{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:02:48Z","timestamp":1791525768469,"version":"4.3.4"},"reference-count":87,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T00:00:00Z","timestamp":1611705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec><jats:title>Objective\/Hypothesis<\/jats:title><jats:p>To define the best surgical technique able to reduce Frey syndrome (FS) incidence after parotidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Systematic review and network meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An arm\u2010based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were the incidence of subjective (clinical) and objective (positive starch\u2010iodine test result) FS, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 3830 patients with a median age of 50.35\u2009years (n\u00a0=\u00a02323; IQR 44.25\u201354.18) were included for six interventions [temporoparietal fascia (TPFF), free fat graft (FFG), acellular dermal matrix (ADM), sternocleidomastoid muscle (SCM) flap, and superficial musculoaponeurotic system (SMAS) flap]. If compared to no treatment, the greatest reduction of subjective (clinical) FS incidence was measured for the TPFF (OR: 0.07, CI: 0.004\u20130.57), the ADM (OR: 0.09, CI: 0.02\u20130.35), and the FFG (OR: 0.11, CI: 0.03\u20130.42) techniques. However, a significant difference was measured also for the SCM flap (OR: 0.38, CI: 0.18\u20130.73) and for the SMAS flap (OR: 0.42, CI: 0.19\u20130.97). All treatments showed a significant reduction of the objective FS incidence if compared to no treatment (FFG, OR: 0.06, CI: 0.002\u20130.62; TPFF, OR: 0.07, CI: 0.01\u20130.33; ADM, OR: 0.11, CI: 0.03\u20130.44; SMAS, OR: 0.36, CI: 0.17\u20130.71; SCM, OR: 0.40, CI: 0.19\u20130.74).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TPFF, ADM, and FFG seem to be the best treatment strategies to prevent FS after parotidectomy. Further randomized controlled trials comparing these techniques should be conducted to define specific indications. <jats:italic>Laryngoscope<\/jats:italic>, 131:1761\u20131768, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29414","type":"journal-article","created":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T13:22:47Z","timestamp":1611753767000},"page":"1761-1768","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Different Surgical Strategies in the Prevention of Frey Syndrome: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0738-8223","authenticated-orcid":false,"given":"Armando","family":"De Virgilio","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Via Rita Levi Montalcini 4 Pieve Emanuele \u2013 Milan Italy"},{"name":"Otorhinolaryngology Unit IRCCS Humanitas Research 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