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���� ����������Vol. 37, pp. 141�146, 2009

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Fig 1. Neck MRI

Fig 2�1. Fig 2�2.

Fig 2�3. Fig 2�4.

Fig 2�1. Pre- and retroauricular incision.Incision starts at the helix insertion. It continues inferiorly and anterior to the ear and curved.

Fig 2�2. Reflected SMAS flap and exposed parotid gland.Fig 2�3. Operation of the facial nerve branches and resection piece.Fig 2�4. Reconstruction for postparotidectomy defect with SMAS flap.

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20�40� �0����/TU1�B F���@��11�� `�_����R��B� !"�H���A��B� !"�/TU1�����F&�����!�5BS��w��/$p�� ��!�6�-C/7��F&� 6�-B��� ���-8��<����9�C���@���� �FC:<�����F&� �-� ���-� ;<-� ����-Bw�op�M��6���&C� ��9�:;B 1 ��:=:>��� ��F&9�� M�p�6�-e�#F� Mitz p13�CS¡?-%� ¢?-op]@-N�C SMAS �:<��F&M���£�� �Fig 4�� SMAS �!AB]@-� �ABS¡?-%opKp�B¤C%� ¢�AB¢?-�¥E��F&� !"��B !"$%��¦ ��F&�G� Vz !"�1cD�A�� §EK��L�F&� Rappaport p14�B� M� SMAS �FG�H�� !"��� *������ �I¨�G� +, �-��0%&M��_�� Freycde�JI����+y���� N� Pages p8�

B� SMAS �©E%&M��_���T�Vª«�%&M�C¬K�@�� ­L� !"�1��MGp�&!®���7�<=���+y��� ��B¯° ±²�� !"���A����������-.<tu(CWM�L&� ¢�_� *��F�&minimal incision��1�RE�� N���T��q³&!®��1*�7�<=%M�WM�L�� Kp�� SMAS flap �©E%&M���+, �-�¥>K´&�Fµ�¶C-.<=<&�G� �1�·�¸¹�¬KHC@&M�� SMAS�º»��+, �-��0%&�1¼�B� 1*

Fig 3. The scar 6 months after parotidectomy.

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1� Woods JE, Weiland LH and Chong GC. Pa-thology and surgery of primary tumors of the

parotid. Surg Clin North Am 1977; 56: 565�573.

2� Stevens KL and Hobsley M. The treatment ofpleomorphic adenomas by formal parotidec-

tomy. Br J Surg 1982; 69: 1�3.3� Maynard JD. Management of pleomorphicadenoma of the parotid. Br J Surg 1988; 75:

305�308.4� �&�������� %&'��'*��;��������� 1988; 5: 59�64�

5� O[Brien CJ. Current management of benignparotid tumors�the role of limited superficialparotidectomy. Head Neck 2003; 25: 946�952.

6� Iizuka K and Ishikawa K. Surgical techniquesfor benign parotid tumors: segmental resection

vs extracapsular lumpectomy. Acta Otolaryn-

gol Suppl 1998; 537: 75�81.

Fig 4. Superficial Musculo-Aponeurotic System: SMAS

Fig. 5. The broken line is minimal incision. The solid

line is face -lift incision.

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7� ����� ������� �������� � 1997; 90: 853�865.

8� Martıÿ-Page◊s C, Garcıÿa-Dıÿez E and Garcıÿa-Arana L. Minimal incision in parotidectomy.

Int J Oral Maxillofac Surg 2007; 36: 72�76.9� ������ ����� SMASectomy. PE-PARS 2006; 8: 71�76.

10� ����� !�"� ��#$� SMAS %&�'()*+,-� PEPARS 2006; 8: 91�97�

11� ./01� ���23������456789:� ;<= 1993; 5: 53�58.

12� >?@A� BC0D"� EFGH� ���IJ��K-LMNO� �� � 2006; 99: 445�448�

13� Mitz V and Peyronie M. The superficial muscu-lo-aponeurotic system �SMAS� in the parotidand cheek area. Plast Reconstr Surg 1976; 58:

80�88.14� Rappaport I and Allison GR. Superficial mus-culoaponeurotic system amelioration of pa-

rotidectomy defects. Ann Plast Surg 1985; 14:

315�323.

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Abstract

A Minimal Incision �so called U-shaped incision� in Parotidectomy�A case report�

Yoshimitsu Saito1, Daisuke Oyake2, Tomoyuki Okada3, Shigeru Kasugai3,

Masahiko Fukasawa4, and Izumi Koizuka4

Large number of cases of parotid gland tumours are benign.

For years, surgical treatment known as conservative parotidectomy which has been an e#ective and

well-established technique has been performed, basically. And, with an intact facial nerve function on the

side of the lesion � a complete removal of the tumour can be made.In order to remove tumours around the auricle a huge incision extentding from the anterior part of the

auricle to the mandibular angle is needed. In the present case, a minimal pre- and retroauricular incision,

namely a U-shaped one was performed and the superficial musculoaponeurotic system �SMAS� flap wasmade after the removal of the tumour. This flap helps to maintain facial symmetry, dissimulating the

retromandibular depression of the post-parotidectomy, and reduces the incidence of Frey’s syndrome, as

well.

We report the result obtained by conservative parotidectomy with a minimal incision using the SMAS

flap in case of a benign parotid gland tumour and compared with other case reports.

Key words

parotidectomy, minimal incision, SMAS flap

1 St Marianna University Postgraduate Medical Training Centre2 Kibougaoka ENT3 Department of Otolaryngology, St Marianna University Yokohama-City Seibu Hospital4 Department of Otolaryngology, St Marianna University School of Medicine

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