Abstract
Frey's syndrome is a complication of parotidectomy that is thought to occur as a result of aberrant regeneration of the postganglionic parasympathetic nerve fibres supplying the parotid gland to severed postganglionic sympathetic fibres which innervate the sweat glands of the face. Frey's syndrome is difficult to treat but is a preventable phenomenon and surgeons must be aware of the available preventative methods during the initial surgery. An unusual case is presented involving a patient with delayed onset of Frey's syndrome 40 years after parotidectomy in childhood. The potential for this long-delayed clinical presentation should be discussed with the patient before surgery in the parotid gland. Diagnostic methods, preventive measures and management options are briefly discussed.
Highlights
Frey’s syndrome consists of gustatory discomfort, sweating and flushing of the skin overlying the parotid area which may be associated with pain in the auriculotemporal nerve distribution
Frey’s syndrome can be socially debilitating and because of the difficulty in its management, preventive measures should be instituted during the initial surgery
Frey’s syndrome is a disorder characterised by unilateral sweating and flushing of the facial skin in the area of the parotid gland occurring during meals
Summary
Frey’s syndrome consists of gustatory discomfort, sweating and flushing of the skin overlying the parotid area which may be associated with pain in the auriculotemporal nerve distribution. A previously well 47 year old housewife presented to the surgical clinic with a 1 year history of worsening right-sided facial gustatory sweating and flushing associated with headaches and dizziness. She explained that the gustatory sweating was socially embarrassing and she was desperate for a solution. Physical examination confirmed a right cervico-mastoid-facial incision from the previous parotidectomy (Figure1) She helpfully offered to show the signs as she munched on an apple and the gustatory sweating and flushing where immediately apparent as shown in figure 2. She was subsequently referred to the ear nose and throat (ENT) clinic for definitive management
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