Superficial musculoaponeurotic system flap in partial parotidectomy and clinical and subclinical Frey's syndrome. Cosmesis and quality of life.

BACKGROUND: Frey's syndrome (FS), facial depression, and noticeable scar may have an impact on patient's quality of life after a parotidectomy. The superficial musculoaponeurotic system (SMAS) flap has been used to ameliorate those effects. METHODS: Forty-seven consecutive parotidectomies were analyzed; SMAS flap was performed in 26 of them. We investigated clinical FS, subclinical FS, and cosmetic satisfaction, and compared SMAS flap versus cases where this was not done. RESULTS: By performing the SMAS flap, the occurrence of clinical FS was reduced; however, there was no significant difference. Nonetheless, there was a significant difference in the perspiration intensity in favor of the group with SMAS flaps. In the cases we studied, the cosmetic satisfaction was high, even though facial contour-filling techniques were not used. CONCLUSIONS: Provided that the intensity of sweating is the main factor affecting the quality of life after surgery in patients, performing a SMAS flap renders the intervention worthwhile.

Endoscopic approaches to pituitary lesions: difficulties and challenges.

INTRODUCTION AND OBJECTIVES: The evolution of surgical approaches to the pituitary region brings benefits to the patient, but also means changes for otolaryngologists, who have to face new difficulties and complications. The objective of this paper was to present our experience in the endoscopic approach to the pituitary region, assessing the difficulties and complications encountered, and to offer possible elements for improvement. MATERIAL AND METHOD: We reviewed the first 40 cases of pituitary approaches we carried out between 2008 and 2011. Interventions were performed by a team of neurosurgeons and otolaryngologists in simultaneous collaboration. We analysed the pathology intervened, complications and difficulties. RESULTS: There were 37 patients operated on for pituitary tumours and 3 cysts; 34 cases were macroadenomas. The complications were 6 cerebrospinal fluid leaks, 3 with meningitis, 6 diabetes insipidus, 1 pulmonary embolism, 1 hydrocephalus and 4 mild nasal complications. CONCLUSIONS: The frequency and type of complications depend on the extent of the endoscopic approach, patient age, tumour size and suprasellar extension. The use of specific instruments, navigation and preoperative assessment of imaging tests help to minimise complications. Prudent implementation of new approaches, knowledge of techniques and complications, and the analysis of the activity allow further progress in access to skull base pathology.