Management of Frey syndrome

Quality of life following surgical treatment of benign parotid disease

To evaluate the quality of life after surgery for benign neoplastic disease of the parotid gland. Forty-nine patients who underwent surgery for benign parotid disease between January 2004 and December 2008 were included in this retrospective study. EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used to determine the quality of life. The variables of these questionnaires were compared with age, gender, educational status, histopathologic diagnosis and Frey syndrome. A statistically significant correlation was noted between the female gender and post-surgical pain, sleeplessness and the use of non-steroid anti-inflammatory drugs (p < 0.001). There was a significant difference between age and difficulties in moving the mouth (p < 0.001). Frey syndrome related to social functions, economical difficulties, speech defect, reduced sexuality, and nutritional parameters were found to be statistically significant (p < 0.001). Frey syndrome is the most common complication that affects the quality of life in patients who had parotidectomy due to a benign parotid disease. Therefore, all patients should be informed about Frey syndrome before parotidectomy.

Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery?

BACKGROUND

Optimal surgery for pleomorphic adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid pleomorphic adenoma capsule and its influence on surgery.

DATA SOURCES

PubMed literature searches were performed to identify original studies.

CONCLUSIONS

Almost all pleomorphic adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.

Salivary gland carcinomas

INTRODUCTION

Salivary gland carcinomas are rare tumours of heterogeneous morphology that require distinctive surgical and adjuvant therapy.

METHODS

Relevant studies were electronically searched in PubMed and reviewed for innovative and important information.

RESULTS

Recent insights in genetic alterations like chromosomal aberrations, expression of receptor tyrosine kinases, malfunction of tumour suppressor genes or DNA promoter methylations increased the knowledge about aetiology and pathogenesis. New histological subtypes are recognised, and a three-tiered grading system seems reasonable. Ultrasound remains the basic diagnostic imaging procedure. New developments comprise the diffusion-weighed magnetic resonance imaging, while fluorodeoxyglucose positron emission tomography/computed tomography shows good diagnostic accuracy in detecting distant metastases and local recurrence. Fine-needle aspiration cytology helps in differentiating a neoplasia from a non-neoplastic lesion while being unreliable in recognising malignancy. In contrast, additional core needle biopsy and/or intraoperative frozen section diagnosis increase the accuracy in diagnosing a malignant lesion. Conservative parotid surgery with nerve monitoring remains state-of-the-art. Free flaps or musculoaponeurotic flaps are proposed for prevention of Frey's syndrome. As parotid cancer often shows skip metastases, complete ipsilateral neck dissection (level I-V) is indicated particularly in high-grade lesions. Adjuvant radio(chemo)therapy increases local tumour control, whereas overall survival is not necessarily improved. Current results of systemic chemotherapy or targeted therapy in advanced tumour stages are disappointing.

CONCLUSION

Despite several developments, salivary gland carcinomas remain a heterogeneous group of tumours challenging both pathologists and clinicians.

Two-stage surgical approach with dermofat graft and lipofilling for the treatment of established Frey syndrome and facial depression deformity

Frey syndrome and facial contour deformity commonly occur after parotid surgery. Although the treatment of established Frey syndrome has focused on medical solutions, surgical solutions to established Frey syndrome have been less reported. Moreover, these methods may not resolve the facial depression. In the presented case here, we used 2-stage surgical approach with dermofat graft and lipofilling for the treatment of established Frey syndrome and facial depression deformity. We considered that this technique provides the easiest, most practical, satisfying, and effective solution for Frey syndrome that develops in the late follow-up period after superficial parotidectomy.

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.

AlloDerm implants for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis

Although Frey syndrome is not life-threatening, it is identified as the most serious and widely recognized sequela of parotidectomy and has significant potential negative social and psychological implications. Several studies have investigated whether AlloDerm® implants prevent Frey syndrome effectively and safely, however, the conclusions are inconsistent. We aimed to evaluate the precise effectiveness of AlloDerm implants for preventing Frey syndrome after parotidectomy, using a systematic review and meta-analysis. We searched randomized and quis-randomized controlled trials in which AlloDerm implants were compared to blank controls for preventing Frey syndrome after parotidectomy, from the PubMed, Embase, the Cochrane Library and the ISI Web of Knowledge databases, without any language restriction. Two reviewers independently searched, identified, extracted data and assessed methodological quality. Relative risks with 95% confidence intervals were calculated and pooled. Five articles involving 409 patients met the inclusion criteria. Meta-analyses showed a significant 85% relative risk reduction in objective incidence (RR=0.15, 95% CI 0.08-0.30; P<0.00001) and 68% in subjective incidence (RR=0.32, 95% CI 0.19-0.57; P<0.00001) of Frey syndrome with AlloDerm implants; there was a significant 91% relative risk reduction in salivary fistula (RR=0.09, 95% CI 0.01-0.66; P=0.02); there was no statistical significance for the incidence of facial nerve paralysis (RR=0.96, 95% CI 0.84-1.09; P=0.51); there was no statistical significance for the incidence of seroma/sialocele (RR=1.36, 95% CI 0.66-2.80; P=0.40); there was a trend for a small effect in improving facial contour. Adverse events related to AlloDerm implants were not found. There is evidence that AlloDerm reduces the incidence of Frey syndrome effectively and safely, and also has the potential to improve facial contour and decrease salivary fistula. However, it is unclear whether AlloDerm implants improve facial contour and decrease other complications. Thus, further controlled evaluative studies incorporating more precise measures are required.

A succinct review of botulinum toxin in dermatology; update of cosmetic and noncosmetic use

Botulinum toxin A has a wide variety of clinical applications in medical and dermatologic sciences. Nowadays, researchers introduce some other indications for botulinum toxin in cosmetic and especially noncosmetic aspects of dermatology such as medical rhinoplasty, hypertrophic scar, chemical brow lift, supraciliary wrinkles, pompholix, eccrine angiomatosis, Hailey-Hailey, dermatochalasis, lichen simplex, nosthalgia parestetica, and granulosis rubra nasi. In this general overview of the use of botulinum toxin in dermatology, an extensive literature search was carried out to updates of all dermatology-oriented experiments and clinical trials on the mentioned aspect of botulinum toxin.

Frey's syndrome--unusually long delayed clinical onset post-parotidectomy: a case report

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.

Parotid carcinoma: Current diagnostic workup and treatment

In this review we present recent progress in diagnostic workup, prognostic evaluation, treatment options and resulting outcomes. Whenever possible, complete resection remains the mainstay of treatment. Sacrifice of facial nerve branches is reserved for the clinically or electromyographically dysfunctioning facial nerve. Clinical or radiological neck disease demands combined surgery and radiotherapy. Treatment of the N0 neck is indicated for advanced stage-high grade tumors but the question remains unanswered whether this should be surgical or radiotherapeutic elective treatment. Surgery alone will cure low stage, low grade tumors, that show no additional negative prognostic factors following adequate resection. In all other tumors postoperative radiotherapy will improve locoregional control. This approach results in good locoregional control, in a way that distant metastasis remains the typical presentation of treatment failure. In this setting, the results of systemic treatment today remain limited, but a huge effort in the molecular biology field has been done to introduce targeted therapy into this domain of head and neck cancer. Disease control remains variable within the patient population. This variation can increasingly be predicted by systems that incorporate the combined information of multivariately identified and quantified prognostic factors into an individualized prognosis for the parotid carcinoma patient.

Familial auriculotemporal nerve (Frey) syndrome

Auriculotemporal nerve (Frey) syndrome in children is rare, and may be misdiagnosed as food allergy. Trauma to the auriculotemporal nerve during forceps-assisted delivery has been implicated in about half of the reported childhood Frey syndrome cases and most patients present with unilateral involvement. We describe two Caucasian sisters with bilateral Frey syndrome, neither of whom was delivered with forceps assistance, and highlight its distinction from food allergy. Frey syndrome may occur in a familial pattern, and in the absence of a history of perinatal trauma.