S2024 Don’t Sweat the Swallowed Stuff: A Case of Frey’s Syndrome After Surgical Correction of Dysphagia Lusoria

Abstract

INTRODUCTION: Dysphagia is a fairly common patient presentation, but dysphagia lusoria is not a common etiology. Fortunately, it is a correctable problem, but sometimes complications can arise from the treatment. CASE DESCRIPTION/METHODS: A 67-year-old white male with past medical history of gastroesophageal reflux disorder (GERD), paranoid schizophrenia, Barrett’s esophagus, lung cancer, and chronic obstructive pulmonary disease (COPD) was referred to Gastroenterology Clinic for dysphagia. He reported that symptoms developed gradually and worsened to the point that he experienced weight loss because of decreased oral intake. Previous EGDs by the local surgery service showed no evidence of strictures, rings, or other abnormalities to explain his dysphagia. Patient then underwent a barium esophagram which showed extrinsic compression upon the posterior esophagus from an aberrant right subclavian artery. At this point, he was diagnosed with Dysphagia Lusoria, a “rare embryologic defect of the aortic arch vasculature characterized by an aberrant retro-esophageal course of the right subclavian artery (RSA), comprising a vascular sling.”1 He underwent a successful right subclavian to right common carotid artery bypass which resulted in complete resolution of dysphagia. However, on return to clinic, he complained of sweating on the right side of his face whenever he chews while eating. DISCUSSION: In the setting of previous neck surgery, he was diagnosed with Frey’s Syndrome, an “aberrant reinnervation of postganglionic parasympathetic neurons to nearby denervated sweat glands and cutaneous blood vessels. Consequently, this results in flushing and sweating in the sympathetically void skin in response to mastication and salivation.”2 Although usually in the setting of parotid gland surgery, it has been reported to occur after neck dissection surgeries. He is currently utilizing topical antiperspirant applied to the face with a plan for Botox injection by Otolaryngology if there is no improvement with antiperspirant use.Figure 1.: Barium esophagram images showing external compression in upper mediastinum.Figure 2.: CT Chest showing an aberrant right subclavian artery causing compression on the posterior esophagus.