Different Surgical Strategies in the Prevention of Frey Syndrome: A Systematic Review and Meta‐analysis.

Objective/Hypothesis: To define the best surgical technique able to reduce Frey syndrome (FS) incidence after parotidectomy. Study Design: Systematic review and network meta‐analysis. Methods: An arm‐based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were the incidence of subjective (clinical) and objective (positive starch‐iodine test result) FS, respectively. Results: A total of 3830 patients with a median age of 50.35 years (n = 2323; IQR 44.25–54.18) were included for six interventions [temporoparietal fascia (TPFF), free fat graft (FFG), acellular dermal matrix (ADM), sternocleidomastoid muscle (SCM) flap, and superficial musculoaponeurotic system (SMAS) flap]. If compared to no treatment, the greatest reduction of subjective (clinical) FS incidence was measured for the TPFF (OR: 0.07, CI: 0.004–0.57), the ADM (OR: 0.09, CI: 0.02–0.35), and the FFG (OR: 0.11, CI: 0.03–0.42) techniques. However, a significant difference was measured also for the SCM flap (OR: 0.38, CI: 0.18–0.73) and for the SMAS flap (OR: 0.42, CI: 0.19–0.97). All treatments showed a significant reduction of the objective FS incidence if compared to no treatment (FFG, OR: 0.06, CI: 0.002–0.62; TPFF, OR: 0.07, CI: 0.01–0.33; ADM, OR: 0.11, CI: 0.03–0.44; SMAS, OR: 0.36, CI: 0.17–0.71; SCM, OR: 0.40, CI: 0.19–0.74). Conclusions: TPFF, ADM, and FFG seem to be the best treatment strategies to prevent FS after parotidectomy. Further randomized controlled trials comparing these techniques should be conducted to define specific indications. Laryngoscope, 131:1761–1768, 2021 [ABSTRACT FROM AUTHOR]