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Frey Syndrome

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Gland-Preserving Salivary Surgery

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Abstract

Frey syndrome, also known as gustatory sweating or auriculotemporal syndrome, is an uncommon condition, but a common sequela of parotidectomy. The syndrome is characterized by sweating, skin flushing, warmth, and pain associated with eating. The generally accepted pathophysiology involves regeneration of parasympathetic nerve fibers following trauma, most commonly surgical. Injection of botulinum toxin is the most common treatment; however, a variety of surgical techniques have also shown efficacy in preventing and treating this condition.

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References

  1. Frey L. Le syndrome du nerf auriculo-temporal. Rev Neurol. 1923;2:97–104.

    Google Scholar 

  2. Jacobsen N, Hopkins C. The bullet that hit a nerve: the history of Lucja Frey and her syndrome. J Laryngol Otol. 2006;120(3):178–80.

    Article  PubMed  Google Scholar 

  3. Dulguerov P, Marchal F, Gysin C. Frey syndrome before Frey: the correct history. Laryngoscope. 1999;109(9):1471–3.

    Article  CAS  PubMed  Google Scholar 

  4. Moltrecht M, Michel O. The woman behind Frey’s syndrome: the tragic life of Lucja Frey. Laryngoscope. 2004;114(12):2205–9.

    Article  PubMed  Google Scholar 

  5. Clayman MA, Clayman SM, Seagle MB. A review of the surgical and medical treatment of Frey syndrome. Ann Plast Surg. 2006;57(5):581–4.

    Article  CAS  PubMed  Google Scholar 

  6. Baillarger M. Mémoire sur l’oblitération du canal Sténon. Gazette Médicale de Paris. 1853;23:194–7.

    Google Scholar 

  7. Singh N, Kohli M, Kohli H. Innovative technique to reduce incidence of Frey’s syndrome after parotid surgery. Am Surg. 2011;77(3):351–4.

    CAS  PubMed  Google Scholar 

  8. Gooden EA, Gullane PJ, Irish J, Katz M, Carroll C. Role of the sternocleidomastoid muscle flap preventing Frey’s syndrome and maintaining facial contour following superficial parotidectomy. J Otolaryngol. 2001;30(2):98–101.

    Article  CAS  PubMed  Google Scholar 

  9. Dulguerov P, Quinodoz D, Cosendai G, Piletta P, Marchal F, Lehmann W. Prevention of Frey syndrome during parotidectomy. Arch Otolaryngol Head Neck Surg. 1999;125(8):833–9.

    Article  CAS  PubMed  Google Scholar 

  10. Lafont M, Whyte A, Whyte J, Saura E, Tejedor MT. Frey syndrome: factors influencing the time to event. Int J Oral Maxillofac Surg. 2015;44(7):834–9.

    Article  CAS  PubMed  Google Scholar 

  11. Wenzel GI, Draf W. Unusually long latency before the appearance of Frey’s syndrome after parotidectomy. HNO. 2004;52(6):554–6.

    Article  CAS  PubMed  Google Scholar 

  12. Shuman AG, Bradford CR. Ethics of Frey syndrome: ensuring that consent is truly informed. Head Neck. 2010;32(8):1125–8.

    Article  PubMed  Google Scholar 

  13. Hays LL. The Frey syndrome: a review and double blind evaluation of the topical use of a new anticholinergic agent. Laryngoscope. 1978;88(11):1796–824.

    Article  CAS  PubMed  Google Scholar 

  14. Hansen JT, Koeppen BM, Netter FH. Netter’s atlas of human physiology. Teterboro: Icon Learning Systems; 2002.

    Google Scholar 

  15. Kreyden OP, Scheidegger EP. Anatomy of the sweat glands, pharmacology of botulinum toxin, and distinctive syndromes associated with hyperhidrosis. Clin Dermatol. 2004;22(1):40–4.

    Article  PubMed  Google Scholar 

  16. Kahn D, Rothman S. Sweat response to acetylcholine. J Investig Dermatol. 1942;5(6):431–44.

    Article  CAS  Google Scholar 

  17. Toure G. Intraparotid location of the great auricular nerve: a new anatomical basis for gustatory sweating syndrome. Plast Reconstr Surg. 2015;136(5):1069–81.

    Article  CAS  PubMed  Google Scholar 

  18. Zohar Y, Siegal A, Siegal G, Halpern M, Levy B, Gal R. The great auricular nerve; does it penetrate the parotid gland? An anatomical and microscopical study. J Craniomaxillofac Surg. 2002;30(5):318–21.

    Article  PubMed  Google Scholar 

  19. Teague A, Akhtar S, Phillips J. Frey’s syndrome following submandibular gland excision: an unusual postoperative complication. ORL J Otorhinolaryngol Relat Spec. 1998;60(6):346–8.

    Article  CAS  PubMed  Google Scholar 

  20. Islam S, Hoffman GR. Two rare causes of Frey syndrome. J Maxillofac Oral Surg. 2010;9(1):107.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Graham RM, Baldwin AJ. An unusual cause of Frey syndrome. Br J Oral Maxillofac Surg. 2009;47(2):146–7.

    Article  PubMed  Google Scholar 

  22. Bouchard C, Perreault MH. Postoperative complications associated with the retromandibular approach: a retrospective analysis of 118 subcondylar fractures. J Oral Maxillofac Surg. 2014;72(2):370–5.

    Article  PubMed  Google Scholar 

  23. Bulut E, Bekçioğlu B. Delayed Frey syndrome after closed treatment of condylar fracture. J Craniofac Surg. 2012;23(4):e308–11.

    Article  PubMed  Google Scholar 

  24. Kragstrup TW, Christensen J, Fejerskov K, Wenzel A. Frey syndrome-an underreported complication to closed treatment of mandibular condyle fracture? Case report and literature review. J Oral Maxillofac Surg. 2011;69(8):2211–6.

    Article  PubMed  Google Scholar 

  25. Sverzut CE, Trivellato AE, Serra EC, Ferraz EP, Sverzut AT. Frey’s syndrome after condylar fracture: case report. Braz Dent J. 2004;15(2):159–62.

    Article  PubMed  Google Scholar 

  26. Kamath RA, Bharani S, Prabhakar S. Frey’s syndrome consequent to an unusual pattern of temporomandibular joint dislocation: case report with review of its incidence and etiology. Craniomaxillofac Trauma Reconstr. 2013;6(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gonzàlez-Mendiola R, Sánchez-Fernández C, De la Hoz-Caballer B, Prieto-Montaño P, Muñoz-Martín T, Garcia-González MC, Sánchez-Cano M. Auriculotemporal syndrome: differential diagnostic of food allergy. Allergy. 2003;58(12):1315.

    Article  PubMed  Google Scholar 

  28. Sánchez-Morillas L, Reaño Martos M, Rodríguez Mosquera M, Iglesias Cadarso A, Pérez Pimiento A, Domínguez Lázaro AR. Auriculotemporal nerve syndrome. Allergol Immunopathol (Madr). 2003;31(5):288–90.

    Article  Google Scholar 

  29. Karunananthan CG, Kim HL, Kim JH. An unusual case of bilateral auriculotemporal syndrome presenting to an allergist. Ann Allergy Asthma Immunol. 2002;89(1):104–5.

    Article  PubMed  Google Scholar 

  30. Dizon MV, Fischer G, Jopp-McKay A, Treadwell PW, Paller AS. Localized facial flushing in infancy. Auriculotemporal nerve (Frey) syndrome. Arch Dermatol. 1997;133(9):1143–5.

    Article  CAS  PubMed  Google Scholar 

  31. Sethuraman G, Mancini AJ. Familial auriculotemporal nerve (Frey) syndrome. Pediatr Dermatol. 2009;26(3):302–5.

    Article  PubMed  Google Scholar 

  32. Buyuktiryaki B, Sekerel BE. Is it food allergy or Frey syndrome? J Allergy Clin Immunol Pract. 2015;3(2):269–70.

    Article  PubMed  Google Scholar 

  33. Caulley L, Hong P. Pediatric auriculotemporal nerve (Frey) syndrome. CMAJ. 2013;185(6):504.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Watkins PJ. Facial sweating after food: a new sign of diabetic autonomic neuropathy. Br Med J. 1973;1(5853):583–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Freedman A. Facial sweating after food in diabetes. Br Med J. 1973;3(5874):291.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Luna-Ortiz K, Sansón-RíoFrío JA, Mosqueda-Taylor A. Frey syndrome. A proposal for evaluating severity. Oral Oncol. 2004;40(5):501–5.

    Article  PubMed  Google Scholar 

  37. Minor V. Eines neues verfahren zu der klinsichen untersugung der schweissabsonderung. Dtsch ZNervenheilk. 1928;101:258–61.

    Google Scholar 

  38. Sato KT, Richardson A, Timm DE, Sato K. One-step iodine starch method for direct visualization of sweating. Am J Med Sci. 1988;295(6):528–31.

    Article  CAS  PubMed  Google Scholar 

  39. Chueasupparobon N, Rawangban W, Tangjaturonrasme N. Treatment of Frey’s syndrome with topical ammonium alum: first report with twenty-two cases. Clin Otolaryngol. 2016;41(5):593–6.

    Article  CAS  PubMed  Google Scholar 

  40. Dai XM, Liu H, He J, Tu MS, Yu LF, Liu L. Treatment of postparotidectomy Frey syndrome with the interposition of temporalis fascia and sternocleidomastoid flaps. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(5):514–21.

    Article  PubMed  Google Scholar 

  41. Demirci U, Basut O, Noyan B, Demir UL, Afsin Ozmen O, Kasapoglu F, Hakan Coskun H, Onart S. The efficiacy of sternocleidomastoid muscle flap on Frey’s syndrome via a novel test: galvanic skin response. Indian J Otolaryngol Head Neck Surg. 2014;66(Suppl 1):291–8.

    Article  PubMed  Google Scholar 

  42. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications. Clin Auton Res. 2003;13(4):256–70.

    Article  PubMed  Google Scholar 

  43. Tuzemen G, Basut O, Ozmen OA, Coskun HH. Galvanic skin response test: a new quantitative diagnostic method for Frey syndrome. J Craniofac Surg. 2013;24(4):1280–4.

    Article  PubMed  Google Scholar 

  44. Isogai N, Kamiishi H. Application of medical thermography to the diagnosis of Frey’s syndrome. Head Neck. 1997;19(2):143–7.

    Article  CAS  PubMed  Google Scholar 

  45. Choi HG, Kwon SY, Won JY, Yoo SW, Lee MG, Kim SW, Park B. Comparisons of three indicators for Frey’s syndrome: subjective symptoms, minor’s starch iodine test, and infrared thermography. Clin Exp Otorhinolaryngol. 2013;6(4):249–53.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Durgut O, Basut O, Demir UL, Ozmen OA, Kasapoglu F, Coskun H. Association between skin flap thickness and Frey’s syndrome in parotid surgery. Head Neck. 2013;35(12):1781–6.

    Article  PubMed  Google Scholar 

  47. Singleton GT, Cassisi NJ. Frey’s syndrome: incidence related to skin flap thickness in parotidectomy. Laryngoscope. 1980;90(10 Pt 1):1636–9.

    CAS  PubMed  Google Scholar 

  48. Taylor SM, Yoo J, Matthews TW, Lampe HB, Trites JR. Frey’s syndrome and parotidectomy flaps: a retrospective cohort study. Otolaryngol Head Neck Surg. 2000;122(2):201–3.

    Article  CAS  PubMed  Google Scholar 

  49. Taylor SM, Yoo J. Prospective cohort study comparing subcutaneous and sub-superficial musculoaponeurotic system flaps in superficial parotidectomy. J Otolaryngol. 2003;32(2):71–6.

    Article  PubMed  Google Scholar 

  50. Allison GR, Rappaport I. Prevention of Frey’s syndrome with superficial musculoaponeurotic system interposition. Am J Surg. 1993;166(4):407–10.

    Article  CAS  PubMed  Google Scholar 

  51. Casler JD, Conley J. Sternocleidomastoid muscle transfer and superficial musculoaponeurotic system application in the prevention of Frey’s syndrome. Laryngoscope. 1991;101(1 Pt 1):95–100.

    CAS  PubMed  Google Scholar 

  52. Bonanno PC, Casson PR. Frey’s syndrome: a preventable phenomenon. Plast Reconstr Surg. 1992;89(3):452–6; discussion 457–8.

    Google Scholar 

  53. Yu LT, Hamilton R. Frey’s syndrome: prevention with conservative parotidectomy and superficial musculoaponeurotic system preservation. Ann Plast Surg. 1992;29(3):217–22.

    Article  CAS  PubMed  Google Scholar 

  54. de Ru JA, van Benthem PP, Bleys RL, Hordijk GJ. Prevention of Frey syndrome in parotid gland surgery. J Otolaryngol. 2007;36(5):291–5.

    Article  PubMed  Google Scholar 

  55. Roark DT, Sessions RB, Alford BR. Frey’s syndrome-a technical remedy. Ann Otol Rhinol Laryngol. 1975;84(6):734–9.

    Article  CAS  PubMed  Google Scholar 

  56. Wallis KA, Gibson T. Gustatory sweating following parotidectomy: correction by a fascia lata graft. Br J Plast Surg. 1978;31(1):68–71.

    Article  CAS  PubMed  Google Scholar 

  57. Baum SH, Pförtner R, Ladwein F, Schmeling C, Rieger G, Mohr C. Use of dermis-fat grafts in the prevention of Frey’s syndrome after parotidectomy. J Craniomaxillofac Surg. 2016;44(3):301–8.

    Article  PubMed  Google Scholar 

  58. Balasundaram I, Nasser NA. Paraumbilical fat graft for the correction of contour deformity following parotidectomy and prevention of Frey syndrome. Int J Oral Maxillofac Surg. 2016;45(3):380–2.

    Article  CAS  PubMed  Google Scholar 

  59. Fasolis M, Zavattero E, Iaquinta C, Berrone S. Dermofat graft after superficial parotidectomy to prevent Frey syndrome and depressed deformity. J Craniofac Surg. 2013;24(4):1260–2.

    Article  PubMed  Google Scholar 

  60. Kim JT, Naidu S, Kim YH. The buccal fat: a convenient and effective autologous option to prevent Frey syndrome and for facial contouring following parotidectomy. Plast Reconstr Surg. 2010;125(6):1706–9.

    Article  CAS  PubMed  Google Scholar 

  61. Sultan MR, Wider TM, Hugo NE. Frey’s syndrome: prevention with temporoparietal fascial flap interposition. Ann Plast Surg. 1995;34(3):292–6; discussion 296–7.

    Google Scholar 

  62. Dai XM, Liu H, Li YS, Ji SG, Qin SH, Liu L. Prevention of Frey syndrome with temporal fascia flap in Parotidectomy. Ann Plast Surg. 2015;75(6):610–4.

    Article  CAS  PubMed  Google Scholar 

  63. Sharma R. Prevention of Frey syndrome with superficial temporal fascia interpositioning: a retrospective study. Int J Oral Maxillofac Surg. 2014;43(4):413–7.

    Article  PubMed  Google Scholar 

  64. Filho WQ, Dedivitis RA, Rapoport A, Guimarães AV. Sternocleidomastoid muscle flap preventing Frey syndrome following parotidectomy. World J Surg. 2004;28(4):361–4.

    Article  PubMed  Google Scholar 

  65. Liu DY, Tian XJ, Li C, Sun SS, Xiong YH, Zeng XT. The sternocleidomastoid muscle flap for the prevention of Frey syndrome and cosmetic deformity following parotidectomy: a systematic review and meta-analysis. Oncol Lett. 2013;5(4):1335–42.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Sanabria A, Kowalski LP, Bradley PJ, Hartl DM, Bradford CR, de Bree R, Rinaldo A, Ferlito A. Sternocleidomastoid muscle flap in preventing Frey’s syndrome after parotidectomy: a systematic review. Head Neck. 2012;34(4):589–98.

    Article  PubMed  Google Scholar 

  67. Li C, Yang X, Pan J, Shi Z, Li L. Graft for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg. 2013;71(2):419–27.

    Article  PubMed  Google Scholar 

  68. Zeng XT, Tang XJ, Wang XJ, Li MZ, Guo Y, Huang W, Niu YM, Leng WD. AlloDerm implants for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis. Mol Med Rep. 2012;5(4):974–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Wang W, Fan JC, Sun CJ, Chen Y, Zhao HW, Ma H, Li CH, Mi K, Liao J, Liu K, Liu JF, Zhu GQ, Li C. Systematic evaluation on the use of acellular dermis matrix graft in prevention Frey syndrome after parotid neoplasm surgery. J Craniofac Surg. 2013;24(5):1526–9.

    Article  PubMed  Google Scholar 

  70. Govindaraj S, Cohen M, Genden EM, Costantino PD, Urken ML. The use of acellular dermis in the prevention of Frey’s syndrome. Laryngoscope. 2001;111(11 Pt 1):1993–8.

    Article  CAS  PubMed  Google Scholar 

  71. Gennaro P, Di Curzio P, Mitro V, Facchini A, Saponaro G, Cascino F, Amodeo G, Gabriele G, Ungari C. Use of irradiate animal pericardium membrane for prevention of Frey’s syndrome after parotidectomy. Eur Rev Med Pharmacol Sci. 2013;17(4):548–51.

    CAS  PubMed  Google Scholar 

  72. May JS, McGuirt WF. Frey’s syndrome: treatment with topical glycopyrrolate. Head Neck. 1989;11(1):85–9.

    Article  CAS  PubMed  Google Scholar 

  73. Goldstein DS, Pechnik S, Moak J, Eldadah B. Painful sweating. Neurology. 2004;63(8):1471–5.

    Article  PubMed  Google Scholar 

  74. Laccourreye O, Bonan B, Brasnu D, Laccourreye H. Treatment of Frey’s syndrome with topical 2% diphemanil methylsulfate (Prantal): a double-blind evaluation of 15 patients. Laryngoscope. 1990;100(6):651–3.

    Article  CAS  PubMed  Google Scholar 

  75. Black MJ, Gunn A. The management of Frey’s syndrome with aluminium chloride hexahydrate antiperspirant. Ann R Coll Surg Engl. 1990;72(1):49–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  76. Drobik C, Laskawi R. Frey’s syndrome: treatment with botulinum toxin. Acta Otolaryngol. 1995;115(3):459–61.

    Article  CAS  PubMed  Google Scholar 

  77. Steffen A, Rotter N, König IR, Wollenberg B. Botulinum toxin for Frey’s syndrome: a closer look at different treatment responses. J Laryngol Otol. 2012;126(2):185–9.

    Article  CAS  PubMed  Google Scholar 

  78. Laskawi R, Drobik C, Schönebeck C. Up-to-date report of botulinum toxin type A treatment in patients with gustatory sweating (Frey’s syndrome). Laryngoscope. 1998;108(3):381–4.

    Article  CAS  PubMed  Google Scholar 

  79. Hartl DM, Julieron M, LeRidant AM, Janot F, Marandas P, Travagli JP. Botulinum toxin A for quality of life improvement in post-parotidectomy gustatory sweating (Frey’s syndrome). J Laryngol Otol. 2008;122(10):1100–4.

    Article  CAS  PubMed  Google Scholar 

  80. Blitzer A, Sulica L. Botulinum toxin: basic science and clinical uses in otolaryngology. Laryngoscope. 2001;111(2):218–26.

    Article  CAS  PubMed  Google Scholar 

  81. de Bree R, Duyndam JE, Kuik DJ, Leemans CR. Repeated botulinum toxin type A injections to treat patients with Frey syndrome. Arch Otolaryngol Head Neck Surg. 2009;135(3):287–90.

    Article  PubMed  Google Scholar 

  82. Dulguerov P, Quinodoz D, Cosendai G, Piletta P, Lehmann W. Frey syndrome treatment with botulinum toxin. Otolaryngol Head Neck Surg. 2000;122(6):821–7.

    Article  CAS  PubMed  Google Scholar 

  83. Xie S, Wang K, Xu T, Guo XS, Shan XF, Cai ZG. Efficacy and safety of botulinum toxin type A for treatment of Frey’s syndrome: evidence from 22 published articles. Cancer Med. 2015;4(11):1639–50.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Annenberg 10th Floor, One Gustave L. Levy Place, Box 1189, New York, NY, 10029-3136, USA

    Benjamin C. Tweel M.D.

  2. Department of Otolaryngology—Head and Neck Surgery, Wexner Medical Center at The Ohio State University, 320 West 10th Avenue, Starling-Loving Hall, B221, Columbus, OH, 43210-1282, USA

    Ricardo Carrau M.D.

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  1. Benjamin C. Tweel M.D.
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  2. Ricardo Carrau M.D.
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Correspondence to Ricardo Carrau M.D. .

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Editors and Affiliations

  1. Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA

    M. Boyd Gillespie

  2. Otolaryngology Head and Neck Surgery, Louisiana State University, New Orleans, Louisiana, USA

    Rohan R. Walvekar

  3. School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Barry M. Schaitkin

  4. Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    David W. Eisele

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Tweel, B.C., Carrau, R. (2018). Frey Syndrome. In: Gillespie, M., Walvekar, R., Schaitkin, B., Eisele, D. (eds) Gland-Preserving Salivary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-58335-8_18

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