Image Based Question – 66194

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.

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Correct Answer » C Explanation

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
	Early	Late
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
	Trismus	Frey’s syndrome
	Parotid fistula