Frey sendromunun tanısında kantitatif yeni bir yöntem: Galvanik deri cevapları testi
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Date
2010
Authors
Tüzemen, Gökhan
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Publisher
Uludağ Üniversitesi
Abstract
Frey Sendromu, parotis cerrahisi sonrası görülen en sık komplikasyonlardan biridir. Bu sendrom parotis cerrahisinden bir süre sonra hastanın operasyon bölgesi cildinde özellikle yemek yeme sırasında olan terleme ve kızarıklık şikayetleri ile kendini gösterir. Frey Sendromunun objektif tanısı amacıyla günümüzde en çok kullanılan test ‘‘Minor’ün nişasta iyot testi’’dir. Bu test kantitatif sonuç vermemesi nedeniyle yetersiz kalabilmektedir. Bunun dışında ortaya atılmış farklı testlerde de benzer yetersizlikler gözlenmiştir. Frey Sendromu tedavisinin güç olması nedeniyle pek çok profilaktik cerrahi yöntem uygulanmıştır. Günümüzde en sık uygulanan yöntem operasyon sahasındaki rezidü parotis dokusu üzerine sternokloidomastoid (SKM) kas flebinin çevrilmesidir. Çalışmamızda ciltteki direnç değişikliğini ölçen galvanik deri cevabıGDC (Galvanic Skin Response) yöntemiyle Minor’ün nişasta iyot testi yetersizliklerinin giderilmesi amaçlandı. Süperfisiyal parotidektomi yapılmış 30 hasta ortalama postoperatif 24,7±25,7 ay (6-109 ay)’da değerlendirildi. Hastalara anket şeklinde semptomatik sorgulama yapıldıktan sonra sialogog (tükürük salgısının arttırıcı) ajan verilererek Minor’ün nişasta iyot testi ve GDC testi uygulandı. Analiz sonucunda GDC testinin tanısal değerliliğinde sensitivite %100 ve spesifite %55 olarak bulundu. Elde edilen sayısal değerlerle Frey Sendromunun şiddeti sınıflandırıldı. Ayrıca çalışmadaki 8 hastaya süperfisiyal parotidektomi sırasında süperior tabanlı SKM kas flebi uygulandı. Flep uygulanan hastalarla uygulanmayan hastalar arasında semptomatik sorgulama ve objektif testlerle değerlendirme yapıldı. Her iki grup arasında Frey Sendromu gelişimi açısından anlamlı farklılık saptanmadı. Süperfisiyal parotidektomi yapılan 30 olgunun Frey Sendromu açısından değerlendirildiği bu çalışmada; 1- Frey Sendromu tanısında kullanılan Minor’ün nişasta iyot testi, semptomatik değerlendirme ve GDC testi karşılaştırıldı. GDC testinin tanısal değerliliğinin %100 sensitif olduğu gösterildi. 2- GDC testi ile elde edilen kantitatif değerlerle Frey Sendromunun şiddet seviyelerinin belirlenmesi sağlandı. 3- Çalışmada, 8 SKM kas flebi uygulanan hastanın değerlendirilmesinde, flep uygulanmayanlara göre Frey Sendromunun önlenmesi açısından bu grupta istatistiksel farklılık saptanmadı. 4- Yaş, cinsiyet ve tümör büyüklüğünün Frey Sendromu gelişiminde herhangi bir etkisinin olmadığı sonucuna varıldı.
Frey’s Syndrome is one of the most seen complications after parotid surgery. This syndrome is evident with redness and sweating complaints on the region after some time from the parotid surgery especially upon eating. Today, the most frequently used method to diagnose Frey’s Syndrome is Minor's starch iodine test. This test may be insufficient due to lack of quantitative results. On the other hand, it was observed that other tests available have some defects, too. Numerous prophylactic surgical methods have been used because Frey’s Syndrome is difficult to be treated. The most widely used method is to turn down the sternocleidomastoid (SCM) muscle flap on the residual parotis tissue on the operational region. The aim of the research was to correct the defects of the Minor's starch iodine test through the method of Galvanic Skin Response (GSR) that measures the skin resistance change. A total of 30 patients who had superficial parotidectomy were examined during an average postoperative period of 24,7±25,7 months (6-109 months). After symptomatic questions were asked with questionnaires, patients were tested with Minor's starch iodine test and GSR test giving sialogogue agent (an agent that stimulates the flow of saliva). Following the analysis, we found the sensitivity of GSR as 100% and its specifity as 55% in predictive value. Severity of Frey’s Syndrome was classified with the numeric values obtained. Also, 8 patients had SCM muscle flap with superior hinge SCM muscle flap during superficial parotidectomy. An assessment was performed with symptomatic questions and objective tests for the patients who had flap and who did not. We could not find any significant difference between these two groups in terms of development of Frey’s Syndrome. It was concluded in the research where 30 cases with superficial parotidectomy were examined in terms of Frey’s Syndrome that: 1- Minor's starch iodine test used for the diagnosis of the Frey’s Syndrome, symptomatic assessment and GSR test were compared. It was proved that predictive value of GSR test was 100% sensitivity. 2- The severity levels of Frey’s Syndrome were obtained with the quantitative values from GSR test. 3- In the evaluation of 8 patients with SCM muscle flap, there was not any statistical difference between this group of 8 patients and those without flap in terms of Frey’s Syndrome prevention. 4- It was concluded that age, sex and the size of tumor did not have any effect on the development of Frey’s Syndrome.
Frey’s Syndrome is one of the most seen complications after parotid surgery. This syndrome is evident with redness and sweating complaints on the region after some time from the parotid surgery especially upon eating. Today, the most frequently used method to diagnose Frey’s Syndrome is Minor's starch iodine test. This test may be insufficient due to lack of quantitative results. On the other hand, it was observed that other tests available have some defects, too. Numerous prophylactic surgical methods have been used because Frey’s Syndrome is difficult to be treated. The most widely used method is to turn down the sternocleidomastoid (SCM) muscle flap on the residual parotis tissue on the operational region. The aim of the research was to correct the defects of the Minor's starch iodine test through the method of Galvanic Skin Response (GSR) that measures the skin resistance change. A total of 30 patients who had superficial parotidectomy were examined during an average postoperative period of 24,7±25,7 months (6-109 months). After symptomatic questions were asked with questionnaires, patients were tested with Minor's starch iodine test and GSR test giving sialogogue agent (an agent that stimulates the flow of saliva). Following the analysis, we found the sensitivity of GSR as 100% and its specifity as 55% in predictive value. Severity of Frey’s Syndrome was classified with the numeric values obtained. Also, 8 patients had SCM muscle flap with superior hinge SCM muscle flap during superficial parotidectomy. An assessment was performed with symptomatic questions and objective tests for the patients who had flap and who did not. We could not find any significant difference between these two groups in terms of development of Frey’s Syndrome. It was concluded in the research where 30 cases with superficial parotidectomy were examined in terms of Frey’s Syndrome that: 1- Minor's starch iodine test used for the diagnosis of the Frey’s Syndrome, symptomatic assessment and GSR test were compared. It was proved that predictive value of GSR test was 100% sensitivity. 2- The severity levels of Frey’s Syndrome were obtained with the quantitative values from GSR test. 3- In the evaluation of 8 patients with SCM muscle flap, there was not any statistical difference between this group of 8 patients and those without flap in terms of Frey’s Syndrome prevention. 4- It was concluded that age, sex and the size of tumor did not have any effect on the development of Frey’s Syndrome.
Description
Keywords
Frey sendromu, Galvanik deri cevabı testi, Minör’ün nişasta iyot testi, Süperfisiyal parotidektomi, Frey’s syndrome, Galvanic skin response test, Minor's starch iodine test, Superficial parotidectomy
Citation
Tüzemen, G. (2010). Frey sendromunun tanısında kantitatif yeni bir yöntem: Galvanik deri cevapları testi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.