A 30-year-old man had a pleomorphic adenoma removed from his left parotid gland. His postoperative course was uncomplicated. Two months later, he noted that his left cheek shows the condition as represented in the picture below while he was eating. Most likely diagnosis is ?
A. Frey’s syndrome.
B. Gustatory sweating.
C. Both A and B.
D. None of the above.
Ans:C. Both A and B.)Frey’s syndrome and Gustatory sweating
Frey’s Syndrome (Gustatory sweating)
- The pathogenesis is based on the aberrant regeneration of sectioned parasympathetic secretomotor fibres of the auriculotemporal nerve with inappropriate innervation of the cutaneous facial sweat glands that are normally innervated by sympathetic cholinergic fibres.
- As a consequence, Frey syndrome is a disorder characterized by unilateral sweating and flushing of the facial skin in the area of the parotid gland occurring during meals that becomes evident usually 1-12 months after surgery.
- It can develop after a variety of insults to the autonomic nervous system, such as trauma or radiation therapy, but is most commonly encountered as a complication of parotidectomy.
- Diagnosis is made based on clinical signs and symptoms and a starch iodine test, called the Minor Iodine-Starch test.
- Good results have been obtained with local injection of botulinum toxin .
Complications of Patotid Gland Surgery
|Intra-operative complications||Post-operative complications|
|Transection of facial nerve||Facial nerve paralysis||Facial synkinesis after facial palsy|
|Rupture of capsulae of parotid tumour||Haemorrhage or haematoma||Hypoesthesia of greater auricular nerve|
|Incomplete surgical resection of parotid tumour||Infection||Recurrent tumour|
|Skin flap necrosis||Soft tissue deficit|
|Cosmetic deformity||Hypertrophic scar or keloid|