptandı. Frey Sendromu yakınmaları olan hastaların GDC değerleri diğer hastalardan anlamlı şekilde daha yüksekti. GDC testinin Frey Sendromu tanısında duyarlılığı %100, özgüllüğü %92 olarak hesaplandı.Çalışmamızda SKM kas flebi uygulamasının Frey Sendromu'nuönlemede etkin bir yöntem olduğu, GDC testinin kantitatif sonuç verebilen, duyarlılığı ve özgüllüğü yüksek bir test olduğu gösterilmiştir.
Frey's Syndrome is one of the most encountered complications after superficial parotidectomy. There are numerous surgical methods identified in order to prevent development of Frey's Syndrome. Sternocleidomastoid (SCM) muscle flap is frequently used because of its simplicity, reliability and effectiveness. In our study SCM muscle flap was placed on the area of the extracted parotid tissue. Minor's starch-iodine test is generally used for the diagnosis of Frey's Syndrome as an objective method. The fact that Minor's starch-iodine has a high positive rate among asymptomatic patients the use of a more specific test suitable. Therefore, galvanic skin responses (GSR) test was used in our study. The aim of the present study was to explore the effect on Frey's Syndrome of the use of SCM muscle flap and the reliability of the GSR measurements among the patients who underwent superficial parotidectomy.Twenty-two patients with flap and 21 patients without flap, both of whom underwent superficial parotidectomy due to benign diseases, were evaluated in our study. GSR's were measured on the area appropriate for preoperative right and left parotid region of the patients. Again, in the 6th month of the postoperative period GSRs of the both sides were measured. The side not operated was accepted as control group.There was not any significant difference between the two groups in terms of age and sex. Four patients (9.3%) had symptoms of Frey's syndrome. All of the patients belonged to the group without flap. The ratio of Frey's syndrome among the patients without flap were estimated as 19%. There was no difference between postoperative GSR measurements of the operated region and intact region among the patients with flap. On the other hand, there were higher values of postoperative GSR measurements of the operated region compared to the intact region among the patients without flap. GSR values of the patients with Frey's syndrome were significantly higher than others. It was found out that sensitivity of GSR test in the diagnosis of Frey's syndrome was 100% and specificity was 92%.It was demonstrated in our study that the use of SCM muscle flap was an effective method in preventing Frey's syndrome and GSR test was a test that provided quantitative results, had a high sensitivity and specificity.
Frey's Syndrome is one of the most encountered complications after superficial parotidectomy. There are numerous surgical methods identified in order to prevent development of Frey's Syndrome. Sternocleidomastoid (SCM) muscle flap is frequently used because of its simplicity, reliability and effectiveness. In our study SCM muscle flap was placed on the area of the extracted parotid tissue. Minor's starch-iodine test is generally used for the diagnosis of Frey's Syndrome as an objective method. The fact that Minor's starch-iodine has a high positive rate among asymptomatic patients the use of a more specific test suitable. Therefore, galvanic skin responses (GSR) test was used in our study. The aim of the present study was to explore the effect on Frey's Syndrome of the use of SCM muscle flap and the reliability of the GSR measurements among the patients who underwent superficial parotidectomy.Twenty-two patients with flap and 21 patients without flap, both of whom underwent superficial parotidectomy due to benign diseases, were evaluated in our study. GSR's were measured on the area appropriate for preoperative right and left parotid region of the patients. Again, in the 6th month of the postoperative period GSRs of the both sides were measured. The side not operated was accepted as control group.There was not any significant difference between the two groups in terms of age and sex. Four patients (9.3%) had symptoms of Frey's syndrome. All of the patients belonged to the group without flap. The ratio of Frey's syndrome among the patients without flap were estimated as 19%. There was no difference between postoperative GSR measurements of the operated region and intact region among the patients with flap. On the other hand, there were higher values of postoperative GSR measurements of the operated region compared to the intact region among the patients without flap. GSR values of the patients with Frey's syndrome were significantly higher than others. It was found out that sensitivity of GSR test in the diagnosis of Frey's syndrome was 100% and specificity was 92%.It was demonstrated in our study that the use of SCM muscle flap was an effective method in preventing Frey's syndrome and GSR test was a test that provided quantitative results, had a high sensitivity and specificity.
Description
Keywords
Süperfisiyal parotidektomi, Frey sendromu, Galvanik deri cevapları, Superficial parotidectomy, Frey’s syndrome, Galvanic skin responses
Citation
Demirci, U. (2011). Süperfisiyal parotidektomi yapılan hastalarda sternokleidomastoid kas flebinin frey sendromu üzerindeki etkisinin galvanik deri cevapları ile değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.