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