Frey's syndrome: treatment by chemical sympathectomy.
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Twelve patients with Frey's syndrome after total parotidectomy for plemorphic adenoma were analysed using simultaneously 2 biosensors. Biosensors allowed for detection of L lactate and amino acid level on intact skin. The assay procedure and the results achieved with the simultaneous use of these 2 biosensors are presented. The L lactate biosensor appears to be an interesting tool for Frey's syndrome analysis. The sensibility of the amino acid biosensor is not sufficient enough to allow its use at time of Frey's syndrome analysis.
Twenty years experience of lateral parotidectomy as suspical treatment for pleomorphic adenoma are reviewed. All cases were managed at the ORL Clinic of the University of Zürich. 167 patients were followed for the frequency of possible recurrent tumors. Three patients (3/123) operated primarily developed a recurrences. Recurrences appeared after an average of 10 years, ranging from 1-30 years. The follow-up time varied from 1 to 21 years (average, 8 years). 39% (13 of 33) of the patients, who were re-operated for a recurrent tumor, developed another recurrence. The second recurrence appeared after an average of 10 years, ranging from 1-22 years. A persistent partial paresis of the facial nerve was found in 1% of the patients operated primarily and in 9% of the patients operated more than once. No paralysis was seen. We now choose "en-bloc" resections of pleomorphic adenomas without intra-operative opening of the tumor capsule as the treatment of choice. This treatment was possible in 83% of all cases, using a lateral parotidectomy. If tumor extends into the medial parotid lobe, total parotidectomy is required.
PURPOSE: To clinically test a new type of parotid surgery termed functional superficial parotidectomy (FSP) to preserve the function of the residual gland. PATIENTS AND METHODS: Sixteen human parotid specimens were dissected, and 19 patients underwent FSP. RESULTS: It was shown that 91.4% of the main parotid ducts were found deep to the surface of the facial nerve. Physical examination, sialography, and scintigraphy showed that function of the residual gland was well preserved by FSP. CONCLUSION: A comparison of the main complications between FSP and conservative superficial parotidectomy showed a significant decrease (P < .01) of Frey's syndrome with FSP.
Frey's syndrome is distinguished by the appearing of erythema, sensation of hotness, sometimes pain, and transpiration discharge in the preauricular and temporal area when ingestion stars. We present an eleven month old child with this pathology and we review the etiology and clinic manifestations of this syndrome.
Lucja Frey was a Polish neurologist born and lived in Lwów, former east Polish town, and died during the war in Lwów's ghetto. In 1923 she described the auriculo-temporalis syndrome, at present well known all over the world. But personality and history of the extraordinary Polish scientist remains obscure. The aim of this paper is to present her silhouette. Because a great number of Polish scientists are also not known abroad, the authors tried to explain the causes of their absence in the world bibliography.
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Since 1979, the SMAS (Superficial Muscular Aponeurotic System) has been used in over 100 parotidectomies to ameliorate the sunken facial appearance, and to prevent Frey's Syndrome. The procedure involves a rhytidectomy incision followed by variations including superior rotation, posterior advancement and plication of the SMAS. Appropriateness of such variations considers the defect from the surgery, and the histology of the tumor.
OBJECTIVE: To describe the results of parotidectomy for pleomorphic adenoma of the parotid gland in 245 patients, 1974-1994. DESIGN: Descriptive. SETTING: Academic Medical Hospital, Free University, Amsterdam, the Netherlands. METHOD: Of all patients follow-up data were obtained by yearly physical diagnostic examination during 10 years, and by a questionnaire (1995) from the general practitioners involved. RESULTS: In the period 1974-1994, 246 primary surgical parotid procedures were performed on 245 patients for pleomorphic adenoma. The surgical procedures included: 131 'partial' and 61 'complete' superficial parotidectomies, 30 partial superficial/ deep lobe parotidectomies, 8 total parotidectomies, and 16 'selective' deep lobe parotidectomies. Eleven patients received postoperative radiotherapy for different reasons. The median follow-up was 95 months. Fourteen patients died without recurrent tumour. Two patients (0.8%) developed a local recurrence, both after total parotidectomy for a deep lobe tumour. None of the patients experienced permanent facial nerve paresis or paralysis. The incidence of auriculotemporal sweating for partial superficial parotidectomy proved to be 6.9% (9/I31) as compared with 13.1% (8/61) for complete superficial parotidectomy. In the later years, in the majority of patients, the posterior branch of the greater auricular nerve was preserved. CONCLUSION: In the hands of the experienced head and neck surgeon partial parotidectomy is an effective treatment for the great majority of pleomorphic adenomas: local recurrence is rare, while in general morbidity is minimal. Rarely there is a need for prolonged follow-up.
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Frey's syndrome is the most common postoperative complication in the parotid gland surgery. The authors report their own experience with 80 patients who underwent surgical operation of superficial or total parotidectomy. In 45 of them was performed the SMAS flap, no SMAS flap performed in the remaining 35 patients. The follow-up was performed by interviewing the patients about their symptoms. The purpose of this work is to show the role of SMAS flap, that minimize the frequency and the intensity of symptoms of the Frey's syndrome.
The records of 41 patients with tumours of the parotid gland treated in ORL Clinic in Białystok from 1990-1995. Were retrospectively reviewed. Malignant tumours constituted 11.5% of all tumours. The most common benign tumour was pleomorphic adenoma. Superficial or total parotidectomy was used as the method of treatment. The incidence of facial nerve dysfunction was 4.87%. Only 4.87% of patients developed Frey's syndrome.
Tumors of the salivary glands are exceptional, representing approximately 2% of head and neck tumors. The parotid gland is most often involved, at a frequency reaching 80%. Histology examination generally shows a pleomorphous adenoma. The choice of a surgical technique best adapted to curative treatment depends on the type of tumor and is widely debated. Our management strategy is based on simultaneous histology examination and superficial parotidectomy. Several pre and intra-operative factors determine the need for resection. We verified our strategy with a retrospective study.
Endoscopic transthoracic sympathicotomy, otherwise an established treatment for palmar hyperhidrosis, was used to treat patients troubled by facial blushing, one of the commonest symptoms of social phobia. The results were evaluated by means of a questionnaire answered by 90 per cent (219/244) of the patients, who rated their symptoms on a visual analogue scale (0-10) after a mean follow-up of eight months. According to the ratings, blushing was significantly reduced from a mean (+/- SEM) of 8.7 +/- 0.1 to 2.2 +/- 0.2 (p < 0.0001). Of the series as a whole, 85 per cent declared themselves satisfied with the outcome.
Sweating and flushing of the forehead and cheeks in response to body heating, embarrassment and strong gustatory stimulation were investigated in 23 patients with a unilateral lesion in the sympathetic pathway to the face. A lesion anywhere along this pathway impaired thermoregulatory sweating and flushing on the denervated side of the forehead in most patients and also of the cheek in some cases. Emotional sweating was also diminished on the denervated side of the forehead irrespective of the site of lesion, but impairment of emotional vasodilatation was noted only with peripheral (second or third neuron) lesions. These findings suggest that sympathetic vasodilator fibres accompany vasoconstrictor and sudomotor fibres through conventional sympathetic pathways to the face. Gustatory sweating and flushing were symmetrical in most patients but flushing was more marked on the denervated side in three cases. Gustatory sweating was accompanied by flushing on the denervated side of the forehead in one patient following section of the T2 and T3 roots. It is concluded that the cervical sympathetic outflow is the main pathway for thermoregulatory flushing and emotional blushing and that diminution or absence of such vasodilator reactions is a usual component of Horner's syndrome unless the responsible lesion is confined to the first thoracic root. Gustatory vasodilatation and sweating is preserved and becomes exaggerated in some instances.
Auriculotemporal or Frey syndrome is characterized mainly by recurrent episodes of facial gustatory flushing and/or sweating, limited to the cutaneous distribution of the auriculotemporal nerve. Although relatively common in adults following injury to the auriculotemporal nerve or parotid disease, the condition has rarely been reported in children. Moreover, in childhood, auriculotemporal syndrome has been described mainly in infancy and early childhood as a sequel of perinatal birth trauma resulting from assisted forceps delivery. We report a 13-year-old girl with a 2-month history of recurrent, painless, preauricular gustatory flushing without sweating, initially suspected to be a food allergy. Detailed inquiry revealed a history of a bicycle accident with mandibular condyle fracture 7 years prior to the onset of symptoms. Our patient demonstrates an unusual presentation of auriculotemporal syndrome in late childhood as gustatory flushing mimicking food allergy. Awareness of this variant is essential for prompt recognition, thus avoiding unnecessary laboratory tests, especially as this condition usually resolves spontaneously.