Süperfisiyal parotidektomi cerrahisinde cilt flep kalınlığının Frey sendromu gelişimi ile ilişkisi
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Dosyalar
Tarih
2012
Kurum Yazarları
Durgut, Osman
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
Uludağ Üniversitesi
Özet
Frey Sendromu, parotidektomi sonrası sık görülen bir komplikasyondur. Bu sendromda, parotidektomi alanında yemek yerken rahatsız edici terleme, kızarıklık ve ısı artışı görülmektedir. Bu sendromun önlenmesi ve tedavisi için farklı medikal ve cerrahi girişimler tanımlanmıştır. Ancak bu girişimler çoğunlukla agresif cerrahi gerektirmekte ya da hasta için ağrılı ve sıkıntı verici olabilmektedir. Botulinum toksin A uygulaması, anti-kolinerjik ajanların kullanımı, sternokleidomastoid kas rotasyonu, fasya lata transplantasyonu ve dermal, dermal-yağ greftler bu tedavilere örnek verilebilir. Tüm cerrahi işlemlerde olduğu gibi süperfisiyal parotidektomide de komplikasyonların oluşmadan engellenmesi, tedavi edilmesinden daha öncelikli olarak düşünülmelidir. Bu yüzden parotidektomilerde uygulanan cerrahi tekniklerin Frey Sendromu gelişimi ile olan ilişkisini saptamak önemlidir.Çalışmamızda süperfisiyal parotidektomi yapılan hastalarda, kaldırılan cilt flep kalınlığı ile Frey Sendromu gelişimi arasındaki ilişki ortaya koymak amaçlanmıştır. Süperfisiyal parotidektomi uygulanan toplam 30 hastanın cilt flepleri randomize olarak yarısında subkutan diğer yarısında da sub-Süperfisiyal Muskuloaponörotik Sistem (sub-SMAS) kaldırıldı. Her iki grupta da intraoperatif olarak cilt flebinin kalınlığı önceden belirlenmiş farklı noktalardan mikrometre ile ölçüldü. Hastalar postoperatif 6. ayda değerlendirildi. Hastalara anket şeklinde semptomatik sorgulama yapıldıktan sonra sialogog (tükürük salgısını arttırıcı) ajan verilerek Minor'ün nişasta-iyot testi uygulandı.Analiz sonucunda 2 hastada (%6,7) subjektif Frey Sendromu saptandı. Bu iki hasta cilt flebi subkutan kaldırılan gruptaydı. Minor'ün nişasta-iyot testiyle yapılan objektif değerlendirme sonucunda ise 25 (%83) hastada Frey Sendromu saptandı. Sub-SMAS cilt flebi grubunda subjektif Frey Sendromu bulunmazken, objektif Frey Sendromu %80 oranında bulundu. Subkutanöz flep grubunda subjektif Frey Sendromu %13, objektif Frey Sendromu %87 oranında bulundu. Frey Sendromu gelişim oranları bakımından subkutanöz ve sub-SMAS gruplar arasında istatistiksel fark tespit edilmedi (p>0,05). Belirlenen noktalardaki cilt flep kalınlığı ile Minor'ün nişasta-iyot testinde gözlenen renk değişikliği alanı arasında da istatistiksel ilişki saptanmadı (p>0,05).Çalışmamızda yaş, cinsiyet, tümör büyüklüğü ve subkutan veya sub-SMAS eleve edilen cilt flebi kalınlığının Frey Sendromu gelişiminde herhangi bir etkisinin olmadığı sonucuna varıldı.
Frey's syndrome is a frequent complication of parotid gland surgery. In the Frey's syndrome, disturbing sweating, redness and warmth are encountered in the area of parotidectomy. Different medical and surgical interventions are defined in order to prevent or treat this syndrome. Some of these interventions can be too agressive and painful for the patient. Injection of botulinum toxin type A, the use of anticholinergic agents, sternocleidomastoid muscle rotation, fascia lata tranplantation and dermal, dermo-fat grafts are some of the treatment modalities. Like in every surgery, in superficial parotidectomy it is more important to prevent the complication rather than to treat it. Thus it is important to establish the relation between surgical techniques of parotidectomy and Frey's syndrome.In this study our objective is to determine the effect of thickness of skin the flaps on occurence of Frey's syndrome. Thirty patients were prospectively evaluated for Frey's syndrome after superficial parotidectomy. 15 patients underwent subcutaneous and 15 patients sub-Superficial Musculoaponeurotic System (sub-SMAS) flap elevation. İn both groups, skin flap thickness was measured with micrometer at previously determined sites intraoperatively. Patients were examined six months post-operatively. After patients were questioned for symptoms to fill a survey, Minor?s starch-iodine test was performed by use of sialogogue agent (an agent which increases saliva secretion).In our study 2 patients (6.7%) had subjective Frey's syndrome. Both patients were in the group of subcutaneous flap elevation. After the objective evaluation with Minors starch-iodine test, we determined that 25 patients (83%) had Frey's syndrome. In SMAS flap group, none of the patients had subjective Frey's syndrome, 80% of the patients had objective Frey's syndrome. In subcutaneous flap group, the incidence of subjective Frey's syndrome was 13%, objective Frey's syndrome was 87%. There was no statistically significant relationship between flap elevation method and Frey's syndrome (p>0,05). There was no statistically significant relation between skin flap thickness in previously determined skin sites and the color change on these sites after Minors starch-iodine test.In this study, we conclude that age, sex, tumor size and sub-SMAS or subcutaneous elevation of the flap regarding skin thickness are not associated with the development of Frey's syndrome.
Frey's syndrome is a frequent complication of parotid gland surgery. In the Frey's syndrome, disturbing sweating, redness and warmth are encountered in the area of parotidectomy. Different medical and surgical interventions are defined in order to prevent or treat this syndrome. Some of these interventions can be too agressive and painful for the patient. Injection of botulinum toxin type A, the use of anticholinergic agents, sternocleidomastoid muscle rotation, fascia lata tranplantation and dermal, dermo-fat grafts are some of the treatment modalities. Like in every surgery, in superficial parotidectomy it is more important to prevent the complication rather than to treat it. Thus it is important to establish the relation between surgical techniques of parotidectomy and Frey's syndrome.In this study our objective is to determine the effect of thickness of skin the flaps on occurence of Frey's syndrome. Thirty patients were prospectively evaluated for Frey's syndrome after superficial parotidectomy. 15 patients underwent subcutaneous and 15 patients sub-Superficial Musculoaponeurotic System (sub-SMAS) flap elevation. İn both groups, skin flap thickness was measured with micrometer at previously determined sites intraoperatively. Patients were examined six months post-operatively. After patients were questioned for symptoms to fill a survey, Minor?s starch-iodine test was performed by use of sialogogue agent (an agent which increases saliva secretion).In our study 2 patients (6.7%) had subjective Frey's syndrome. Both patients were in the group of subcutaneous flap elevation. After the objective evaluation with Minors starch-iodine test, we determined that 25 patients (83%) had Frey's syndrome. In SMAS flap group, none of the patients had subjective Frey's syndrome, 80% of the patients had objective Frey's syndrome. In subcutaneous flap group, the incidence of subjective Frey's syndrome was 13%, objective Frey's syndrome was 87%. There was no statistically significant relationship between flap elevation method and Frey's syndrome (p>0,05). There was no statistically significant relation between skin flap thickness in previously determined skin sites and the color change on these sites after Minors starch-iodine test.In this study, we conclude that age, sex, tumor size and sub-SMAS or subcutaneous elevation of the flap regarding skin thickness are not associated with the development of Frey's syndrome.
Açıklama
Anahtar kelimeler
Frey Sendromu, Cilt flebi, Minor’ün nişasta-iyot testi, Süperfisiyal parotidektomi, Frey’s syndrome, Skin flap, Minor's starch-iodine test, Superficial parotidectomy
Alıntı
Durgut, O. (2012). Süperfisiyal parotidektomi cerrahisinde cilt flep kalınlığının Frey sendromu gelişimi ile ilişkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.