Frey syndrome

Parotid REF: Bailey and love 24’ed page 734

Frey syndrome:

• Aka gustatory sweating
• Universally seen in parotid surgery
• Damage to major salivary gland innervation
• Inappropriate regeneration of parasympathetic fibers
• Sweating and erethema in surgical bed with seating
• Test- starch iodine test for diagnosis
• Rx- symptomatic

The auriculotemporal (Frey’s syndrome) syndrome is due to auriculotemporal nerve injury.

At the time of meals, the parotid region and the cheek in front of it become red, hot and painful; very soon beads of perspiration appear on this area.

Cutaneous hyperaesthesia is also present over this area and becomes evident to the patient while shaving.

Frey syndrome:

• Aberrant nerve regeneration after parotid gland injury or surgery may result in ipsilateral flushing and sweating with eating and salivation.
• Sweating occurs in the distribution of the auriculotemporal nerve after an injury, abscess, or surgery in the parotid region. 
• Freys syndrome can be seen in infants and children, often following birth trauma with forcep delivery.

Gustatory sweating (auriculotemporal syndrome) commonly occurs following parotid surgery or other surgery or trauma that results in opening of the parotid capsule. It is thought to arise as a result of damage to the autonomic nerve fibres supplying the parotid gland and the overlying sweat glands. During the healing process parasympathetic secretomotor fibres to the parotid gland regenerate into the nerve sheaths of the sympathetic secretomotor nerves to the sweat glands.

Frey’s syndrome is characterized by sweating, warmth and redness of the face as a result of salivary stimulation by the smell or taste of food. It is usually a result of injury to auriculotemporal nerve after a parotid surgery.

Ans. is ‘c’ i.e., Redness and sweating over the auriculotemporal during meal 

Auriculotemporal syndrome (Syn. Frey’s Syndrome)

Partial injury to the auriculotemporal nerve gives rise to such syndrome. This type of injury:

• May be congenital, possibly due to birth trauma.
• May be accidental injury.
• May be caused by inadverent incision for drainage of parotid abscess.
• May occasionally follow superficial parotidectomy.

• Clinical features: There is flushing and sweating of the skin innervated by the auriculotemporal nerve particularly during meal and presence of cutaneous hyperaesthesia in front and above (the ear the area supplied by the auriculotemporal nerve.)

  – The postganglionic parasympathetic fibres become united to the sympathetic nerves from the superior cervical ganglion which are concerned to supply vessels and sweat glands of that region. This causes flushing and sweating of the skin.

  Following injury to the auriculotemporal nerve, postganglionic parasympathetic fibres from the otic ganglion grow down the sheaths of the cutaneous filaments, so hyperaesthesia follows stimulation of the secretomotor nerves.

  Treatment: If the symptoms persist, the treatment is avulsion of the auriculotemporal nerve in front of the auricle where it lies just posterior to the superficial temporal vessels.

Ans. is ‘c’ i.e., It occurs immediately after the parotid surgery

Frey’s syndrome (gustatory sweating)

• Gustatory sweating or Frey’s syndrome involves post-parotidectomy facial sweating and skin flushing while eating.
• The symptoms usually occur several months or even years after parotid surgery.
• The likely pathophysiology is aberrant regeneration of postganglionic secretomotor parasympathetic nerve fibres (originating from the otic ganglion) misdirected through several axonal sheaths of post-ganglionic sympathetic fibres feeding the sweat glands. These sympathetic fibres are to the sweat glands of the skin in the dissected field.
• The frey’s syndrome is likely due to injury to auriculotemporal nerve with faulty regeneration, therefore Frey’s syndrome is also known as Auriculotemporal syndrome.
• A variant of Frey’s syndrome in which there is gustatory facial flushing but not sweating, occurs following facial paralysis due to faulty regeneration following injury to the facial nerve. So, Frey’s syndrome is not limited to parotid surgery with injury to auriculotemporal nerve.

Ans. is ‘a’ i.e., Post traumatic nerve fibres of facial nerve with parasympathetic of auriculotemporal nerve

Frey’s syndrome (gustatory sweating)

• Gustatory sweating or Frey’s syndrome involves post-parotidectomy facial sweating and skin flushing while eating.
• The symptoms usually occur several months or even years after parotid surgery.
• The likely pathophysiology is aberrant regeneration of postganglionic secretomotor parasympathetic nerve fibres (originating from the otic ganglion) misdirected through several axonal sheaths of post-ganglionic sympathetic fibres feeding the sweat glands. These sympathetic fibres are to the sweat glands of the skin in the dissected field.
• The frey’s syndrome is likely due to injury to auriculotemporal nerve with faulty regeneration, therefore Frey’s syndrome is also known as Auriculotemporal syndrome.
• A variant of Frey’s syndrome in which there is gustatory facial flushing but not sweating, occurs following facial paralysis due to faulty regeneration following injury to the facial nerve. So, Frey’s syndrome is not limited to parotid surgery with injury to auriculotemporal nerve.