An unusual cause of Frey syndrome

Intraparotid Location of the Great Auricular Nerve: A New Anatomical Basis for Gustatory Sweating Syndrome

BACKGROUND

Gustatory sweating syndrome (also known as Frey syndrome or auriculotemporal nerve syndrome) is thought to result from a lesion of the auriculotemporal nerve. A lesion of this nerve can lead to aberrant regeneration of nerve fibers to the sweat glands and blood vessels. The occurrence of signs outside the region of the auriculotemporal nerve prompted the author to search for another anatomical basis for this syndrome.

METHODS

The author dissected 46 great auricular nerves from their origin to the parotid gland and in the infratemporal fossa. The author investigated the different connections of the great auricular nerve with the facial nerve and the auriculotemporal nerve.

RESULTS

The great auricular nerve was found to essentially be a parotid nerve. There was a set of intraparotid nerve connections on 14 of the 46 half-heads that were dissected. The author was able to discern three types of parotid great auricular nerve connections, which he designates as either type 1, connection with the trunk of the facial nerve and its branches; type 2, connection with the auriculotemporal nerve; or type 3, connection with the auriculotemporal nerve and the facial nerve with the formation of an intraparotid nerve circle.

CONCLUSIONS

Having clearly established the nerve connections of the great auricular nerve, the author believes that it is primarily this nerve that is responsible for gustatory sweating syndrome. This allows for a better understanding of the sympathetic nervous system features and the manifestation of the syndrome outside the region of the auriculotemporal nerve.

Perioral gustatory sweating: case report

OBJECTIVE

Presentation of a case of perioral Frey syndrome.

DESIGN

Case report.

SUBJECT

A 72-year-old woman with hyperhidrosis around the mouth and chin.

RESULTS

This patient suffered from bilateral perioral gustatory sweating following a mandibular osteotomy; such a case has not previously been described. Possible pathophysiological hypotheses are discussed in relation to the anatomy and innervation of the salivary glands.

CONCLUSION

Perioral gustatory sweating is a rare complication of osteotomy.