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PubMed1999

Prevention of Frey's syndrome and volume deficit after parotidectomy using the superficial temporal artery fascial flap.

Frey's syndrome (gustatory sweating) is thought to be caused by aberrant regeneration to the sweat glands of the face. We present a double-layered fascial flap based on the superficial temporal artery which can be used to cover the parotid bed at the time of parotidectomy and consists of both the temporoparietal fascia and the fascia over the temporalis muscle. We used this superficial temporal artery fascial flap (STAFF) in 24 of 47 patients reviewed after parotid surgery and found a significantly lower incidence of gustatory sweating and a far less noticeable post-parotidectomy volume deficit or 'hollow'.

Adolescent↗
PubMedDate not supplied

Frey's syndrome: treatment with topical glycopyrrolate.

Gustatory sweating and flushing of the facial skin, or Frey's syndrome, is fairly common after parotidectomy. The most likely mechanism is aberrant reinnervation of the sweat glands of the face by the severed parotid parasympathetic nerve fibers. A survey of 61 patients having undergone parotidectomy yielded 29 (47.5%) with gustatory sweating. Twenty-three percent (14 patients) considered the symptoms severe. In a double-blind study, five of those 14 patients were alternately treated with topically applied placebo and with glycopyrrolate (an anticholinergic agent) as 0.5% lotion, 2% lotion, and 2% cream. All five patients showed some improvement with the test preparations, but had longer lasting and more effective lessening of symptoms with the 2% glycopyrrolate preparations. There were no adverse side effects. We therefore believe that the topical application of a 2% glycopyrrolate preparation is a safe and effective treatment for severe gustatory sweating following parotidectomy.

Administration, Topical↗
PubMed2001

The use of acellular dermis in the prevention of Frey's syndrome.

EDUCATIONAL OBJECTIVE: At the conclusion of this presentation, the participant should be able to discuss the indications and advantages of using acellular dermis in the prevention of post-parotidectomy gustatory sweating (Frey's Syndrome). INTRODUCTION: Gustatory sweating is a common postoperative problem and a challenge to treat. The purpose of this study was to evaluate the role of acellular dermis in preventing post-parotidectomy gustatory sweating. METHODS: Sixty-four patients were randomly assigned to two groups. Group I consisted of 32 patients who underwent a superficial lobe parotidectomy. Group II consisted of 32 patients who underwent a superficial lobe parotidectomy and underwent intraoperative placement of acellular dermis within the parotid bed, between the skin flap and the remaining parotid tissue. The implanted volume of acellular dermis was determined by the amount required to aesthetically restore lateral facial contour. All 64 patients were evaluated for gustatory sweating by identical phone and mail questionnaires. Thirty randomly chosen patients (group I = 15, group II = 15) were evaluated using a modified Minor's Starch-Iodine Test (MSIT). In all 30 patients, the MSIT was administered to both sides of the face. RESULTS: The responses to questionnaires (N = 64) demonstrated the subjective presence of gustatory sweating in 3 of 32 patients (9.3%) in group I, whereas group II demonstrated a subjective incidence in 1 of 32 patients (3.1%). The objective incidence determined by those who underwent the MSIT (n = 30) revealed a 40% (6) and 0% incidence of Frey's Syndrome in groups I and II, respectively. The complication rate in group I was 9% (3 seromas) and in group II it was 25% (7 seromas and 1 wound infection). CONCLUSIONS: Acellular dermis appears to be an effective method for preventing post-parotidectomy gustatory sweating, despite its higher complication rate.

Biocompatible Materials↗
PubMed2026

Long-Term Survey to Assess Recurrence and Complications of Surgically Treated Pleomorphic Adenoma.

OBJECTIVE(S): To (1) report on the long-term recurrence rate of surgically managed pleomorphic adenoma (PA) and (2) assess long-term surgical outcomes after parotidectomyMethods:Cross-sectional survey of all patients with a pathologic diagnosis of PA who underwent surgical management in a tertiary care center from 01/1997 to 12/2023 and had access to an electronic patient portal. Surveys were delivered via electronic patient portal or phone call with 6 questions to assess recurrence and long-term surgical outcomes. Time to first recurrence and recurrence free survival were analyzed using a Kaplan-Meier curve. RESULTS: Seven hundred-forty-five patients met inclusion criteria and received the survey, with a 56% response rate (n&#x2009;=&#x2009;420). The clinical median follow-up length was 51&#x2009;days, which extended to a median length of 6.2&#x2009;years following the survey. The median change in follow-up length was 5.37&#x2009;years (P&#x2009;<&#x2009;.001). The recurrence rate was 1% at 5&#x2009;years, with a median time to first recurrence of 7.54&#x2009;years. 13% and 9% of responders reported facial asymmetry and incisional cosmetic concerns, respectively. 33% of patients reported experiencing Frey syndrome, which increased from 5.2% of survey responders with documented Frey syndrome at their original post-operative assessment. CONCLUSION: Long-term assessment of PA outcomes confirms low recurrence rates, suggesting regular surveillance of recurrence is likely unnecessary. Complaints of Frey syndrome increased in frequency with longer term follow-up, which should be considered during patient counseling. LEVEL OF EVIDENCE: 3.

Humans↗
PubMed1989

[Two cases of Frey's syndrome].

During the taking of meals, complex symptoms such as perspiration, rubor, and febrile sensation can appear on the skin overlying the temporal area or the parotid gland after the passage of some time after an operation in the parotid area or trauma inflicted to this area. This phenomenon is usually called Frey's syndrome. We recently encountered two cases of this syndrome. The patients were a 16-year-old boy who developed this syndrome following open reduction of the fractured left temporomandibular articular process and a 72-year-old man who developed it following left hemimandibulectomy and left radical neck dissection performed for the treatment of left mandibular gingival cancer. Frey's syndrome is a relatively rare surgery-associated complication. However, it may be advisable to inform the patient of this possibility prior to an operation, because patients may be severely afflicted by heavy perspiration if this syndrome develops over an extensive area.

Adolescent↗
PubMed1991

Frey's syndrome following parotid surgery.

Twenty-one patients were followed up with a home visit after having parotid surgery at the Westmead Centre between January 1988 and October 1989. Nine of these patients (42.8%) had objective gustatory sweating as proven by Minor's Starch Iodine Test, with three of these (14.3%) having symptoms of Frey's syndrome. Symptoms started an average of 4.3 months after surgery. None of the three were anxious enough about their symptoms to seek medical treatment. Those patients with objective gustatory sweating were more likely to be women. No statistical significance was found in regard to the presence or absence of greater auricular nerve section, facial nerve paresis, age or type of operation (superficial parotidectomy or otherwise). Frey's syndrome is a benign condition and explanation and reassurance are usually adequate therapy.

Adult↗
PubMed1976

Frey's syndrome after parotid surgery.

The operative records of seventy-one patients who had parotid surgery carried out in the ten year period from 1964 to 1973 were reviewed. Forty-one (67%) of the operations were suprafacial parotidectomies. Of the fifty patients who agreed to reassessment in a special clinic, seventeen had a noticeable degree of Frey's syndrome, and of these fourteen were submitted to further investigations. Minor's test in these fourteen patients showed the greater auricular nerve to be involved in six patients, the ariculotemporal nerve in four, and both nerves in two. The results in two patients were inconclusive. Because the starch test reveals only the distribution of the gustatory sweating, a useful adjunct is described for investigating Frey's syndrome. By blocking of the contralateral greater auricular nerve in the neck and mapping out of the anesthetized area, its sensory distribution is demonstrated. We conclude that it is manifestly unwise to avulse the auriculotemporal nerve if the sweating occurs in the distribution of the greater auricular nerve.

Adolescent↗
PubMed2002

The role of gustatory flushing in Frey's syndrome and its treatment with botulinum toxin type A.

After parotid surgery, gustatory sweating and flushing occur more frequently, the former reportedly in 15-100% of cases, while no reliable data are available for the latter. Although botulinum toxin (BoNT) is effective in controlling sweating, little is known about its effect on flushing. In 17 patients suffering from Frey's syndrome after parotid surgery, we studied the gustatory flushing phenomenon as compared to gustatory sweating, analyzing their frequency, area, type of stimulus and response to BoNT administration. Cutaneous blood flow (CBF) was monitored by laser Doppler flowmetry (LDF) on affected and unaffected areas of the cheek in basal conditions and after meals, before and then 1 month after starting the BoNT injections. The Minor test was used to identify the sweating area. Flushing was observed in 7 of 17 patients after masticatory activity, spicy meals or citrus fruits. No clinical data correlated with any presence of flushing. Flushing regressed completely after BoNT administration and CBF reached similar values in the affected and unaffected sites. No adverse effects were observed. BoNT administration proved an effective and safe treatment for gustatory sweating and flushing in patients with Frey's syndrome.

Adult↗
PubMed1991

[Frey's syndrome (gustatory sweating) after fracture of the temporomandibular joint].

Damage of the auriculo-temporal nerve with consecutive Frey's syndrome (gustatory sweating) can occur with fractures of the temporomandibular joint (TMJ) as a result of the anatomic proximity. A case of marked gustatory sweating as a rare complication of a mandibular joint fracture and alternation of therapy are reported.

Fracture Fixation, Internal↗
PubMed2002

The significance of the margin in parotid surgery for pleomorphic adenoma.

OBJECTIVES/HYPOTHESIS: Superficial parotidectomy dramatically reduced the high rates of tumor recurrence that occurred with simple enucleation of parotid pleomorphic adenoma (PPA). However, there is not agreement in the medical literature confirming the exact margin of parotid tissue to be resected to avoid recurrence. Worldwide, SP and/or partial superficial parotidectomy (PSP) is commonly practiced for the treatment of PPA. In Europe and Asia, reports covering a spectrum from total parotidectomy (TP) to extracapsular dissection (ECD) are common. The outcomes (capsular exposure, tumor-facial nerve interface, capsular rupture, recurrence, facial nerve dysfunction, and Frey syndrome) from surgical treatment of mobile, superficial PPA smaller than 4 cm are not significantly altered by surgical approach (TP, PSP, or ECD). STUDY DESIGN: Retrospective series of pathological specimens were correlated with their clinical outcomes to compare TP, PSP, and ECD. Historical data review and meta-analysis were also performed. METHODS: Matched pairs of 60 pathological specimens of PPA (20 cases treated by TP, PSP, and ECD, respectively) were compared for capsular exposure and the degree of cellularity of tumors. Statistical analysis of the respective rates of tumor-facial nerve interface, capsular rupture, recurrence, permanent and transient facial nerve dysfunction, and Frey syndrome was performed. RESULTS: Focal capsular exposure occurs in virtually all parotid surgery for PPA, regardless of the type of operation (margin). Dissecting PPA from the facial nerve led to a positive margin in 25% of cases. Capsular rupture does result in a significantly higher rate of recurrence and did not vary among surgical approaches (TP, PSP, and ECD). Tumor-facial nerve interface did not vary significantly by surgical approach. A less complete parotidectomy did not result in a higher rate of recurrence. Less parotid tissue sacrifice did not result in a lower rate of permanent facial nerve dysfunction, although it did result in significantly less transient facial nerve dysfunction and Frey syndrome. Hypocellular tumors did not have a higher incidence of capsular rupture or recurrence. Multicentric PPA was not identified in the clinically negative deep lobe for TP specimens. The most common cause of recurrence for PPA today is enucleation. CONCLUSIONS: The major outcomes of surgical treatment for small PPA (capsular exposure, tumor-facial nerve interface, capsular rupture, recurrence, and permanent facial nerve dysfunction) are not significantly altered by the amount of parotid tissue sacrifice (TP, PSP, or ECD). More complete parotidectomy results in higher rates of transient facial nerve dysfunction and Frey syndrome. Focal capsular exposure occurs in virtually all cases of parotid surgery for PPA. Dissecting PPA from the facial nerve results in cases with positive margins because of incomplete capsule or perforating pseudopodia. Few separations of pseudopodia from the main tumor occur with expertly performed contemporary parotid surgery because most of the PPA has a margin of normal parotid tissue. Minimal margin surgery in ECD is not recommended.

Adenoma, Pleomorphic↗
PubMed1998

[Treatment of Frey's syndrome with botulinum A toxin].

A 74-year-old woman suffered from severe gustatory sweating and flushing of the preauricular skin following parotidectomy (Frey's syndrome). She was treated with intracutaneous botulinum A toxin injections in the affected skin area. Minor's test was used to determine the extent of the affected area. Within one week, the symptoms disappeared. After three weeks, Minor's test was repeated and showed minimal residual hyperhidrosis. These small areas were treated again. No side effects were noted. At follow-up one year later, the patient was free of symptoms.

Aged↗
PubMedDate not supplied

Variation's in the use of SMAS (superficial musculoaponeurotic system) to prevent Frey's syndrome after parotidectomy.

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.

Face↗
PubMed1997

Frey's syndrome after parotidectomy: a retrospective and prospective analysis.

Gustatory sweating is a well-known sequela after parotid surgery. In a retrospective and prospective study of patients undergoing parotid surgery, the onset, time course, extent, and treatment modalities of Frey's syndrome were analyzed. Twenty-two percent of the patients evaluated by questionnaires and 43% of the patients followed prospectively within 1 year were found to be symptomatic. Although the Minor starch-iodine test was positive in 38% of patients at 3 months, none of these patients experienced symptoms. Up to 12 months after surgery the rate of patients who tested positive increased to 96% and the total area of sweating expanded to a mean value of 18 cm2. Whereas most of the patients are not markedly disturbed, few patients (5% to 10%) suffer from severe gustatory sweating. These patients present a therapeutic challenge.

Adenoma, Pleomorphic↗
PubMed1975

[The free dermis fat transplantation as adjunct in the surgery of the parotid gland (author's transl)].

In order to overcome the short comings of a total parotidectomy in reference to appearance and the possible Frey syndrom, the author proposes the free dermis fat transplant directly after the extirpation of the gland. This diminishes the formation of serous fluid in the operated area. Long term observations showed no signs of the Frey syndrome. Further experimental research and clinincal observations will determine if the free fat transplantation is a workable method to prevent the Frey syndrom.

Adipose Tissue↗
PubMed2005

[Sixty-two cases report of surgical treatment of parotid pleomorphic adenoma].

OBJECTIVE: To define the most appropriate surgical modality for parotid pleomorphic adenoma (PPA). METHODS: Sixty-two cases with PPA who underwent surgical treatment from January 1996 and December 2003 were reviewed retrospectively. The course of disease before treatment, tumor size, surgical modality, post-operative histopathological findings, recurrence and the complications were analyzed. RESULTS: There have been no recurrence in all 44 patients operated by superficial parotidectomy (SP), in all 16 patients operated by partial superficial parotidectomy plus partial deep parotidectomy (PSP + PDP), and in all 2 cases operated by total parotidectomy (TP). Pathological findings showed that in 6 cases (10%) the capsule of PPA was incomplete in focal areas and leaded to instances of positive margins, and in 28 cases (45%) the proliferation and mitosis were found in tumor cells with capsule invasion. 2 cases (4.5%) treated by SP had transient facial nerve dysfunction, while none of the 16 cases treated by PSP + PDP had facial nerve dysfunction. Frey syndrome occurred in 8 cases (18%) treated by SP, in 2 cases (13%) treated by PSP + PDP and in all 2 cases (13%) treated by total parotidectomy. The total rate of Frey syndrome in all 62 cases was 19.3%. CONCLUSIONS: For the superficial PPA smaller than 4 cm, surgical procedure of PSP + PDP is as efficacy as SP, with relatively lower rates of complications like facial nerve dysfunction and Frey syndrome.

Adenoma, Pleomorphic↗