Скачать или смотреть FREY SYNDROME//ATS//GUSTATORY SWEATING

Introduction
• Definition: Frey Syndrome is a condition characterized by gustatory sweating and flushing over the parotid or cheek region, typically after parotid gland surgery or trauma.
• Also known as: Auriculotemporal nerve syndrome

Etiology
• Most commonly iatrogenic:
• Parotidectomy (superficial or total)
• Parotid abscess drainage
• Trauma to parotid region
• Less common:
• Forceps injury at birth (infants)
• TMJ surgery
• Submandibular gland procedures

Pathophysiology
• Involves aberrant regeneration of auriculotemporal nerve fibers:
• Post-injury, parasympathetic fibers (to salivary glands) grow along sympathetic fibers to sweat glands (of skin).
• So, instead of stimulating saliva secretion, the patient sweats and flushes during eating (“gustatory sweating”).

▶️ Key Nerve:
• Auriculotemporal nerve (branch of mandibular nerve, CN V3)
• Normally carries parasympathetic fibers from otic ganglion to parotid gland
• Post-surgery, it regenerates into sweat glands of overlying skin

Diagnosis

A. Clinical History
• Strong association with surgery or trauma
• Postprandial sweating is characteristic

B. Starch-Iodine Test (Minor’s Test)
• Standard diagnostic test
• Procedure:
1. Apply iodine to affected area
2. Allow it to dry
3. Sprinkle starch (usually cornstarch)
4. Ask patient to chew/taste something sour (e.g., lemon juice)
5. Sweating areas turn deep blue/purple

C. Infrared thermography (less common)
• Detects local heat changes during food stimuli

Differential Diagnosis
• Gustatory flushing (without sweating) – more common in children
• Hyperhidrosis
• Neuropathies (e.g., diabetic)
• Red ear syndrome
Management

A. Conservative
• Mild cases: Reassurance and observation
• Topical agents:
• Antiperspirants (aluminum chloride)
• Anticholinergics (glycopyrrolate cream, scopolamine)

B. Botulinum Toxin (Botox) Injection
• First-line treatment for moderate-to-severe cases
• Local injection into affected skin
• Lasts ~6 months

C. Surgical
• Reserved for refractory or extensive cases:
• Interpositional grafts during parotidectomy (e.g., temporalis fascia, sternocleidomastoid flap)
• Sectioning of auriculotemporal nerve (less common now)

8. Prevention
• Intraoperative measures:
• Use of fascia flap (SMAS, sternocleidomastoid, or temporoparietal fascia) during parotidectomy
• Meticulous nerve preservation

9. Prognosis
• Benign condition, though socially distressing
• High response to Botox therapy
• Can recur after months or years
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