Auriculotemporal Syndrome Research Articles

Postprandial facial rash in an infant.

This article describes an infant who developed a facial rash within minutes of eating certain foods. The rash resolved within 30 minutes. The patient was diagnosed with auriculotemporal syndrome or Frey syndrome, which is characterized by sweating or flushing in the preauricular area when the patient consumes certain foods, especially those that are acidic, sour, or spicy. Because most patients outgrow the syndrome, no treatment is needed.

Allergie alimentaire chez l’enfant : éviter les erreurs diagnostiques

A clinical manifestation occurring after a meal is not always caused by a food allergy. The semiological analysis, the time of onset between exposure and signs, the consideration of favorable or confounding circumstances or the selection of the probable allergen are necessary data for etiological diagnosis. There are many differential patterns depending on the clinical presentation and age, such as non-specific release of histamine, viral urticaria, auriculo-temporal syndrome, food poisoning, acute gastroenteritis for exemple. The practitioner can also be mistaken in his diagnostic approach by a wrong selection and/or interpretation of paraclinical explorations. The main purpose is to avoid inadequate medical follow-up and useless avoidance diet.

Moderní terapeutické možnosti syndromu Freyové – analýza pěti případů

Introduction: Frey‘s syndrome (SF), auriculotemporal syndrome, is an often neglected complication occurring in 6–96% of patients after parotid gland surgery according to recent studies. It arises on the basis of aberrant ingrowth of parasympathetic fi bers into the sheaths of denervated sweat glands after auriculotemporal nerve damage. The syndrome is characterized by a triad of symptoms: sweating, redness and burning or even pain in connection with food intake. Diagnosing these problems is not a time-consuming process and there are a number of therapeutic options. However, the vast majority of approaches, whether surgical or non-surgical, have only a short-term effect and carry a number of complications. The application of botulinum toxin A (BTXA) represents a relatively simple, effective and safe treatment option consisting of intradermal application of the solution according to a predetermined Frey syndrome activation map. Objectives: Presentation and evaluation of pilot results of therapeutic application of BTXA in patients dia gnosed with Frey‘s syndrome. Material and methods: Retrospective analysis of a group of 5 patients who underwent parotid gland surgery of various extents at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital at St. Anny in Brno between 2006 and 2019, in whom there was a signifi cant manifestation of SF symptoms on the basis of which BTXA was therapeutically applied. Results: Evaluating the subjective manifestations of SF in all patients in our cohort, after the application of BTXA, showed that the problems signifi cantly decreased from “annoying and reducing their quality of life” to “never” or “almost never” occurring. Objective results of the Minor test interpreted by SketchAndCalc showed a decrease in SF activation of 91.6% on average. Only two patients required re-administration of BTXA at 6 and 19 months intervals. No adverse reactions to BTXA were reported or observed with any of the patients. Conclusion: BTXA is an eff ective and safe way to treat patients with Frey‘s syndrome. Keywords: parotidectomy – Frey syndrome – auriculotemporal syndrome – gustatory sweating – botulinum A toxin

Auriculotemporal syndrome following forceps delivery.

An 8-month-old boy, born at term via vaginal delivery with forceps assistance, presented to our allergy clinic with symptoms concerning for fruit allergy. He was otherwise healthy, on no medications and without surgical history. After the introduction of solid foods at 4 months, the patient

Auriculotemporal Frey syndrome not associated with surgery or diabetes: systematic review

Patients who undergo salivary gland, neck, or facelift surgery or suffer from diabetes mellitus often develop Frey syndrome (also known as auriculotemporal syndrome or gustatory sweating). Frey syndrome has been occasionally reported to occur in subjects without history of surgery or diabetes but this variant of Frey syndrome has not been systematically investigated. We searched for original articles of Frey syndrome unrelated to surgery or diabetes without date and language restriction. Article selection and data extraction were performed in duplicate. Our systematic review included 76 reports describing 121 individual cases (67 males and 54 females) of Frey syndrome not associated with surgery or diabetes. The age at onset of symptoms was ≤ 18 years in 113 (93%) cases. The time to diagnosis was 12 months or more in 55 (45%) cases. On the other hand, an allergy evaluation was performed in half of the cases. A possible cause for Frey syndrome was detected in 85 (70%) cases, most frequently history of forceps birth (N = 63; 52%). The majority of the remaining 22 cases occurred after a blunt face trauma, following an auriculotemporal nerve neuritis or in association with a neurocutaneous syndrome. The cause underlying Frey syndrome was unknown in 36 cases. Conclusion: Frey syndrome not associated with surgery or diabetes almost exclusively affects subjects in pediatric age and is uncommon and underrecognized. Most cases occur after forceps birth. There is a need to expand awareness of this pseudo-allergic reaction among pediatricians and allergists.What is Known:• Pre-auricular reddening, sweating, and warmth in response to mastication or a salivary stimulus characterize Frey syndrome.• It usually occurs after salivary gland surgery and in diabetes.What is New:• In children, Frey syndrome is rare, and most cases occur after a forceps-assisted birth.• In childhood, this condition is often erroneously attributed to food allergy.

Frey's Syndrome: A Review of Aetiology and Treatment.

First described by Polish Neurologist Łucja Frey in 1923, Frey’s syndrome (FS), or auriculotemporal syndrome, is a rare condition characterised by gustatory sweating, typically encountered as sequelae following invasive head and neck surgery. The pathophysiology of FS can be described by aberrant reinnervation of postganglionic parasympathetic neurons to the surrounding denervated sweat glands and cutaneous blood vessels.Multiple invasive procedures have been associated with FS ranging from salivary gland surgery to burn reconstruction and thoracoscopic sympathectomies. Rarely, FS can be secondary to trauma or non-surgical aetiologies, including diabetes and infection.Physical symptoms vary based on the severity and surface area affected by FS and range from mild symptoms to severe psychosocial morbidity for patients. Surgeons operating in the head and neck, including otolaryngologists, maxillofacial surgeons, and plastic surgeons, should be aware of this potential complication and be up to date with diagnosis and treatment strategies for FS.This review article summarises the literature relating to FS focusing on its aetiologies, symptomatology, prevention, and available treatments, aiming to provide an up-to-date review of this condition for surgeons operating in the head and neck region. Although various treatment options have been suggested, these are often limited to topical agents that require life-long administration for symptom control. Further research is recommended to identify the optimal treatment for this condition and the role of surgery as a treatment for severe or refractory cases.

M234 BILATERAL GUSTATORY FACIAL FLUSHING PRESENTING FOR FOOD ALLERGY EVALUATION

Auriculotemporal syndrome is a disorder involving flushing or sweating in the auriculotemporal nerve distribution in association with eating or drinking. It rarely occurs in infancy and is typically unilateral. We present here an uncommon case of bilateral auriculotemporal syndrome that was mistaken for food allergy.

Conventional versus Modified Preauricular Incision Approaches to the Management of Temporomandibular Joint Ankylosis in Sana’a City, Yemen: A Comparative Clinical Study

Objective: To compare between the conventional and modified preauricular incision approaches to the management of temporomandibular joint (TMJ) ankylosis among Yemeni patients in Sana’a city, Yemen.
 Methods: This comparative clinical study recruited ten patients (7 males and 3 females; age range: 6–35 years) with true fully or partially bony or fibrous TMJ ankylosis. These patients were admitted to and followed up in the Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Science and Technology Hospital in Sana’a in the period from May 2013 to February 2016. Five patients with condylar capsule ankylosis were subjected to the conventional preauricular approach, while the other five cases with ankylosis that extends beyond the condylar capsule and reaches the zygomatic arch were subjected to the modified preauricular approach. Both approaches were evaluated and compared for the time required, intra- and post-operative complications and aesthetic results.
 Results: The mean times required to carry out the operations were 4.45 and 3.20 hours for conventional and modified preauricular approaches, respectively.Facial nerve injury was present in two patients undergoing the conventional preauricular approach, but this reversed to normal after four to five months. Patient of both groups experienced no facial paralysis or post-operative auriculotemporal syndrome. Intra-operative bleeding was mild to moderate among the patients of both approaches, and none of the patients required blood transfusion intra- or post-operatively. Major blood vessels were injured in three cases undergoing the conventional preauricular approach. All patients subjected to both approaches showed satisfactory aesthetic end results.
 Conclusions: Conventional and modified preauricular approaches provide excellent accessibility and visibility to the surgical field during the management of TMJ ankylosis among Yemeni patients, with the latter being slightly superior. In addition, the modified preauricular approach is associated with fewer complications, absence of facial nerve injury and reduced surgical time compared to the conventional approach.

Conventional versus Modified Preauricular Incision Approaches to the Management of Temporomandibular Joint Ankylosis in Sana’a City, Yemen: A Comparative Clinical Study

Objective: To compare between the conventional and modified preauricular incision approaches to the management of temporomandibular joint (TMJ) ankylosis among Yemeni patients in Sana’a city, Yemen.
 Methods: This comparative clinical study recruited ten patients (7 males and 3 females; age range: 6–35 years) with true fully or partially bony or fibrous TMJ ankylosis. These patients were admitted to and followed up in the Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Science and Technology Hospital in Sana’a in the period from May 2013 to February 2016. Five patients with condylar capsule ankylosis were subjected to the conventional preauricular approach, while the other five cases with ankylosis that extends beyond the condylar capsule and reaches the zygomatic arch were subjected to the modified preauricular approach. Both approaches were evaluated and compared for the time required, intra- and post-operative complications and aesthetic results.
 Results: The mean times required to carry out the operations were 4.45 and 3.20 hours for conventional and modified preauricular approaches, respectively.Facial nerve injury was present in two patients undergoing the conventional preauricular approach, but this reversed to normal after four to five months. Patient of both groups experienced no facial paralysis or post-operative auriculotemporal syndrome. Intra-operative bleeding was mild to moderate among the patients of both approaches, and none of the patients required blood transfusion intra- or post-operatively. Major blood vessels were injured in three cases undergoing the conventional preauricular approach. All patients subjected to both approaches showed satisfactory aesthetic end results.
 Conclusions: Conventional and modified preauricular approaches provide excellent accessibility and visibility to the surgical field during the management of TMJ ankylosis among Yemeni patients, with the latter being slightly superior. In addition, the modified preauricular approach is associated with fewer complications, absence of facial nerve injury and reduced surgical time compared to the conventional approach.

A Modified Preauricular Approach for Treating Intracapsular Condylar Fractures to Prevent Facial Nerve Injury: The Supratemporalis Approach

The facial nerve remains at risk of injury with the preauricular approach; thus, preservation of the functional integrity of the facial nerve is considered an important factor in the success of temporomandibular joint surgery. The aim of this study was to prevent facial nerve injury using the supratemporalis approach in the treatment of intracapsular condylar fractures. In this prospective cohort study, the population consisted of patients diagnosed with intracapsular condylar fractures who received surgical treatment from July 2005 to May 2014. Patients in the experimental group were treated with the supratemporalis approach, and patients in the control group were treated with the traditional preauricular surgical technique. The primary outcome variable was facial never injury. The continuity correction χ(2) and test Student t test were used. Eighty-four patients (112 sides) with intracapsular condylar fractures were treated surgically (56men, 28 women; mean age, 29.85yr; range, 4 to 70yr); 44 patients (64 sides) were treated with the supratemporalis approach and 40 patients (48 sides) were treated with the traditional preauricular approach. Facial contours and functions recovered well postoperatively in all 84 patients. Seven cases of facial nerve injury, 2 of which were permanent, were observed in the group treated with the traditional preauricular approach, and no facial nerve injuries were observed in the group treated with the supratemporalis approach. None of the patients sustained auriculotemporal syndrome or wound infection complications. The supratemporalis approach prevented facial nerve injury and did not increase the frequency of other complications.

Recurring Facial Erythema in an Infant.

Causes of facial rashes and erythema in infants are many but rarely only happen during feeding times which are commonly and sometimes wrongly attributed to food allergy. There is a rare condition called Auriculotemporal nerve syndrome that is characterized by recurrent episodes of gustatory facial flushing and sweating along the cutaneous distribution of Auriculotemporal nerve: the so-called Frey syndrome. This condition is most frequently observed in adults usually after parotid surgery. It is rare in children and is mostly attributed to forceps assisted delivery. It can also be misinterpreted as food allergy. Here we report a case of an infant with Frey syndrome without any history of perinatal trauma, which was considered initially as food allergy and highlights the importance of distinguishing it from food allergy.

Auriculotemporal syndrome in a 61-year-old woman

At the time this abstract was prepared, Jamie Jackson was a student in the PA program at Duquesne University in Pittsburgh, Pa. Brenda Swanson-Biearman is an assistant professor in the PA program at Duquesne University.

Frey's Syndrome Consequent to an Unusual Pattern of Temporomandibular Joint Dislocation: Case Report with Review of Its Incidence and Etiology

Frey's syndrome was first described in the 18(th) century. Recognizing it as a nonspecific condition, the symptom of gustatory sweating in patients with parotid gland inflammation was described by Duphenix and Baillarger. However, as a specific diagnostic entity, gustatory sweating, following trauma to parotid glands, was first described by Polish neurologist Lucie Frey, in 1923, and hence he proposed the term auriculotemporal syndrome. The condition is characterized by sweating, flushing, a sense of warmth, and occasional pain in the preauricular and temporal areas, following the production of a strong salivary stimulus. Several etiologies of Frey's syndrome have been mentioned in the literature; however, none attribute dislocation of the "intact" mandibular condyle as a cause of the syndrome. Reviewing its pathophysiology, etiology, and incidence in detail, we describe a case of Frey's syndrome subsequent to superolateral dislocation of the intact mandibular condyle following fracture of the anterior mandible. Its management and prevention are also discussed in brief.

Facial Flushing with Food: The Auriculotemporal Syndrome

A 25-year-old woman complained of a bilateral facial rash that developed while consuming a variety of foods, including citrus fruits and sweets. The rash had occurred throughout her life without an inciting event and was not associated with other symptoms. In clinic, the rash was reproduced within 1 min after chewing a tart candy. Auriculotemporal syndrome (AS), also known as gustatory flushing or Frey’s syndrome, is an under-recognized cause of facial erythema that is commonly mistaken for a food allergy. It is likely caused by aberrant regeneration of parasympathetic nerves that innervate sympathetic cutaneous vasculature and sweat glands, resulting in facial flushing and sweating following gustatory stimuli1. AS is typically unilateral and occurs in approximately 23 % of individuals following parotid surgery2. Trauma, inflammation, and local tumors are among reported causes in non-postoperative cases, but are not always identified by patient history. Bilateral involvement may be explained by congenital malformation, although is usually seen in infants3. The persisting symptoms described by our patient are unusual. No testing is needed to confirm the diagnosis. Treatment is usually not required, since spontaneous remission typically occurs within 2–5 years among non-postoperative cases4. For severe cases, anticholinergics, topical antiperspirants, botulinum toxin injection, or surgery provide variable success.

Delayed Frey Syndrome After Closed Treatment of Condylar Fracture

Frey syndrome is also known as auriculotemporal syndrome and gustatory sweating. It is characterized by the occurrence of hyperesthesia, flushing, and warmth or sweating over the distribution of the auriculotemporal nerve and/or greater auricular nerve while eating foods that produce a strong salivary stimulus. It is commonly seen as a complication of parotidectomy and open surgery of temporomandibular joint. It can also be caused by other forms of trauma, including blunt trauma, but rarely does it occur without trauma. The relation between fracture displacement of the condyle and Frey syndrome adds further support to the view of the intimate anatomic relationship of the auriculotemporal nerve with the capsule of the temporomandibular joint. However, despite the proximity of these structures and the high incidence of condylar fracture (25%-36% of mandibular fractures), Frey syndrome is rare after this type of fracture. Symptoms are sometimes delayed and can be very slight; often neither the patient nor the surgeon realizes their presence. The symptoms usually appear 5 weeks to 1 year after nerve damage.In this clinical report, we presented the delayed occurrence of Frey syndrome in a patient in 6 years after closed reduction of condylar fracture. One prospective study and 11 case reports describing the development of Frey syndrome after closed treatment of mandibular condyle fractures were found in the last 4 decades. Our clinical report participates to literature as a 12th case report.

Antiperspirantien bei der Behandlung der fokalen Hyperhidrose

In Europe often no clear distinction is made between deodorant and antiperspirant. Particularly in Germany, the labeling "deo" is used for both. Only antiperspirants are capable of influencing the activity of eccrine sweat glands. In the treatment of focal hyperhidrosis, the use of aluminum chloride solutions represents the first choice. The efficacy is well documented in a variety of studies. Subjective side effects include pruritus and - less often - irritant dermatitis, which can be treated symptomatically and usually does not require discontinuation of the treatment. Rare variants of focal hyperhidrosis like auriculotemporal syndrome, Ross syndrome and nevus sudoriferus also are suitable for treatment with topical aluminum chloride hexahydrate solutions.

Síndrome de Frey simulando eritema malar por alergia alimentar

OBJETIVO: Relatar um caso de síndrome de Frey em lactente, cujo eritema malar foi inicialmente associado à alergia alimentar. DESCRIÇÃO DO CASO: Lactente de um ano de idade, encaminhado ao ambulatório de alergia alimentar com eritema malar unilateral, localizado na área de distribuição do nervo auriculotemporal, após a ingestão de frutas e legumes. Nesta época, o paciente encontrava-se em dieta de restrição destes alimentos devido ao diagnóstico clínico de alergia alimentar. O paciente apresentava história de parto vaginal e tocotraumatismo. COMENTÁRIOS: O diagnóstico da síndrome de Frey (síndrome auriculotemporal ou de sudorese gustativa) foi estabelecido com base nas características clínicas do eritema malar desencadeado após a ingestão de alimentos e exclusão do diagnóstico de alergia alimentar. Nestes pacientes, o dano ao nervo auriculotemporal decorre, em geral, de tocotraumatismo, com regeneração alterada das fibras nervosas, resultando no eritema malar com a estimulação gustativa. Este caso ressalta a necessidade do diagnóstico correto da alergia alimentar, de tal modo que não sejam impostas dietas restritivas desnecessárias ao paciente. Em pacientes com eritema malar na trajetória do nervo auriculotemporal após ingestão de alimentos, a possibilidade da síndrome de Frey deve ser considerada.

Management of frey syndrome

Almost all patients who undergo parotidectomy will to some extent develop Frey syndrome (auriculotemporal syndrome or gustatory sweating) after surgery, because of aberrant regeneration of cut parasympathetic fibers between otic ganglion and subcutaneous vessels. However, only the minority of these patients needs treatment. The syndrome consists of gustatory sweating, flushing, and warming over the preauricular and temporal areas. Thick skin flap and partial superficial parotidectomy are the most important techniques to minimize the risk of developing symptomatic Frey syndrome. Intracutaneous injection of botulinum toxin A is an effective, long-lasting, and well-tolerated treatment of Frey syndrome. If recurrence occurs, the treatment can be repeated.

Síndrome de Frey en la infancia

Frey's syndrome, also known as auriculotemporal syndrome is characterized by recurrent episodes of facial flushing and/or sweating along the distribution of the auriculotemporal nerve, that occurs in response to gustatory stimuli. The disorder is rare in children. We report a 4-year-old girl with flushing without hyperhidrosis in the left cheek on eating.

Frey's Syndrome in Childhood

Frey's syndrome, also known as auriculotemporal syndrome is characterized by recurrent episodes of facial flushing and/or sweating along the distribution of the auriculotemporal nerve, that occurs in response of gustatory stimuli. The disorder is rare in children. We report a 4-year-old girl with flushing without hyperhydrosis in the left cheek on eating.