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PubMedDate not supplied

Auriculotemporal (Frey) syndrome in late childhood: an unusual variant presenting as gustatory flushing mimicking food allergy.

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.

Adolescent↗
PubMedDate not supplied

The Frey syndrome: a simple, effective treatment.

The benign but socially embarrassing problem of gustatory sweating and flushing (Frey syndrome) has been studied in the past in search of a simple but effective treatment. Twenty-two patients participated in clinical trials of glycopyrrolate on an investigational basis, 17 of which have been followed up for four to five years. Double-blind comparisons of the efficacy and side effects of topical scopolamine (solution and cream) and glycopyrrolate (roll-on lotion, solution, and cream) are also presented. The use of 1% glycopyrrolate roll-on lotion and cream were associated with an average of three days of complete control of gustatory sweating and a remarkably low incidence of side effects.

Administration, Topical↗
PubMed1997

Early results using a porcine dermal collagen implant as an interpositional barrier to prevent recurrent Frey's syndrome.

Frey's syndrome is a common complication of salivary gland surgery. Although it is usually preventable by raising the skin flap in the superficial musculoaponeurotic system layer, the treatment of the established condition often requires further surgery. There are many surgical options to treat this condition. The method described in this paper avoids the morbidity of a second operative site by using a biocompatible interpositional layer to prevent the sweat glands of the skin being inappropriately cross-innervated. The follow-up period on both patients was 12 months. This factor needs to be taken into account despite the early improvement observed.

Adenoma, Pleomorphic↗
PubMed1986

Frey's syndrome.

Frey's syndrome is a form of gustatory hyperhidrosis that develops following surgery, trauma, or disease of the parotid gland area. Several theories have been proposed to explain the resulting symptomatology. Treatment often is difficult or ineffective. An unusual case is presented involving a patient with delayed onset of symptoms who responded well to topical application of 20% aluminum chloride in anhydrous ethyl alcohol.

Aluminum Hydroxide↗
PubMed2001

[Frey syndrome after lateral parotidectomy. Follow-up and therapeutic outlook].

BACKGROUND: Gustatory sweating is a common complication of parotid surgery. PATIENTS AND METHODS: In order to evaluate the incidence of Frey's syndrome following superficial parotidectomy, 69 patients who underwent surgery due to adenoma were studied. Forty-three patients (62%) suffered from gustatory sweating following superficial parotidectomy, and 33 of them requested treatment. Nineteen patients felt that their quality of life had been decreased by the symptoms. RESULTS: Minor's starch iodine test proved that 85% of the patients who did not notice Frey's syndrome after surgery actually had a subclinical manifestation. Eight patients were successfully treated with intracutaneous injections of botulinum toxin A. Within 1 week gustatory sweating disappeared. CONCLUSION: Frey's syndrome is present in almost all patients following superficial parotidectomy and there is a strong need for treatment. Intracutaneous injection of botulinum toxin A is an effective treatment in severe cases of the syndrome.

Adenoma↗
PubMed1995

[Therapy of Frey syndrome with botulinum toxin A. Experiences with a new method of treatment].

The effectiveness of botulinum toxin for the treatment of Frey's syndrome is demonstrated. Since December 1993, 14 patients with severe symptomatic gustatory sweating have been treated at the ENT Department, University of Göttingen. Botulinum toxin A (approximately 0.5 U/cm2) was injected intracutaneously into the affected skin area as determined by Minor's starch iodine test. Gustatory sweating in the treated skin area ceased completely within 2 days and did not reappear during the period of following (13 months maximum follow-up). There were no side effects. Findings show that local botulinum toxin injections are a highly effective, safe and minimally invasive treatment for Frey's syndrome. Moreover, this could be a new therapeutic tool for other forms of hyperhidrosis.

Adult↗
PubMed2002

[Treatment of Frey syndrome with intracutaneous injections of botulinum toxin].

In a prospective study, we have examined the efficacy of intracutaneous injections of botulinum toxin in Frey's syndrome. In a controlled study, the long term results after surgical treatment for parotid tumors were investigated in 98 consecutive patients. Patients, who reacted positive by Minor's iodine-starch test, and who had subjective complaints too, were offered treatment. A total of four patients entered the study. The affected area was visualised by Minor's iodine-starch test. The coloured areas were injected with botulinum toxin (Botox) 2.5 U/0.1 ml. We injected 0.5 U/cm2. The distance between each injections points was 1 cm. All patients became free of symptoms. The injections were given with little discomfort to the patients and no side effects. At the control one year after the injections three patients had minor recurrent complaints, which were treated successfully by reinjections. Botulinum toxin injections are thus safe and effective in the treatment of FS.

Adult↗
PubMed1999

Recurrent gustatory sweating (Frey syndrome) after intracutaneous injection of botulinum toxin type A: incidence, management, and outcome.

OBJECTIVE: To evaluate the duration of effectiveness of intracutaneous injection of botulinum toxin type A for gustatory sweating as well as the incidence, severity, management, and outcome of recurrent gustatory sweating. DESIGN: An inception cohort with a minimum of 18 months of follow-up. SETTING: A tertiary care center and university teaching hospital. PATIENTS: Thirty-three patients with severe gustatory sweating. INTERVENTION: Intracutaneous injection of 25 to 175 IU (mean, 86 IU) of botulinum toxin type A. MAIN OUTCOME MEASURES: Analysis of the effectiveness of the intracutaneous injection of botulinum toxin type A using the Kaplan-Meier actuarial life-table method; completion of the Minor starch-iodine test in patients without symptomatic recurrent gustatory sweating; and the patients' self-assessment of the severity of the recurrent gustatory sweating. RESULTS: The 1-, 2-, and 3-year actuarial estimate for symptomatic recurrent gustatory sweating was 27%, 63%, and 92%, respectively. In the 7 patients without symptomatic recurrent gustatory sweating, the Minor starch-iodine test revealed persistent gustatory sweating in 6, resulting in an overall 97% rate (32 of 33 patients) for recurrent gustatory sweating. No statistical relationship could be demonstrated between the duration of effectiveness, the incidence of recurrent gustatory sweating, the severity of recurrent gustatory sweating, and the following variables: age, sex, cause of gustatory sweating, skin surface involved, and dose of botulinum toxin type A injection. Within the group of 26 patients with symptomatic recurrent gustatory sweating, (1) the severity of the recurrent gustatory sweating was always reduced when compared with the severity of the initial gustatory sweating, and (2) the recurrent gustatory sweating always remained amenable to reinjection of botulinum toxin type A. CONCLUSIONS: The present series demonstrated a linear regression in the effectiveness of the intracutaneous injection of botulinum toxin type A in patients with gustatory sweating, while no factors appeared to be statistically related to the duration of effectiveness and/or the incidence of recurrent gustatory sweating. However, because the severity of recurrent gustatory sweating is reduced when compared with the severity of the initial gustatory sweating and because recurrent gustatory sweating remains amenable to reinjection of botulinum toxin type A, we believe that the intracutaneous injection of botulinum toxin type A should become the first-line treatment option in patients with gustatory sweating.

Adolescent↗