Innovative Technique to Reduce Incidence of Frey's Syndrome after Parotid Surgery

2011 ◽  
Vol 77 (3) ◽  
pp. 351-354 ◽  
Author(s):  
Neeraj Singh ◽  
Monica Kohli ◽  
Harjeet Kohli
Keyword(s):  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Control Group ◽  
Regenerated Cellulose ◽  
P Value ◽  
Frey’S Syndrome ◽  
Exact Test ◽  
Parotid Surgery ◽  
Frey's Syndrome ◽  
Aberrant Regeneration

Frey's syndrome was first described by Lucia Frey, a Polish neurologist in 1923. It is well accepted that it involves injury to the branches of the auriculotemporal nerve with subsequent aberrant regeneration. Due to this abnormal communication, the skin glands and vessels are always stimulated at the same time as eating and mastication, which results in symptoms such as flushing and sweating. The incidence of Frey's syndrome in the literature has been variously described from 6 to 96 per cent. We analyzed the chart of 18 patients who had parotidectomy from March 2002 to December 2009. All procedures were performed by a single surgeon at the same facility. A total of 16 superficial and three total parotidectomies were done; one patient had bilateral parotidectomy. Oxidized regenerated cellulose (Interceed) was used after 10 surgeries (study group) and no adjuvant was used after nine surgeries (control group). All of the surgeries were done using similar technique. All the patients were followed-up with for a period of about 6 months postoperatively. The absolute risk reduction associated with the placement of an Interceed was 11 per cent. The small number of cases (n = 19) and an empty cell limits statistical analysis (a Fisher's exact test revealed a P value of 0.44). Clearly the low number of procedures restricted the power to test these differences. The development of Frey's syndrome is a very disabling but under-reported complication. The placement of a temporary barrier like Interceed may help in the prevention of Frey's syndrome without increasing any complications.

Prevention of Frey’s Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 “Formal” Parotidectomies for Benign Pathologies

2021 ◽  
pp. 000348942199018
Author(s):  
Kostas Vahtsevanos ◽  
Angelos Chatziavramidis ◽  
Ioannis (Yiannis) Papadiochos ◽  
Georgios Koloutsos ◽  
Anastasios Stefanidis ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Frey’S Syndrome ◽  
Randomized Controlled Studies ◽  
Parotid Surgery ◽  
Porcine Dermal Collagen ◽  
Frey's Syndrome ◽  
Dermal Collagen ◽  
Group A ◽  
Group B ◽  
Collagen Graft

Background: Frey’s syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. Methods: We conducted a 20-year retrospective study including the patients who had undergone “formal” (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. Results: We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey’s syndrome was found after the use of dermal collagen interpositional barrier ( P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor’s test was positive at an incidence of 59.09% in Group A and 21.87% in Group B ( P = .004, 95% CI). Severe Frey’s syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B ( P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey’s syndrome in the compared groups, Conclusion: Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey’s syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

Frey's syndrome: treatment with botulinum toxin

1997 ◽  
Vol 111 (9) ◽  
pp. 839-844 ◽  
Author(s):  
A. Bjerkhoel ◽  
O. Trobbe
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Surgical Techniques ◽  
Frey’S Syndrome ◽  
Need For Treatment ◽  
Gustatory Sweating ◽  
Parotid Surgery ◽  
Frey's Syndrome ◽  
Before And After ◽  
Set Up

AbstractFrey's syndrome, i.e. gustatory sweating on the cheek, is a fairly common embarrassment after parotid gland surgery. New surgical techniques have been proposed to avoid this complication, but are not widely in use. Hence, there is need for treatment of Frey's syndrome. All surgical and topical treatments have drawbacks. This study was set up in order to evaluate a recently described treatment. One hundred and two patients were interviewed after parotidectomy. Thirty-one of them had noticed gustatory sweating and 15 patients underwent Minor's starch iodine test before, and after, treatment with intracutaneous injections of botulinum toxin A (Botox®, Allergan Inc., USA). Thirteen of the patients did not experience any gustatory sweating at follow-up (one to 13 months). Minor's starch test showed total disappearance of gustatory sweating in 12 of the 15 treated patients. The only side effect was a discreet, transitory affection of the orbicularis oris muscle in one patient. As this treatment is minimally invasive it could be an attractive treatment for Frey's syndrome if the effect is maintained. Complaints of local hypoaesthesia and pain were also common after parotid surgery.

scholarly journals A comparative study between endoscope assisted transtympanic pop-in tympanoplasty and permeatal underlay tympanoplasty

2018 ◽  
Vol 6 (2) ◽  
pp. 65-68 ◽  
Author(s):  
Meera Bista ◽  
Toran KC
Keyword(s):  
Success Rate ◽  
College Teaching ◽  
Control Group ◽  
P Value ◽  
Fisher Exact Test ◽  
Taste Sensation ◽  
Exact Test ◽  
Medical College ◽  
Prospective Longitudinal ◽  
Made In

Background: Otoscopic procedure like tympanoplasty is one of the magic wands that an ear nose throat surgeon possesses to alleviate the suffering of a hearing impaired patient. Endoscopic trans-tympanic pop in technique is an alternative method where tympanic fascial graft is placed medial to tympanic membrane remnant through the perforation without elevation of tympanomeatal flap and angled endoscope is used to assess the ossicular chain.Objective: The study was done to compare the results of endoscope assisted trans-tympanic pop-in tympanoplasty with permeatal underlay tympanoplasty.Methods: The study is a prospective, longitudinal and experimental study conducted in Kathmandu Medical College Teaching Hospital from January 2016 to June 2016. A total of sixty-two patients, thirty-one in study and thirty-one in control group were present. The comparison was made in terms of success rate, decrease in taste sensation and time taken for the procedure. Data analysis was done by SPSS version 20. Categorical data were tested by Fisher Exact test and p-value of <0.005 was considered statistically significant.Result: Among 62 patients, 55 had successful graft uptake (88.7% success rate). Hearing improvement was seen in 51 patients (88.25%). Regarding taste sensation 5 out of 62 had decrease in taste sensation after surgery (8%). Time taken was approximately 30 to 45 minutes (mean =44.1min) in endoscopic transtympanic pop-in type and 60 to 90 minutes (mean =73.8 min) in permeatal underlay type.Conclusion: We can conclude that endoscopic trans-tympanic pop-in tympanoplasty gives similar hearing and graft uptake result but with less time and greater ease as compared to permeatal underlay technique.

scholarly journals Effect of Dates Consumption On Bleeding, Duration, And Types of Labor

2019 ◽  
Vol 4 (1) ◽  
pp. 85
Author(s):  
Kuswati Kuswati ◽  
Rohmi Handayani
Keyword(s):  
Treatment Group ◽  
Pregnant Women ◽  
Design Research ◽  
Sampling Technique ◽  
The Body ◽  
Control Group ◽  
P Value ◽  
Fisher Exact Test ◽  
Control Group Design ◽  
Exact Test

Dates are a good source of nutrition for the body if consumed regularly both in the form of dried fruit, wet, as well as in the form of palm juice extracts, especially for pregnant and maternal mothers. Pregnant women who are going to give birth are in desperate need of drinks and foods that are rich in sugar, this is because of the many contractions of the uterine muscles when it comes to removing the baby, especially if it takes a long time. Dates contain potuchin hormone which functions to bind the uterus and muscles of the uterus so that it can help reduce postpartum bleeding. Besides, there is the hormone oxytocin which can help stimulate contractions in the muscles of the uterus so as to facilitate labor. The purpose of this study was to determine the effect of consumption of dates on bleeding, length of labor and type of labor. This type of research is a Pre experiment with a post-test Only Control Group Design research design. The population in this study were all pregnant women in the working area of South Klaten Public Health Center with estimated deliveries from July to September 2018. While the sample size was 60 samples consisting of 30 treatment group respondents and 30 control group respondents. The sampling technique used in this study was Quota sampling. Data analysis using Fisher Exact test and Mann-Whitney U test with p-value considered significant is p = 0.05. The results of the study of bleeding showed that there were no significant differences in the estimation of blood loss and during labor and type of delivery between the treatment group and the control group (p-value = 0.5). The results of the study about the length of labor showed that there was an effect of date consumption on the length of labor, with a value of p = 0,000

scholarly journals Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients

2020 ◽  
Vol 133 (1) ◽  
pp. 53-63
Author(s):  
Young-Eun Jang ◽  
Sang-Hwan Ji ◽  
Eun-Hee Kim ◽  
Ji-Hyun Lee ◽  
Hee-Soo Kim ◽  
...  
Keyword(s):  
Success Rate ◽  
Radial Artery ◽  
Normal Saline ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Control Group ◽  
Radial Artery Cannulation ◽  
Artery Cannulation

Background Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation. Methods This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 μg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm. Results A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, –25.2%; 95% CI, –39.6 to –10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P &lt; 0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%). Conclusions Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Frey's syndrome after parotid surgery

1976 ◽  
Vol 132 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Angus B. Gordon ◽  
R.V. Fiddlan
Keyword(s):  
Frey’S Syndrome ◽  
Parotid Surgery ◽  
Frey's Syndrome

How can Frey's syndrome be prevented or treated following parotid surgery?

2013 ◽  
Vol 123 (7) ◽  
pp. 1573-1574 ◽  
Author(s):  
Robert L. Witt ◽  
Edmund A. Pribitkin
Keyword(s):  
Frey’S Syndrome ◽  
Parotid Surgery ◽  
Frey's Syndrome

scholarly journals The Method and Results of a Treatment Targeting SARS-CoV-2-Activated Inflammasomes

2021 ◽  
Author(s):  
Badar Kanwar ◽  
Asif Khattak ◽  
Chul Joong Lee ◽  
Jenny Balentine ◽  
R. E. Kast ◽  
...  
Keyword(s):  
Case Series ◽  
Cross Sectional Study ◽  
Control Group ◽  
P Value ◽  
Test Statistic ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Pyrin Domain ◽  
Significant Difference

Abstract Background Clinicians in critical care medicine considered dapsone administration to treat SARS-CoV-2 inflammasome. Dapsone is useful in the molecular regulation of Nod-like receptor family pyrin domain-containing 3 (NLRP3). Objective To study the targeting of NLRP3 itself or up-/downstream factors of the NLRP3 inflammasome by dapsone must be responsible for its observed preventive effects, functioning as a competitor. Methods This is case series with or without intervention; a cross-sectional study. We set out to use objective criteria of improvement, such as A. a reduction in the FIO2 requirement and B. a decrease in the progression of hypoxia. We treated the patients with standard COVID-19 ARDS treatment with dapsone 100 mg to target NLRP3 inflammasomes. Results The 22 cases were treated with standard COVID-19 therapy with dapsone (trial group), and the 22 cases were the control group. The comparison was made assuming that only decreased FIO2 was influential in the trial and control groups, which applied to only the ARDS onset stage. The chi-square statistic is 5.1836. The p-value is .02280. Fisher’s exact test statistic value is 0.0433. (The result is significant at p < .05) Furthermore, the ARDS-onset mortality rates were 0% (with dapsone) and 40% (without dapsone). Conclusion There was a significant difference in dapsone treatment results in the ARDS-onset group. We confirmed that dapsone clinically treated the onset of ARDS by targeting SARS-CoV-2-activated inflammasomes. Like chemically reacting substances, inflammasome and dapsone are competing, proving that it is only effective in treating early ARDS.

Frey's syndrome and parotid surgery

1998 ◽  
Vol 23 (4) ◽  
pp. 291-301 ◽  
Author(s):  
S. Sood ◽  
M. S. Quraishi ◽  
P. J. Bradley
Keyword(s):  
Frey’S Syndrome ◽  
Parotid Surgery ◽  
Frey's Syndrome

scholarly journals Error-Based Teaching Approach Decreases Vessel Anastomosis Errors: A Pilot Study

2019 ◽  
Vol 04 (02) ◽  
pp. e73-e76
Author(s):  
Eric de Haas ◽  
Jill P. Stone ◽  
William de Haas ◽  
Christiaan H. Schrag
Keyword(s):  
Traditional Education ◽  
Control Group ◽  
P Value ◽  
Live Animal ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Surgical Residents ◽  
Synthetic Materials ◽  
Fisher’S Exact Test ◽  
To Receive

Abstract Background Microsurgical anastomosis of vessels is a challenging skill that surgical residents should practice on models before attempting in the clinical setting. These skills are often taught using synthetic materials, animal tissue, or live animal models. With increasing constraints on surgical resident's time, it is important to maximize efficiency of microsurgical training. The purpose of this study is to determine if teaching surgical residents about common vessel anastomosis errors decreases the total number of suture errors during a 4-day training course. Methods Plastic surgery residents (R1–R3) were randomly assigned to receive additional teaching focused on either common microsurgical errors or traditional microsurgical manuals. The residents then performed anastomosis on rat femoral arteries in which the total number of sutures and errors were recorded by staff microsurgeons who were blinded to the intervention. Results Residents who received teaching on common microsurgical errors performed a total of 73 sutures of which 12 were errors. The control group who studied using traditional microsurgical manuals performed a total of 125 sutures of which 38 were errors. There was a statistically significant decrease in the total number of suture errors (Fisher's exact test; p-value = 0.04) and in the number of partial depth bite errors (Fisher's exact test p-value = 0.03). Conclusion Teaching surgical residents about common vessel anastomosis errors decreased the total number of errors when compared with traditional education methods using microsurgery manuals. Partial depth bite errors were also decreased through error-based teaching.

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