Key aspects in the reduction of probability to establish symptomatic Frey’s syndrome
Intraoperatively, the prevention of synkinesis seems to be key, not affecting the superficial sweat glands and is done by increased skin flap thickness or using local fascia or muscle flaps. Therefore used flaps can be a transposition fascia flap, a temporoparietal fascia flap [11], a sternocleidomastoid muscle flap, and a superficial musculoaponeurotic system flap. [3, 12]
Further, the use of acellular dermal matrix (ADM)[13], the injection of polyglycolic acid[14], elevation of a vascularized fat flap[15] or free fat grafts (AFG) with abdominal free fat [8]can prevent symptomatic Frey’s syndrome.[3]