Frey's syndrome

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Frey's syndrome
Synonyms	Auriculotemporal syndrome, gustatory sweating
Pronounce	N/A
Specialty	Neurology, Otolaryngology
Symptoms	Sweating and flushing on the cheek area during eating
Complications	N/A
Onset	After parotid gland surgery or trauma
Duration	Chronic
Types	N/A
Causes	Aberrant nerve regeneration
Risks	Parotidectomy, facial trauma
Diagnosis	Clinical examination, Minor's iodine-starch test
Differential diagnosis	Hyperhidrosis, Facial flushing
Prevention	Careful surgical technique
Treatment	Botulinum toxin injections, Antiperspirants, surgical intervention
Medication	N/A
Prognosis	Generally good with treatment
Frequency	Common after parotid surgery
Deaths	N/A

Frey's syndrome (also known as Baillarger's syndrome, Dupuy’s syndrome, auriculotemporal syndrome,<ref name="NIH">

Frey's syndrome(link). {{{website}}}. National Institutes of Health, U.S. Department of Health & Human Services.

Accessed 17 December 2012.

</ref> or Frey-Baillarger syndrome) is a rare neurological disorder resulting from damage to or near the parotid glands responsible for making saliva, and from damage to the auriculotemporal nerve often from surgery.<ref name="NIH"/><ref name="NEJM"/> The symptoms of Frey's syndrome are redness and sweating on the cheek area adjacent to the ear (see focal hyperhidrosis). They can appear when the affected person eats, sees, dreams, thinks about or talks about certain kinds of food which produce strong salivation. ^{(December 2012)}

Observing sweating in the region after eating a lemon wedge may be diagnostic.<ref name="NEJM">, 
 Images in clinical medicine. Frey's syndrome, 
 The New England Journal of Medicine, 
 
 Vol. 355(Issue: 1),
 pp. 66,
 DOI: 10.1056/NEJMicm040462,
 PMID: 16822997,</ref>

Signs and symptoms

Signs and symptoms include erythema (redness/flushing) and sweating in the cutaneous distribution of the auriculotemporal nerve, usually in response to gustatory stimuli. There is sometimes pain in the same area, often of a burning nature. Between attacks of pain there is sometimes numbness or other altered sensations (anesthesia or paresthesia). This is sometimes termed "gustatory neuralgia".

Causes

Frey's syndrome often results as a side effect of surgeries of or near the parotid gland or due to injury to the auriculotemporal nerve, which passes through the parotid gland in the early part of its course. The auriculotemporal branch of the mandibular (V3) branch of the trigeminal nerve carries parasympathetic fibers to the parotid salivary gland and sympathetic fibers to the sweat glands of the scalp. As a result of severance and inappropriate regeneration, the parasympathetic nerve fibers may switch course to a sympathetic response, resulting in "gustatory sweating" or sweating in the anticipation of eating, instead of the normal salivatory response.<ref name="NEJM"/> It is often seen with patients who have undergone endoscopic thoracic sympathectomy, a surgical procedure wherein part of the sympathetic trunk is cut or clamped to treat sweating of the hands or blushing. The subsequent regeneration or nerve sprouting leads to abnormal sweating and salivating. It can also include discharge from the nose when smelling certain food. Rarely, Frey's syndrome can result from causes other than surgery, including accidental trauma, local infections, sympathetic dysfunction and pathologic lesions within the parotid gland.<ref>,

 Frey syndrome-an underreported complication to closed treatment of mandibular condyle fracture? Case report and literature review, 
 Journal of Oral and Maxillofacial Surgery, 
 
 Vol. 69(Issue: 8),
 pp. 2211–6,
 DOI: 10.1016/j.joms.2010.12.033,
 PMID: 21496996,
 
 
 Full text,</ref>

An example of such rare trauma or localized infection can be seen in situations where a hair follicle has become ingrown, and is causing trauma or localized infection near or over one of the branches of the auriculotemporal nerve.

Diagnosis

Diagnosis is made based on clinical signs and symptoms and a starch iodine test, called the Minor Iodine-Starch test. The affected area of the face is painted with iodine which is allowed to dry, then dry corn starch is applied to the face. The starch turns blue on exposure to iodine in the presence of sweat.<ref name="ChoiKwon2013">,

 Comparisons of Three Indicators for Frey's Syndrome: Subjective Symptoms, Minor's Starch Iodine Test, and Infrared Thermography, 
 Clinical and Experimental Otorhinolaryngology, 
 
 Vol. 6(Issue: 4),
 pp. 249–53,
 DOI: 10.3342/ceo.2013.6.4.249,
 PMID: 24353866,
 PMC: 3863675,</ref>

Treatments

• Injection of botulinum toxin A<ref>

Onabotulinumtoxina (Injection Route, Intradermal Route, Intramuscular Route)(link). '. Mayo Clinic.

Accessed 18 December 2012.

</ref>

• Surgical transection of the nerve fibers (only a temporary treatment)

^{(December 2012)}

• Application of an ointment containing an anticholinergic drug such as scopolamine

^{(December 2012)}

Cochrane reviews of interventions to either prevent<ref>,

 Graft interposition for preventing Frey's syndrome in patients undergoing parotidectomy, 
 The Cochrane Database of Systematic Reviews, 
 
 Vol. 10,
 pp. CD012323,
 DOI: 10.1002/14651858.CD012323.pub2,
 PMID: 31578708,
 PMC: 6953270,</ref> or treat<ref>, 
 Interventions for the treatment of Frey's syndrome, 
 The Cochrane Database of Systematic Reviews, 
 
 
 pp. CD009959,
 DOI: 10.1002/14651858.CD009959.pub2,
 PMID: 25781421,</ref> Frey’s syndrome have found little or no evidence to support their effectiveness or safety, and conclude that further clinical trials are needed.

Epidemiology

The condition is rare, although the exact incidence is unknown.<ref name = "NORD">

Frey Syndrome(link). NORD (National Organization for Rare Disorders).

Accessed 2019-01-26.

</ref>

Prevalence

The exact incidence of Frey syndrome is unknown.<ref name = "NORD" /> The disorder most often occurs as a complication of the surgical removal of a parotid gland (parotidectomy). The percentage of individuals who develop Frey syndrome after a parotidectomy is controversial and reported estimates range from 30-50 percent. In follow-up examinations, approximately 15 percent of affected individuals rated their symptoms as severe. Frey syndrome affects males and females in equal numbers.

History

It is named after Łucja Frey-Gottesman.<ref>synd/390 at Who Named It?</ref> The disorder was first reported in the medical literature by Baillarger in 1853. A neurologist from Poland, Dr. Lucja Frey, provided a detailed assessment of the disorder and coined the term "auriculotemporal syndrome" in 1923.<ref>,

 Le syndrome du nerf auriculo-temporal., 
 Rev. Neurol., 
 
 Vol. 2,
 pp. 97–104,</ref>

External links

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