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腉腎腌腄 臝腩腪腥腫腨腰腼臭膋膵膺 Vol. 37, pp. 141146, 2009 Minimal incision 腀腁腂腄腃腈腅腊腉腆腇 腌腃 腓腄 腛腎 腗腒 1 腙腉 腑腃 腏腉 2 腅腆 腓腘 腚腈 3 腆腏 腎腊腜 3 腕腆 腍腝 腖腌 腔腋 4 腋腃 腐腆 腃腐腗 4 : 21 1 13 膿腹臣臅腗臭腐腑臙臅腓腁腡腆腎腗膾腘臄臌腆膞臩腓腁腠臗膙腤腸自腌 腤膍臦腖臃腠臏腅腕腉腢腙腕腟腕腂腌腅腌膿膁臇腯腗臅腖臬腌膿臤腅腟腹膌膉 腖膹腡臱腂腇腏臠膅腘腃腥腅腯腆膧腈腕腠臕臉腆臭腇腈腕腡膬膃腾膿膁臇腯腗膿 腹臣臅腖臬腌臕臉腤膰臐膠腖腃腡腏腛膿臤腞腠膿膡腖膹腡 U 膻臠膅腖腒膿腹臣 腐腑臠臏臌腤膸膩腌腏腋腟腖臌膡膪臒腓腁腡腗膏腵膘腝 Frey 臒膢膗腠腜腗腏 Superficial Musculo-Aponeurotic System SMASFlap 腤膳臚腌膥腕臌膡膙腽腤臻腏 腗腓臂膎腗膜臵膨膴腔腔腜腖膫腍腡腅腀腍腃 膿腹臣臅Minimal incisionSMAS flap 膿腹臣臅腗臭腐腑臙臅腓腁腠腎腗膾腘臄臌腆膞臩腓腁腡膿腹臣腘膂膋臵腖膐臗膙 腆腎腗臼腤臨膩腌腒腂腡腏腛臄臌腖腁腏腐腒腘 臗膙腗臃腠腭腂腆臊腓腁腡腑腚腠膙腤腸自腌臅腤膍臦腖臃腠臏腅腕腉腢腙腕腟腕 腊腢腚腓膆臋臌腓腘膯腆臫腂腔腋腢膿腹臣 臠臏臌腆腜腐腔腜膇臁腅腑腮臦腕膾腧腙腔腌腒 膧腈膩腣腢腒腇腏 13腊腢腖臬腌膖1 腖膿腹臣臧臔腤腑腉腒腐腑臵腖臠臏腍腡膿腹臣腐腑 臠臏臌 4腆膸膩腋腢膿腹臣臢臠臏臌腔膊腌腒 腜膯腄腦腘臺致臷腓腁腠臌膡腗 Frey 臒膢膗腗腆至腹腌腏腔腗膫腆腕腋腢腒腂腡 57腌腅 膿膁臇腯腗臅腖臬腌膿臤腅腟腹膌膉腖膹 腡臱腂腇腏臠膅腘腃腥腅腯腆膧腈腕腠臕臉腆臭 腇腈腕腡Pages 8腟腘腊腗臕臉腤膰臐膠腖腄腋腃腡腏腛膿 膁臇腯腗膿腹臣臅腖臬腌膿臤腞腠膿膡腖膹 minimal incision 腖腒膿腹臣腐腑臠臏臌腤膸膩腌 膥腕膙腽腤臻腏腔膫腌腏膬膃腾腊腗 minimal incision face-lift 膼腖膳臚腋腢腡臙膕Superficial Musculo-Aponeurotic System: SMASflap 910腤膶腍腡腊腔腖腞腐腒臌膡腗膚膟腔膔腖腗膏腵Frey 臒膢膗腗腠腜 腆腻腓腁腐腏腗腓臂膎腗膜臵膨膴腤腺腃膫腍 : 65 臎臙: 腴膿腹腁腋腏: 3 臤腅腟腴膿腹腤臀膈腌腏腆膄臥腌腕腂腏腛膖腰臆臘腴膿腹臣臅腆膒腣 腢臜膮腺腧腟臵腖腒臸腼臓膁臆臘腔腕腡1 臝腩腪腥腫腨腰腼臭膋 臑膝臈腦腫腧腀 2 腬膓膿腲膤腼 3 臝腩腪腥腫腨腰腼臭膋腶膷臞腐腌腲膤腼 4 臝腩腪腥腫腨腰腼臭膋 腲膤腼 141 65

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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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