The aberrant regeneration theory explains the physiopathology of freys syndrome. This complication likely starts because of damage to the auriculotemporal nerve which is the result of an injury to the parotid glands. This damage commonly happens during surgical procedures of the parotid gland. Freys syndrome is secondary to the sympathetic denervation of sweat glands the reinnervation through the auriculotemporal nerve is a secondary event. Freys syndrome or auriculotemporal syndrome also termed gustatory sweating typically refers to the phenomenon of increased facial sweating andflushing after. Images in clinical medicine from the new england journal of medicine freys syndrome. Botulinum toxin treatment for symptomatic freys syndrome abigail aradcohen, md and andrew blitzer, md, dds otolaryngologyhead and neck surgery 2000 122. Sternocleidomastoid muscle transfer and superficial masculoaponeurotic system plication in the prevention of freys syndrome.
Gustatory sweating, known as frey syndrome,1 results from misdirected regeneration of parasympathetic fibers normally innervating. Frey syndrome auriculotemporal nerve syndrome or gustatory sweating. All the information, content and live chat provided on the site is intended. Freys syndrome in infancy archives of disease in childhood. Lou gehrigs disease, myasthenia gravis or lamberteaton syndrome. However, only 10% of patients have symptoms requiring treatment. Pdf freys syndrome is a complication of parotidectomy that is thought to occur as a result of aberrant regeneration of the. The first description of unilateral focal gustatory hyperhidrosis consequential to a parotid abscess was provided as early as 1757 by duphenix, 1 in 1853 by baillarger, 2.
The questions and answers section regarding freys syndrome in the journal 1 brought to light another rarely encountered automatic dysfunction. Freys syndrome genetic and rare diseases information. Auriculotemporal nerve syndrome, also known as frey syndrome, is an uncommon clinical entity in children. Botox injection for freys syndrome iowa head and neck protocols. More recently, good early results have been obtained by the local injection of botulinum toxin,8,9 but further investigation into its use is required. The profuse unilateral facial sweating response to gustatory stimulation may indeed become milder with passage of time, but the victim of such a distressing situation may perceive it as being endless. Here you can see if there is any natural remedy andor treatment that can help people with frey syndrome. Ryan osborne and jason hamilton of the osborne head and neck institute preform 34 parotid and reconstructive procedures per week and have pioneered techniques that prevent freys syndrome in their patients. It was first noted in 1923 by a polish doctor named lucie frey.
A 4yearold boy with a history of asthma was referred for evaluation of possible food allergy. The minor starchiodine test was performed, revealing areas of abnormal sweating figure 1. The incidence of frey s syndrome after parotidectomy greatly varies in the literature. Freys syndrome consequent to an unusual pattern of. Frey syndrome, ask a doctor about diagnosis, treatment and. This nerve, when it heals, reattaches to sweat glands instead of the original salivary gland which had been. Symptoms usually develop within several months of the. The mandibular nerve supplies the tissues ofthe lower jaw the teeth,part ofthe oral cavity, the lower lip,the temporomandibular joint,part of the. Symptoms started 6 months after surgery for a benign left parotid tumor.
The symptoms of freys syndrome are redness and sweating on the cheek area adjacent to the ear. Evaluation and treatment of frey syndrome medcrave online. Clinical results in the management of freys syndrome with. Permanent treatment is available in the form of reconstructive surgery. Have you ever come across freys syndrome auriculotemporal nerve syndrome in infancy. Frey s syndrome is a disorder in which a strong salivary response is replaced by sweating and reddened skin on certain parts of the face. Historically, surgical treatment of frey syndrome has not been used. Due to parasympathetic and sympathetic secretomotor stimuli misdirected to cholinergic receptors of sweat glands during healing after parotid surgery. The most common objective tests are a lemon which brings out the facial flushing and starchiodine which demonstrates the gustatory. The parotid glands are the largest salivary glands in the body located just below the ears on either side of the face. The syndrome of facial gustatory sweating and flushing, described by lucie frey in 1923, 1 has come to bear her name because frey not only correctly described the symptoms, but also put them in context of the autonomic innervation of the parotid gland and facial skin.
Pdf freys syndrome unusually long delayed clinical onset post. Freys syndrome in children is rare and often erroneously attributed to food allergy. The most common complication of parotid surgery is gustatory sweating or frey syndrome. Drummond mechanism of gustatory flushing in freys syndrome injury to a branch ofthe mandibular nerve typically interrupts the sympathetic supply within the distribution ofthat nerve branch. In adults, the syndrome usually results from surgical injury or trauma to the parotid gland. He had a history of isolated left facial flushing appearing during meals, extending from the corner of the cheek to the temple and tragus, beginning at 4 months of age, at weaning. Download here free healthcaremagic app to ask a doctor. This reaction occurs typically as a response to foods that generally cause extreme salivation and most often it is not associated with pain. It most often occurs as a complication of surgery involving the parotid gland a major salivary gland located below the ear. Material and methods a total of 10 patients suffering from freys syndrome were selected for this study table 1. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Patients with auriculotemporal nerve syndrome frey syndrome have facial flushing, sweating, or both localized to the distribution of the auriculotemporal nerve that occurs in response to gustatory stimuli. Intracutaneous injection of botulinum toxin a is an effective, long.
Freys syndrome also known as baillargers syndrome, dupuys syndrome, auriculotemporal syndrome, or freybaillarger 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. Cantaraella f, berlusconi a, mele v, cogiamanian f, and barbieri s. The most common indication of freys syndrome is a spontaneous sweating in response to a food stimulus, which may be in any form. Freys syndrome as a differential diagnosis for food. The sweating that may be mild or profuse may be around the ears, on the. Treatment of frey s syndrome with botulinum toxin type b. Freys syndrome as a differential diagnosis for food allergy. Almost all patients who undergo parotidectomy will to some extent develop frey syndrome auriculotemporal syndrome or. Frey syndrome nord national organization for rare disorders.
Since symptoms occur during meals, she postulated that parasympathetic fibers that normally stimulate the parotid gland to. For language access assistance, contact the ncats public information officer. All surgical and topical treatments have drawbacks. An unusual case is presented involving a patient with delayed onset of freys syndrome 40 years after parotidectomy in childhood. Frey s syndrome was suspected, and the lemon test was performed. Frey s syndrome fs is an unavoidable sequela following the surgery of the parotid gland. Prevention of freys syndrome and volume deficit after. He had to continuously dab his face with a cloth during a meal. A 42yearold woman presented with left facial sweating whenever she ate. Here is a diagnosis that will amaze your peers and make you the temporary star of the clinical meeting. Two weeks following intradermal injection of botulinum toxin targeting areas of hyperhidrosis, symptoms resolved and repeat minor test revealed. The main symptoms of frey syndrome are undesirable sweating and flushing occurring on the cheek, temple. Management of frey syndrome using botulinum neurotoxin a case report.
Frey s syndrome symptoms, causes, diagnosis, and treatment information for frey s syndrome frey s syndrome with alternative diagnoses, fulltext book chapters, misdiagnosis, research treatments, prevention, and prognosis. Otolaryngologyhead and neck surgery 2010 143, 214218 list of donors the department of otolaryngology and the university of iowa wish to acknowledge the support of those who share our goal in improving the care of. If you have problems viewing pdf files, download the latest version of adobe reader. What are the signs and symptoms of frey s syndrome. May 19, 2015 symptoms, risk factors and treatments of freys syndrome medical condition freys syndrome is a rare neurological disorder resulting from damage to or near the parotid glands responsible for. Jun 24, 2017 xie s, wang k, xu t, guo x s, shan xf, et al. Botox injection for freys syndrome iowa head and neck. Freys syndrome, or gustatory sweating, is named after lucja frey, who first described it as auriculotemporal syndrome in 1923. Jul 30, 2017 the symptoms of freys syndrome are redness and sweating on the cheek area adjacent to the ear.
Unlike adults, children do not exhibit sweating over the affected area of skin. Botulinum toxin treatment for symptomatic freys syndrome. New surgical techniques have been proposed to avoid this complication, but are not widely in use. The auriculotemporal syndrome is known worldwide as frey s syndrome. It mostly occurs due to any trauma caused, while surgically operating on the salivary glands parotids very infrequently, infants and newborns have also been observed to develop this condition. May 09, 2020 frey s syndrome is a disorder in which a strong salivary response is replaced by sweating and reddened skin on certain parts of the face. Article information, pdf download for the frey syndrome. Clinical results in the management of freys syndrome with injections of botulinum toxin. Freys syndrome, or auricotemporal syndrome leads to facial flushing and a rash associated with eating certain foods. May 29, 2018 freys syndrome may affect any individual regardless of age, sex, racial, or ethnic inclination. It is caused by an anastomotic communication with facial sweat glands by parasympathetic secretomotor nerve fibers intended for the excised parotid gland.
Gustatory sweating, or frey s syndrome, is a fairly common sequela of partial or radical parotidectomy, submaxillary gland surgery, or radical neck dissection. Frey s syndrome, also called gustatory sweating or auriculotemporal syndrome, comprises facial sweating, flushing, and sometimes pain in the preauricular and temporal areas following production of a strong salivary stimulus. It is a neurological disorder resulting from damage to or near the parotid glands responsible for making saliva, and from damage to the facial nerve often from surgery. As soon as the patient ate a lemon wedge, his left auricular and parotic regions became flushed and sweaty arrow, panel b. Frey syndrome is a rare disorder that most often occurs as a result of surgery in the area near the parotid glands. One year after resection of a parotid neoplasm, a 44yearold man developed sweating over the left side of the face while eating see video. Leemans, md, phd1 1 department of otolaryngologyhead and neck surgery, vu university medical center, amsterdam, the netherlands. Are there natural treatments that may improve the quality of life of people with frey syndrome. Current therapy in otolaryngologyhead and neck surgery. The aim of this study was to analyse the incidence with the help of a new series of patients and to discuss. Mechanism of gustatory flushing in freys syndrome exodontia. Pdf freys syndrome auriculotemporal syndrome or gustatory sweating is a dysfunction of the auriculotemporal. An article regarding the management of freys syndrome published in 2007, noted that up to 40% of patients will admit gustatory sweating if asked and about 95% of all patients who underwent parotidectomy show evidence of freys syndrome. It is caused by injury to a nerve, called the auriculotemporal nerve, typically after surgical trauma to the parotid gland.
Freys syndrome can be prevented by having reconstructive surgery after parotidectomy. Apr 07, 2010 freys syndrome is difficult to treat but is a preventable phenomenon and surgeons must be aware of the available preventative methods during the initial surgery. Frey s syndrome or the auriculotemporal syndrome consists of discomfort, localized facial sweating, and flushing during mastication. Graft interposition for preventing freys syndrome in. Freys syndrome is due to damage of the auriculotemporal nerve and leads to sweating and flushing of the face associated with eating or thinking about food. The aim of this study is to publicize the results achieved by our team in the treatment of freys syndrome with injections of botulinum toxin type a. He was born at term and the delivery was complicated by failure to progress, requiring the use of forceps. Pediatric auriculotemporal nerve frey syndrome cmaj. Frey s syndrome, also known as baillarger s syndrome, is a potential complication of the procedure known as parotidectomy, which is the removal of a portion of an essential salivary gland. It is widely thought to be the result of aberrant crossinnervation of auriculotemporal nerve fibres following injury to this region. It may also occur following neck dissection, facelift procedures, or trauma to the area near the parotid gland.
World map of frey syndrome find people with frey syndrome through the map. He has been treated successfully with botulinum toxin. Freys syndrome unusually long delayed clinical onset post. Siegmar reinert, in maxillofacial surgery third edition, 2017. Freys syndrome is a syndrome that includes sweating while eating gustatory sweating and facial flushing. The little information about her is fragmentary, contradictory, and often incorrect. The condition is rare in infants, but usually manifests during infancy with the. Frey published a report detailing her eponymous illness after treating a polish soldier who experienced gustatory sweating after sustaining an infected bullet wound affecting the parotid gland. These symptoms generally appear when the affected person eats. Katherine george, in maxillofacial surgery third edition, 2017.
Reports of surgical transection of the auriculotemporal nerve, tympanic nerve. The parotid gland is the largest of the salivary glands and is located at the level of the cheek. Management of frey syndrome using botulinum neurotoxin. Thick skin flap and partial superficial parotidectomy are the most important techniques to minimize the risk of developing symptomatic frey syndrome. Almost all patients who undergo parotidectomy will to some extent develop frey syndrome auriculotemporal syndrome or gustatory sweating after surgery. Frey s syndrome is a rare, neurological disorder that causes a person to sweat excessively while eating. These symptoms generally appear when the affected person eats, sees, dreams, thinks about or talks about certain kinds of food which produce strong salivation. Frey syndrome auriculotemporal syndrome, gustatory sweating develops in approximately 10% to 20% of all parotidectomies, rarely following the removal of a submandibular gland. However, the jewish physician lucja frey, after whom it was named, has fallen into obscurity. Frey s syndrome also known as baillargers syndrome, dupuys syndrome, auriculotemporal syndrome, 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 the symptoms of frey s syndrome are redness and sweating on the cheek area adjacent.