Frey's Syndrome Research Articles

Cross-sectional study on the occurrence of Frey's syndrome following superficial parotidectomy or extracapsular dissection

BackgroundMost studies that examine postoperative outcomes after parotidectomy in patients with benign parotid gland tumors are based on retrospective chart reviews. Data about long-term results in patients with parotid gland surgery with patient contact are still sparsely published. MethodsDuring the period of 1960–2005, a total of 127 patients underwent either extracapsular dissection (ECD) or superficial parotidectomy (SP) and were available for interview. Patients were questioned about their postoperative outcome after parotid gland surgery. ResultsThe mean follow-up was 21.5 years. A total of 42 and 85 patients underwent ECD and SP, respectively. No significant differences were observed in the rates of permanent facial paralysis (SP 1.2% vs. ECD 7.1%; p = 0.1053) or recurrence (SP 4.7% vs. ECD 11.9%; p = 0.1557), and Frey's syndrome was diagnosed only after SP (10.6% vs. 0% after ECD, p = 0.0293). Frey's syndrome was detected more often compared to retrospective chart analysis. ConclusionWe conclude that Frey's syndrome is underdiagnosed after SP without standardized follow-up examinations. Long-term follow-up should be applied to detect and treat gustatory sweating.

Analysis between Retromandibular and Periangular Transmasseteric Approach for Fixation of Condylar Fracture - A Prospective Study.

Introduction:Condylar fractures make up for an average of 17.5%–52% of all mandibular fractures. The aim of the present study was to compare the ease, success, and complications between retromandibular and periangular transmasseteric approaches when used for open reduction and internal fixation of condylar fractures.Materials and Methods:A total 20 cases with condylar fracture, ten each for retromandibular and periangular transmasseteric approach, were included in the study. Patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Postoperative occlusion, maximum mouth opening, range of movement, facial nerve function, visibility, convenience of plating, and time taken for exposure, fixation, and closure were recorded. Incidence of complications such as wound dehiscence, wound infection, hematoma, sialocele formation, Frey's syndrome, and hypertrophic scars were also evaluated.Results:The mean exposure time in the retromandibular approach was 10 min 31 s and 9 min 17 s in the periangular transmasseteric approach. The incidence of facial nerve injury was 2 of 10 patients in the retromandibular group and 3 of 10 patients in the periangular transmasseteric group, all of which resolved within 6 months. The incidence of sialocoele was 2 of 10 in the retromandibular group. The time taken for exposure of the fracture site was statistically significant between the two approaches (P = 0.048) with longer time required for retromandibular approach.Discussion:It can be summarized that both the approaches are comparable and well suited for surgical management of condylar fractures. It was observed that in displaced condylar neck fractures, greater difficulty was experienced in the periangular transmasseteric approach than the retromandibular approach.

Type a botulinum toxin in the management of spontaneous salivary otorrhea: a case report

BackgroundSpontaneous salivary otorrhea is a rare presentation only previously documented twice in literature where parotid salivary secretions are found in the external auditory canal. Conventional treatment of spontaneous parotid salivary fistulas includes surgical management with interposed grafts, fistula tract ablation, and possible superficial parotidectomy. Associated risks include facial nerve injury, Frey syndrome and facial scarring. Here we report the first case of spontaneous salivary otorrhea conservatively managed with a type A botulinum toxin (BTA) injection.Case presentationA 17-year-old female presented with a 5-month history of left sided otorrhea and transient left facial swelling associated with gustatory stimulation. The otorrhea fluid tested positive for salivary amylase and negative for beta 2 transferrin. Fifty units of BTA were injected into the left parotid gland under ultrasound guidance. Cessation of symptoms was achieved 3 weeks after intervention. The patient remains symptom-free at the 2 year follow up.ConclusionBTA injection was well tolerated under ultrasound guidance and has led to long-term resolution of the patient’s symptoms. BTA injection appears to be a safe and effective way to conservatively manage this rare presentation of spontaneous salivary otorrhea.

Prevention of Frey Syndrome

Prevention of Frey Syndrome

Coexistence of Frey Syndrome and Cutaneous Mastocytoma

Auriculotemporal or Frey syndrome in children is rare and often misdiagnosed as food allergy. Here, we report a case of Frey syndrome and coincidental cutaneous mastocytoma in a 6-month-old boy. In view of the benign nature of this syndrome, no therapy is recommended. This rare disease should be kept in mind in order to prevent unnecessary diagnostic tests and elimination diets.

Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases.

The aim of this study was to explore the changes in philosophy in the surgical therapy of benign parotid tumors over a period of 19 years. The records of all patients treated for benign parotid tumors between 2000 and 2018 were evaluated. Data were analyzed with respect to the number of procedures carried out per year of the study according to each of the different surgical modalities and the incidence of postoperative complications. Statistical analysis was performed using the x2 test. A P value of <.05 was considered statistically significant. A total of 2988 patients were included in this study. Our analysis showed that the increasing performance of extracapsular dissection was associated with a progressive reduction in the incidence of temporary facial nerve palsy and Frey's syndrome, while the rate of permanent facial nerve palsy remained consistently low. One of the most controversial issues in head and neck surgery is which therapeutic approach is best in patients with benign parotid tumors. Our analysis demonstrated that a change of strategy towards reducing invasiveness was possible, with exceptional functional results. Avoidance of facial nerve dissection is feasible in more than two-thirds of cases with benign tumors. 4b Laryngoscope, 130: 1941-1946, 2020.

Graft interposition for preventing Frey's syndrome in patients undergoing parotidectomy.

Graft interposition for preventing Frey's syndrome in patients undergoing parotidectomy.

Unilateral facial erythema following food chewing

A 3 yrs old girl presented with unilateral facial erythema and sweating after gustatory stimuli. She had history of mycoplasma and Brucella infection. She developed left facial palsy that has been resolved. She received antibiotics and corticosteroids. CT scan and MRI brain were normal. Interestingly, the child fulfill the clinical diagnosis of Frey syndrome. Frey's syndrome is characterized by unilateral sweating and flushing of the skin in the area of the parotid gland, occurring during meal, or on salivary stimulation. It is a common complication following surgery/injury in the parotid gland region/temporomandibular joint surgery; however, very few cases had been reported following herpetic infection. The condition may be misdiagnosed as contact dermatitis or food allergy, but these can be excluded by the normal skin texture and typical unilateral distribution on the pre-auricular area and cheek. The diagnosis is made on clinical grounds, and further testing is not needed. It is important for the clinician to recognize its unusual symptoms as early as possible to prevent its potential negative social and psychological effect on the patient. Mycoplasma infection, as in this case, is a rare cause of Frey’s syndrome. Here we highlight the importance of considering Frey syndrome in these cases as Patients can be reassured of the benign nature of the condition and that symptoms usually resolve spontaneously in children.

Evaluation of harmonic scalpel assisted extracapsular dissection for benign parotid tumors

To investigate the clinical outcomes and prognosis of harmonic scalpel assisted extracapsular dissection for benign parotid tumors. A total of 132 patients with full medical archives who were diagnosed as benign parotid tumors from 3 medical centers were retrospectively analyzed. The included patients were divided into 3 groups according to tumor positions, namely, superficial pre-auricular, superficial tail, and deep lobe. The intra- and peri-operative variables, complications, functional outcomes and recurrence rates were analyzed with SPSS 16.0 software package. The surgical and drainage time were longer and the blood loss and drainage amount were significantly greater in deep lobe group (P<0.01). Facial nerve damage occurred more frequently in deep lobe group (P=0.022), while damages of great auricular nerve and parotid fascia, as well as capsule rupture were similar among 3 groups (P>0.05). More patients with decreased sensation or sialocele were observed in deep lobe group (P=0.004, 0.043, respectively), and no significant differences were found for wound infection and Frey's syndrome among 3 groups (P>0.05).Transient facial nerve paralysis occurred more frequently in deep lobe group (P<0.01), while permanent facial nerve paralysis was similar (P=0.052). No significant difference was observed for tumor recurrence (P=1.000). HS-ECD displays good outcomes and prognosis for benign tumor of parotid gland, with improved esthetic and functional results as well as fewer complications and recurrence rate postoperatively.

Postoperative complications after removal of pleomorphic adenoma from the parotid gland: A long-term follow up of 297 patients from 2002 to 2016 and a review of publications

Pleomorphic adenomas are rounded, lumpy, capsulated lesions that are more common in women. They are typically benign, but can be associated with malignancy in a minority of cases (such as carcinoma ex pleomorphic adenoma), between 3% - 12% of the time, according to available data. The purpose of our study was to evaluate clinical outcomes in patients with benign parotid gland tumours after extracapsular dissection (ECD) or superficial parotidectomy (SP). We made a retrospective study of 297 patients who had had benign tumours of the parotid gland, and had been referred to our department from 2002 – 2016 to have either procedure. We measured the statistical differences between the two techniques (evaluated recurrence rate and complications) with the chi squared test. The chosen level of statistical significance was p<0.05. Median (range) follow-up time was 43 months (25–168) months. Haematoma and hypoaesthesia were significantly more common after SP than after ECD (8.9% compared with 7.7%, and 16.8% compared with 5.6%, respectively). Transient facial nerve injury, Frey syndrome, and facial paralysis were significantly more common after SP than after ECD (23.6% compared with 1.5%, 6.7% compared with 1% and 6,7% compared with 0%, respectively). ECD had the advantage of reduced operating time, lower morbidity and lower recurrence rate, and could be considered the treatment of choice for pleomorphic adenoma of the parotid gland up (to 3cm) which are mobile and sited in the superficial lobe of the parotid gland.

Analysis of predictors for Frey syndrome after parotidectomy

Objective:To analysis the data of the patients with parotid tumors, clarify the contributing factors of Frey syndrome, and to evaluate the role of soft tissues membrane SIS in prevention of Frey syndrome after parotidectomy. Method:The data of 95 patients who suffered from parotid tumors and underwent parotidectomy were included in this study. The relationship between the patients' age, sex, tumor location ,tumor size, disease pathology, type of resection, SIS application and the incidence of Frey syndrome were statistically analyzed . Result:The incidence of Frey syndrome after parotidectomy for 95 patients was 25.3%. Age, sex, tumor location and size, disease pathology, type of resection did not appear to be associated with development of Frey syndrome（P>0.05）. SIS application was the only statistically significant factor（P<0.01）, and SIS could prevent Frey syndrome after parotidectomy. Conclusion:Frey syndrome is one of the common complicationsafter parotidectomy. Implantation of SIS is an effective method for prevention of Frey syndrome after parotidectomy.

Partial superficial parotidectomy versus superficial parotidectomy for treatment of parotid benign tumors: evidence-based medicine analysis

Objective:The aim of this study is to systematically assess the postoperative outcomes of partial superficial parotidectomy（PSP） and superficial parotidectomy（SP） by systematic literature review and Meta-analysis, and to provide a theoretical basis for the selection of the appropriate surgical approach in clinical process. Method:Relevant studies that compared the outcomes of PSP and SP for the parotid benign tumors were searched in Pubmed, CNKI and Wanfangdata databases, and Meta-analysis was performed using software RevMan 5.0. Result:24 studies were selected for the Meta-analysis. A total of 2 795 participants were included in those studies, of whom 1 301 underwent PSP and 1 494 underwent SP. The recurrence rates for PSP and SP were 1.14%（10 of 874） and 0.6%（6 of 993）, respectively. There were no statistically significant difference in recurrence rate between PSP and SP. The rates of transient facial nerve paresis for PSP and SP were 11.60%（122 of 1 052） and 27.37%（350 of 1 279）, respectively. The rates of permanent facial nerve paralysis for PSP and SP were 1.04%（6 of 579） and 4.46%（31 of 695）, respectively. The incidences of Frey's syndrome in PSP group and SP group were 9.20%（95 of 1 033） and 30.32%（409 of 1 349）, respectively. The rate of salivary fistulafor PSP and SP were 5.38%（37 of 688） and 11.25%（65 of 578）. PSP could reduce the risk for complications compared with SP. Conclusion:This systematic review with meta-analysis suggests that PSP has a similar recurrence rate as SP, but PSP can significantly reduce the postoperativecomplications.

Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.

Clinical value of V-shaped concealed incision in parotid benign tumors

Objective:The aim of this study is to explore the clinical value of V-shaped concealed incision in parotid benign tumors surgery.Method:Thirty-two patients with benign parotid tumors who were hospitalized from January 2016 to December 2017 were selected. All patients were treated with a V-shaped incision approach, starting from the anterior dermatoglyph of the tragus,extending downward to the earlobe and backward to the posterior earlobe, which formed an intersection point of the earlobe for parotid benign tumors,superficial lobectomy and facial nerve dissection.The greater auricular nerve and parotid masseter fascia were preserved,and the occult incision and prognosis were followed up for 1 year.Result:①All patients achieved primary healing without salivary fistula and infection.The visual analogue scale (VAS) score of 32 patients with postoperative aesthetic satisfaction was 0.②Of the 32 patients,only 2 had temporary facial paralysis after operation, which returned to normal after 1 and 2 months,while the rest had no facial paralysis symptoms.③The posterior and inferior auricular branches of the greater auricular nerve were preserved in all the 32 patients, and the sensation of the lobe was numb to varying degrees after the operation. After 3 months,the sensation recovered completely.④Two patients had skin flushing and sweating on the affected cheek during masticatory exercise, while the others had no Frey syndrome. ⑤Five patients who were repaired with sternocleidomastoid muscle flaps during operation were reexamined one year after operation.There was no significant asymmetric depression on the operative side compared with the healthy side.⑥All the 32 patients were followed up for 1 year without recurrence.Conclusion:The V-shaped concealed incision is performed for benign tumor resection of the parotid gland. The incision approach is concealed and the scar is not obvious.The surgical field is clear and easy to operate.It is not easy to damage the facial nerve and the ear nerve. After the operation,the patient has a satisfactory facial shape.The parotid gland secretion function is basically normal,which is superior to the traditional S-shaped incision and has good clinical application value.

Parotid pleomorphic adenomas: Factors influencing surgical techniques, morbidity, and long-term outcome relative to the new ESGS classification in a retrospective study

PurposeTo assess long-term results after treatment of parotid pleomorphic adenomas (PPAs) with different surgical techniques, standardized according to the European Salivary Gland Society (ESGS) classification system. MethodsWe analyzed ESGS categories, occurrence of facial nerve paresis (FNP), Frey's syndrome, histopathology, and recurrences. Surgical modalities were compared, differentiating techniques with and without facial nerve dissection. A strict protocol ensured a postoperative follow-up-period of more than 7 years. Results205 patients were included. A complete follow-up was possible in 138 patients, 77 of whom underwent extracapsular dissection (ED) and 61 of whom had other surgical modalities (OSMs). ESGS categories correlated with the extent of surgery, significantly with the risk for FNP and Frey's syndrome, but not with recurrences. Recurrences did not differ significantly between ED and OSMs, whereas the risks for FNP (p < 0.001 each) and Frey's syndrome (p = 0.000) were significantly higher after OSMs in comparison with ED. Young women with a stroma-rich (myxoid) tumor subtype appear to have the greatest risk for recurrences. ConclusionED is the treatment of choice for PPAs, if possible, resulting in similar recurrence rates but significantly fewer comorbidities in comparison with more extensive surgery. After the treatment of PPAs, a long-term follow-up is needed, including imaging.

Acellular dermal matrix (Insuregraf) in the prevention of Frey's syndrome and surgical site depression after parotidectomy.

BackgroundParotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications.MethodsFrom March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey’s syndrome, surgical site depression, and patient satisfaction rate in both groups.ResultsThe incidence of Frey’s syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group.ConclusionApplication of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey’s syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.

Autologous Free Fat Graft for Repair of Concave Deformity After Total Parotidectomy.

Resectioning of giant maxillofacial tumors has been shown to cause facial depression deformity, representing a persistent challenge for surgeons. Here, the authors review their experience using autologous free fat grafts to repair total parotidectomy defects. This review aims to encourage the surgical field to pay more attention to this century-old treatment technique. Patients were included who underwent free fat transfer for tissue reconstruction after total parotidectomy at the Affiliated Stomatology Hospital of China Medical University between 2012 and 2018. Patients with bleeding disease or postoperative follow-up less than 6 months were excluded. Twenty-three patients between the ages of 35 and 68 were included in this analysis. Ten patients (6 males, 4 females) underwent fat grafting at the time of total parotidectomy, and a control group of 13 patients (9 males, 4 females) underwent total parotidectomy without correction of concave deformities. There were significant differences between fat graft group and control group in terms of age (44.9 ± 9.0117 years versus 56.385 ± 8.9586 years; P = 0.006), Frey syndrome questionnaire score (1 ± 0 versus 2.385 ± 1.0439; P = 0.00), blood loss (195.7 ± 54.8777 mL versus 107.769 ± 22.8916 mL; P = 0.001), postoperative drainage (319.8 ± 103.1803 mL versus 230.385 ± 53.5701 mL; P = 0.027), duration of postoperative drainage (122.4 ± 23.8663 hours versus 90.462 ± 22.2434 hours; P = 0.003), and satisfaction questionnaire score (8.5 ± 0.8498 versus 3 ± 1.1547; P = 0.00). The difference in operation time between the fat graft group and control group was not significant (417 ± 108.0062 min versus 351.538 ± 91.7475 min; P = 0.131). Autologous free fat grafting resulted in more blood loss as well as an increased volume and duration of postoperative drainage. Remarkably, however, patients had superior satisfaction, lower Frey syndrome scores, and similar operation times with use of free fat grafting after parotidectomy. The authors recommend such grafting be utilized to repair concave deformities secondary to total parotidectomy.

Extracapsular dissection via sternocleidomastoid muscle-parotid space approach-a new operative technique for treating clinically benign tumor in the parotid tail.

The aim of this study was to introduce extracapsular dissection via the sternocleidomastoid muscle-parotid space approach (ECD-SMPSA) as a modified operative technique for removal of clinically benign tumors from the parotid tail. The study included 52 patients with clinically benign tumors in the parotid tail, and the patients were divided into 2 groups: one group was treated with ECD-SMPSA and the other with extracapsular dissection (ECD). All of the patients were followed up for at least 2 years. The ECD-SMPSA group had lower incidence of subjective Frey syndrome (P = .03) and higher satisfaction with the cosmetic result after the surgery (P = .023) compared with the ECD group. All of the patients were free of salivary fistulae. Facial palsy (P = .234) and earlobe numbness (P = .291) were not significantly different between the groups (P < .05). With careful preoperative assessment, ECD-SMPSA may be a more suitable approach for the treatment of clinically benign tumors in the parotid tail.

Extracapsular dissection versus partial superficial parotidectomy for the treatment of benign parotid tumours

The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial superficial parotidectomy (PSP). A comprehensive literature investigation was conducted by searching electronic databases. A systematic review and meta-analysis of comparative studies were performed to assess ECD and PSP for the treatment of BPTs with fixed-effects models. The outcomes analysed were transient or permanent facial nerve injury, Frey syndrome, recurrence rate, infection, and salivary fistula/sialocele. A total of 1641 patients from seven studies (1120 ECD-treated and 521 PSP-treated patients) were included in this meta-analysis. Transient facial nerve injury (odds ratio (OR)=0.28, 95% confidence interval (CI): 0.11–0.71; p=0.008) and Frey syndrome (OR=0.12, 95% CI: 0.03–0.48; p=0.003) were less prevalent in the ECD group. The rates of permanent facial nerve injury (OR=0.77, 95% CI: 0.35–1.70; p=0.520), recurrence rate (OR=0.17, 95% CI: 0.02–1.75; p=0.14), infection (OR=0.70, 95% CI: 0.07–6.67; p=0.76), and salivary fistula/sialocele (OR=0.40, 95% CI: 0.06–2.66; p=0.350) were similar in both groups. Although there was a trend that ECD showed a reduced risk for complications, the present results are not sufficient to conclude that ECD is more beneficial than PSP.

RETRACTED: Minimal Scar Dissection for Partial Parotidectomy via a Modified Cosmetic Incision and an Advanced Wound Closure Method

To evaluate the usefulness of the modified cosmetic incision (MCI) and advanced wound closure method in partial parotidectomy by comparison with the modified Blair incision (MBI). This study retrospectively enrolled 44 patients who underwent partial parotidectomy for benign parotid tumors. These patients were divided into 2 groups: MCI group and MBI group. The MCI surgical procedures were performed via a minimal facelift incision with no preauricular incision, postauricular and hairline incision, or extensive hairline incision and an advanced wound closure method, using continuous absorbable intradermal sutures and skin adhesive. The MBI surgical procedures were performed via a conventional MBI and standard transdermal, interrupted, nonabsorbable suturing approach. The operation variables and the cosmetic results of the patients in each group were compared. A total of 23 patients underwent the MCI and advanced wound closure approach and 21 patients underwent the MBI and standard wound closure approach. No significant differences were found in gender, mean age, tumor size, or tumor site between the 2 groups (P>.05). No differences between groups were seen in operative time and intraoperative blood loss volume (P>.05). Several postoperative complications, such as facial paralysis, Frey syndrome, salivary fistula, infection, or tumor recurrence, did not differ between the 2 groups (P>.05). However, postoperative drainage volume in the MCI group was significantly lower than that in the MBI group (P<.01). Moreover, the postoperative cosmetic satisfaction, skin numbness, and scar evaluation results in the MCI group were better than those in the MBI group (P<.001). MCI combined with continuous absorbable intradermal sutures and skin adhesive for partial parotidectomy is technically feasible and safe and could produce excellent cosmetic outcomes in selected patients with benign parotid tumors.