Effectiveness of Barrier Techniques in Preventing Frey's Syndrome Following Parotidectomy: A Systematic Review

Background: Frey’s syndrome (FS), also referred to as gustatory sweating or auriculotemporal syndrome, is a common postoperative complication following parotidectomy resulting from aberrant parasympathetic nerve regeneration. Numerous reconstructive and barrier techniques have been proposed to minimize its occurrence. Objective: To systematically evaluate the effectiveness of various interpositional barrier techniques in reducing the incidence of Frey’s syndrome following parotid gland surgery. Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Embase, Scopus, and Cochrane Library were searched for studies evaluating barrier techniques used after parotidectomy. Randomized controlled trials, prospective comparative studies, and retrospective studies reporting postoperative Frey’s syndrome outcomes were included. Extracted data included study design, sample size, diagnostic modality, follow-up duration, and type of reconstructive barrier employed. Results: Barrier techniques including temporoparietal fascia (TPF) flap, sternocleidomastoid (SCM) muscle flap, superficial musculoaponeurotic system (SMAS) flap, acellular dermal matrix (ADM), and free fat grafts demonstrated a substantial reduction in postoperative Frey’s syndrome incidence compared with conventional closure. Among the evaluated techniques, TPF flap and ADM showed the most consistent long-term efficacy. Considerable heterogeneity was observed regarding diagnostic criteria and duration of follow-up. Conclusion: Interpositional barrier techniques significantly reduce the incidence of Frey’s syndrome following parotidectomy. Fascia-based flaps and ADM appear to provide superior protection and improved cosmetic outcomes. Further multicenter randomized clinical trials with standardized diagnostic criteria and long-term follow-up are necessary to establish the optimal reconstructive strategy.