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Frey's syndrome: treatment with botulinum toxin

Published online by Cambridge University Press:  29 June 2007

A. Bjerkhoel  and
O. Trobbe
A. Bjerkhoel*
Affiliation:
Department of Otolaryngology, Lanssjukhuset Ryhov, Jönköping, Sweden.
O. Trobbe
Affiliation:
Department of Otolaryngology, Lanssjukhuset Ryhov, Jönköping, Sweden.
*
Address for correspondence: Anders Bjerkhoel, M.D., Department of Otolaryngology, Länssjukhuset Ryhov S-55185 Jönköping. Sweden. Fax: 44-36321717
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Abstract

Frey's syndrome, i.e. gustatory sweating on the cheek, is a fairly common embarrassment after parotid gland surgery. New surgical techniques have been proposed to avoid this complication, but are not widely in use. Hence, there is need for treatment of Frey's syndrome. All surgical and topical treatments have drawbacks. This study was set up in order to evaluate a recently described treatment. One hundred and two patients were interviewed after parotidectomy. Thirty-one of them had noticed gustatory sweating and 15 patients underwent Minor's starch iodine test before, and after, treatment with intracutaneous injections of botulinum toxin A (Botox®, Allergan Inc., USA). Thirteen of the patients did not experience any gustatory sweating at follow-up (one to 13 months). Minor's starch test showed total disappearance of gustatory sweating in 12 of the 15 treated patients. The only side effect was a discreet, transitory affection of the orbicularis oris muscle in one patient. As this treatment is minimally invasive it could be an attractive treatment for Frey's syndrome if the effect is maintained. Complaints of local hypoaesthesia and pain were also common after parotid surgery.

Keywords

Auriculotemporal syndromeSweating, gustatoryHyperhidrosisBotulinum toxins, Surgery, parotid gland

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 9 , September 1997 , pp. 839 - 844
Copyright
Copyright © JLO (1984) Limited 1997

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References

Bonnano, P. C., Casson, P. R. (1992) Frey's syndrome: a preventable phenomenon. Plastic and Reconstructive Surgery 89: 452–458.CrossRefGoogle Scholar
Brookes, G. B., Anderson, T. J., Elston, J. S. (1995) In Handbook of Botulinum Toxin Treatment (Moore, P., ed.) Blackwell Science Ltd., Osney Mead, Oxford, pp 181–208. 103–130, 90–102.Google Scholar
Coldwater, K. B. (1954) Surgical treatment of the auriculotemporal syndrome. Archives of Surgery 36: 54–57.CrossRefGoogle Scholar
Drobik, C., Laskawi, R. (1995) Frey's syndrome: treatment with botulinum toxin. Acta Oto-Laryngologica 115: 459–461.CrossRefGoogle ScholarPubMed
Drobik, C., Laskawi, R., Schwab, S. (1995) Die Therapie des Frey-Syndroms mit Botulinumtoxin A. Erfahrungen mit einer neuen Behandlungsmethode. HNO 43(11): 644–648.Google Scholar
Drott, C., Gothberg, G., Claes, G. (1995) Endoscopic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. Journal of the American Academy of Dermatology 33(1): 78–81.CrossRefGoogle ScholarPubMed
Duphénix, M. (1757) Observations sur les fistules du canal salivaire de Stenon: 1. Sur une playe compliquée á la joue ou le canal salivaire fut déchiré. Memoires de l'Académie royale de Chirurgie 3: 431–439.Google Scholar
Duthie, A. M., Dunkley, A. S. (1981) Frey's syndrome: Treatment by chemical sympathectomy. Suid-A frikaanse Tydskrif vir Chirurgie 19: 239–242.Google ScholarPubMed
Erickson, J. C. (1985) Management of Frey's syndrome (Letter). Journal of the American Medical Association 253: 2735.Google Scholar
Faber, C. E., Pedersen, A. T. (1996) Pain and sensory impairment following parotidectomy. A descriptive study. Ugeskrift for Laeger 158(3): 270–273.Google ScholarPubMed
Ford, F. R., Woodhall, R. (1938) Phenomena due to misdirection of regenerating fibres of cranial, spinal and automatic nerves, clinical observations. Archives of Surgery 69: 54.Google Scholar
Frey, L. (1923) Le syndrome du nerf auriculo-temporal. Revue Neurologique 2: 97.Google Scholar
Haxton, H. A. (1948) Gustatory sweating. Brain 71: 16–25.CrossRefGoogle ScholarPubMed
Hays, L. L., Novack, A. J., Worsham, J. C. (1982) The Frey syndrome: A simple, effective treatment. Otolaryngology – Head and Neck Surgery 90: 419.CrossRefGoogle ScholarPubMed
Harada, T., Inoue, T., Harashina, T., Hatoko, M., Ueda, K. (1993) Dermis-fat graft after parotidectomy to prevent Frey's syndrome and the concave deformity. Annals of Plastic Surgery 33: 450–452.CrossRefGoogle Scholar
Kidd, H. A. (1955) Total parotidectomy with preservation of facial nerve. A review of 47 cases. British Medical Journal 2: 1309.CrossRefGoogle ScholarPubMed
Kohnblut, A. D., Westphal, P., Miehlke, A. (1974) The effectiveness of a sternomastoid muscle flap in preventing postparotidectomy occurrence of the Frey syndrome. Acta Oto-Laryngologica 77: 368–373.CrossRefGoogle Scholar
Laage-Hellman, J. E. (1958) Treatment of gustatory sweating and flushing. Acta Oto-Laryngologica 49: 132.CrossRefGoogle ScholarPubMed
May, J. S., McQuirt, W. F. (1989) Frey's syndrome: treatment with topical glycopyrrolate. Head and Neck 11: 85–89.CrossRefGoogle ScholarPubMed
Mealey, B. L. (1994) Bilateral gustatory sweating as a sign of diabetic neuropathy. Oral Surgery, Oral Medicine and Oral Pathology 77(2): 113–115.CrossRefGoogle ScholarPubMed
Minor, V. (1927) Em neues Verfahren zu der klinischen Untersuchung der Schweβabsonderung. Deutsche Zeitschrift für Nervenheilkunde 101: 302–306.CrossRefGoogle Scholar
Montecucco, C., Schiavo, G. (1994) Mechanism of action of tetanus and botulinum neurotoxins. Molecular Microbiology 13: 1–8.CrossRefGoogle ScholarPubMed
Redleaf, M. I., McCabe, B. F. (1993) Gustatory otorrhea: Frey's syndrome of the external auditory canal. Annals of Otology, Rhinology and Laryngology 102: 438–440.CrossRefGoogle ScholarPubMed
Roark, D. T., Sessions, R. B., Alford, B. R. (1975) Frey's syndrome – a technical remedy. Annals of Otology, Rhinology and Laryngology 84(6): 734–739.Google ScholarPubMed
Sandstedt, P., Hydén, D., Ödkvist, L. M. (1981) Bell's palsy - part of a polyneuropathy? Acta Neurologica Scandinavica 64: 66–73.CrossRefGoogle ScholarPubMed
Schulze-Bonhage, A., Schröder, M., Ferbert, A. (1996) Botulinum toxin in the therapy of gustatory sweating. Journal of Neurology 243(2): 143–146.CrossRefGoogle ScholarPubMed
Sellin, L. C. (1981) The action of botulinum toxin at the neuromuscular junction. Medical Biology 59: 11–20.Google ScholarPubMed
Shemen, L. J. (1995) Expanded polytef for reconstructing postparotidectomy defects and preventing Frey's syndrome. Archives of Otolaryngology – Head and Neck Surgery 121: 1307–1309.CrossRefGoogle ScholarPubMed
Singleton, G. T., Cassisi, N. J. (1980) Frey's syndrome: incidence related to skin flap thickness in parotidectomy. Laryngoscope 90: 1636–1638.CrossRefGoogle ScholarPubMed
Spiro, R. H., Martin, H. (1967) Gustatory sweating following parotid surgery and radical neck dissection. Annals of Surgery 165: 118–127.CrossRefGoogle ScholarPubMed
Sultan, M. R., Wider, T. M., Hugo, N. E. (1995) Frey's syndrome: Prevention with temporoparietal fascial flap interposition. Annals of Plastic Surgery 34: 292–297.CrossRefGoogle ScholarPubMed
Young, A. G. (1956) Unilateral sweating of the submental region after eating (chorda tympani syndrome). British Medical Journal 2: 976–979.CrossRefGoogle ScholarPubMed