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Abstract
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.
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Affiliation(s)
- Angelos Mantelakis
- Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
| | - George Lafford
- Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
| | - Chang Woo Lee
- Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, GBR
| | - Harry Spencer
- Plastic and Reconstructive Surgery, St. George's University Hospitals NHS Foundation Trust, London, GBR
| | - Jean-Luc Deval
- Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Anil Joshi
- Otolaryngology - Head and Neck Surgery, Lewisham and Greenwich NHS Trust, London, GBR
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Dell'Aversana Orabona G, Salzano G, Abbate V, Piombino P, Astarita F, Iaconetta G, Califano L. Use of the SMAS flap for reconstruction of the parotid lodge. Acta Otorhinolaryngol Ital 2017; 35:406-11. [PMID: 26900246 PMCID: PMC4755052 DOI: 10.14639/0392-100x-395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of our study was to evaluate the benefits of the SMAS flap in patients with benign tumours of the parotid gland treated by superficial parotidectomy. We carried out a retrospective chart review on 123 patients suffering from benign tumours of the parotid gland admitted to our Institution between March 1997 and March 2010. A superficial parotidectomy was performed in all the cases reported. Our sample was divided in two groups basing SMAS flap reconstruction done (Group 2) or not (Group 1) after superficial parotidectomy. Reconstruction using SMAS flap was accomplished in 64 patients. Chi-square test was used to assess statistical difference between the two groups. The level of statistical significance was P < 0.05. No significant differences concerning hematoma, wound infection and facial paralysis were observed between the first and second group (3.38 vs 1.56% [P > 0.05], 8.47% vs 4.68% [P > 0.05], 5.08% vs 0.00% [P > 0.05]). Transient facial nerve weakness, fistula, dip skin and Frey's syndrome were significantly more frequent without SMAS flap reconstruction (10.16% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 20.33% vs 0% [P < 0.05] respectively). The use of the SMAS flap is able to reduce the cosmetic and functional complications that occur after the removal of a benign tumour of the parotid through the superficial parotidectomy technique, above all, it reduces the occurrence of Frey's syndrome.
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Affiliation(s)
- G Dell'Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - G Salzano
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - V Abbate
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - P Piombino
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - F Astarita
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - G Iaconetta
- Neurosurgery Department, University of Salerno, Salerno, Italy
| | - L Califano
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
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Bayır Ö, Çelik EK, Saylam G, Tatar EÇ, Saka C, Dağlı M, Özdek A, Korkmaz MH. The Effects of Superficial Musculoaponeurotic System Flap on the Development of Frey's Syndrome and Cosmetic Outcomes After Superficial Parotidectomy. Turk Arch Otorhinolaryngol 2016; 54:158-164. [PMID: 29392039 DOI: 10.5152/tao.2016.1987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the outcomes of superficial musculoaponeurotic system (SMAS) flap and classic techniques in superficial parotidectomy in terms of Frey's syndrome (FS) and cosmetic satisfaction. Methods In this study, a retrospective chart review of patients that underwent superficial parotidectomy was performed. These patients were divided into two subgroups: group 1 included patients in which the SMAS flap was harvested and group 2 comprised the remaining patients on whom classic superficial parotidectomy was performed. All the patients were evaluated clinically and with Minor's starch-iodine test for FS. For the evaluation of the cosmetic results, the patient's satisfaction was queried according to the incision scar and surgical field skin retraction/facial symmetry. Both groups were compared in terms of complications and numbness of surgical area. Results Fifty-five patients (31 male and 24 female) with a mean age of 50.19 years were included in the study. Thirty-two patients were in group 1 and 23 in group 2. Thirteen patients (23.7%) described as having FS and six of them were in group 1, while seven were in group 2. Minor's starch-iodine test was positive in nine patients in group 1 (28.1%) and six patients in group 2 (26.1%) (p=1.000). With regard to cosmetic satisfaction, eight patients (25%) stated mild discomfort from the incision scar and two patients (6.3%) stated cosmetic dissatisfaction for facial asymmetry in group 1. In group 2 for the same factors the number of patients were 11 (47.8%) and 2 two (8.7%), respectively (p=0.027). There were no statistically significant differences in means of complication and numbness (p>0.05). Conclusion According to our study results, there was no superiority between both the groups in terms of FS and incision scar satisfaction. We determined that there was a significant benefit of SMAS flap application in the prevention of volume loss and surgical area retraction.
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Affiliation(s)
- Ömer Bayır
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Elif Kaya Çelik
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cem Saka
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muharrem Dağlı
- Department of Otolaryngology, Head and Neck Surgery, Abant İzzet Baysal University School of Medicine, Bolu, Turkey
| | - Ali Özdek
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology, Head and Neck Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Ruiz M, Porta-Etessam J, Garcia-Ptacek S, de la Cruz C, Cuadrado ML, Guerrero AL. Auriculotemporal Neuralgia: Eight New Cases Report. Pain Med 2016; 17:1744-8. [PMID: 26921888 DOI: 10.1093/pm/pnw016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/18/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Auriculotemporal neuralgia (ATN) is an infrequent syndrome consisting in strictly unilateral pain in the temporal region associated with nerve tenderness, which can be successfully treated with anesthetic blockade. We analysed clinical characteristics and treatment response in a series of eight patients. METHODS Series of consecutive patients diagnosed with ATN at Headache Clinics of two university hospitals in Spain. Data on demographic and pain characteristics, as well as response to treatment are presented. RESULTS Eight patients (seven women). Mean age at onset was 52.8 ± 14.3 years. Pain was strictly unilateral (left-sided in five cases, right-sided in three), and triggered by pressing the preauricular area. Four patients presented background pain, mostly dull in quality, with an intensity of 5.75 ± 1.2 on the verbal analogical scale (VAS). In six, burning exacerbations occurred, ranging from 2 seconds to 30 minutes, with intensity 7.3 ± 1.5 on VAS. Complete relief was achieved with gabapentin in three cases, anaesthetic blockade in three and spontaneously in two. CONCLUSION ATN is uncommon in headache units. Gabapentin is a good alternative therapeutic option to anesthetic blockade.
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Affiliation(s)
- M Ruiz
- *Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Spain
| | - J Porta-Etessam
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - S Garcia-Ptacek
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Geriatrics, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - C de la Cruz
- *Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Spain
| | - M L Cuadrado
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - A L Guerrero
- *Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Spain;
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Lafont M, Whyte A, Whyte J, Saura E, Tejedor M. Frey syndrome: factors influencing the time to event. Int J Oral Maxillofac Surg 2015; 44:834-9. [DOI: 10.1016/j.ijom.2015.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/21/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
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Demirci U, Basut O, Noyan B, Demir UL, Afsin Ozmen O, Kasapoglu F, Hakan Coskun H, Onart S. The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response. Indian J Otolaryngol Head Neck Surg 2014; 66:291-8. [PMID: 24533401 PMCID: PMC3918314 DOI: 10.1007/s12070-012-0492-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022] Open
Abstract
The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis.
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Affiliation(s)
- Ugur Demirci
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Oguz Basut
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Behzat Noyan
- />Department of Physiology, Uludag University Medical Faculty, Bursa, Turkey
| | - Uygar Levent Demir
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - O. Afsin Ozmen
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Fikret Kasapoglu
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - H. Hakan Coskun
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Selcuk Onart
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
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Choi HG, Kwon SY, Won JY, Yoo SW, Lee MG, Kim SW, Park B. Comparisons of Three Indicators for Frey's Syndrome: Subjective Symptoms, Minor's Starch Iodine Test, and Infrared Thermography. Clin Exp Otorhinolaryngol 2013; 6:249. [PMID: 24353866 PMCID: PMC3863675 DOI: 10.3342/ceo.2013.6.4.249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/25/2013] [Accepted: 08/18/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To correlate Frey's syndrome with subjective symptoms, Minor's starch iodine test results, and infrared thermography measurements, and to discuss the utility of thermography as a quantitative diagnostic method. METHODS This study included 59 patients who underwent unilateral parotidectomy. A subjective clinical questionnaire and an objective Minor's starch iodine test were performed to evaluate the incidence of Frey's syndrome. Infrared thermography was performed, and the subjects were divided into seven groups according to the temperature differences between operated and unoperated sites. The thermal differences were correlated with the results from Minor's starch iodine test and the subjective symptoms questionnaire. RESULTS Of the 59 patients, 20 patients (33.9%) reported subjective symptoms after eating; 30 patients (50.8%) tested positive for Minor's starch iodine test, 19 patients (63.3%) of which reported subjective symptoms. Of the 29 patients who were negative for the iodine test, 2 patients (6.9%) reported subjective symptoms. Thus, subjective symptoms were well correlated with Minor's starch iodine test (r=0.589, P<0.001). As the thermal differences with infrared thermography increased, the number of patients with subjective symptoms increased (χ(2)=22.5, P<0.001). Using infrared thermography, the mean temperature difference in the positive group for the iodine test was 0.82℃±0.26℃, and that in the negative group was 0.10℃±0.47℃. With increased thermal differences, more patients showed positivity in the iodine test (χ(2)=29.9, P<0.001). CONCLUSION Subjective symptoms, Minor's starch iodine test, and infrared thermography are well correlated with one another. Quantitative thermography provides clues for the wide variation in the incidence of Frey's syndrome, and could be a useful method for diagnosing and studying Frey's syndrome.
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Durgut O, Basut O, Demir UL, Özmen ÖA, Kasapoglu F, Coskun H. Association between skin flap thickness and Frey's syndrome in parotid surgery. Head Neck 2013; 35:1781-6. [DOI: 10.1002/hed.23233] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Osman Durgut
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Oguz Basut
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Uygar Levent Demir
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Ömer A. Özmen
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Fikret Kasapoglu
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
| | - Hakan Coskun
- Department of Otolaryngology; Uludağ University Medical School; Nilufer-Bursa Turkey
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