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Yaşar EK, Polat B, Alagöz MŞ. Brief Clinical Study: An Alternative Method to Prevent Frey Syndrome After Resection of Huge Masses in Parotis: De-epithelialized Skin Flap Use. J Craniofac Surg 2023; Publish Ahead of Print:00001665-990000000-00736. [PMID: 37236619 DOI: 10.1097/scs.0000000000009417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 05/28/2023] Open
Abstract
Frey syndrome is still a significant problem in postparotidectomy patients 6 to 18 months after surgery. The most accepted theory of the pathogenesis of Frey syndrome is the aberrant regeneration theory. Creating a barrier between the remnant parotid gland and the overlying skin prevents Frey syndrome. A 51-year-old female patient who developed pleomorphic adenoma in the parotid gland was operated. After superficial parotidectomy, a barrier between the underlying postganglionic parasympathetic nerves in the deep parotid gland and the overlying cutaneous tissue was created with a local skin flap to prevent Frey syndrome. The patient was successfully treated, and she was followed up to 5 years. No postoperative complications were observed. No signs of Frey syndrome were found in follow-up. This case highlights that local skin flaps can be an innovative natural method as it is a quick and simple method to create this barrier in the presence of expanded skin.
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Affiliation(s)
- Emrah Kağan Yaşar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kocaeli University Faculty of Medicine Plastic, Kocaeli, Turkey
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Ganesan A, Rao B. Frey's syndrome: A misdirected reflex action!! – A case report. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2021. [DOI: 10.4103/jiaomr.jiaomr_207_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim J, Kim M, Kim Y, Lee HL. A Case of Frey's Syndrome Diagnosed and Followed Up Using the Quantitative Sudomotor Axon Reflex Test. J Clin Neurol 2019; 15:585-587. [PMID: 31591854 PMCID: PMC6785473 DOI: 10.3988/jcn.2019.15.4.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jaehwan Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Minkyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - YeEun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Lim Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Martin H, Jayasinghe J, Lowe T. Superficial parotidectomy versus extracapsular dissection: literature review and search for a gold standard technique. Int J Oral Maxillofac Surg 2019; 49:192-199. [PMID: 31301925 DOI: 10.1016/j.ijom.2019.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/24/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Abstract
Benign parotid tumours usually present as a slow-growing, asymptomatic mass in the pre-auricular region. Although they are uncommon, surgical excision is the mainstay of treatment due to the risk of malignant transformation in some benign tumours. Surgical techniques have evolved over the years, with superficial parotidectomy and extracapsular dissection being the current procedures of choice. There is currently no gold standard, and it remains unclear which surgical modality is the superior option. A literature review was performed in relation to the relative merits of each technique and to evaluate the reasons underpinning the ongoing debate. A total of 16 papers comparing the main clinical outcomes of the procedures were critically reviewed using the PRISMA protocol. Overall, extracapsular dissection indicated a reduced recurrence rate, facial nerve paralysis, Frey syndrome, and operation time. The superior outcomes following extracapsular dissection could be attributed to the less radical nature of the procedure. However, there were various limitations identified within the review that may have affected the results. Selection bias was the most significant, with patients assigned to the different procedures depending on the tumour size and location. Consequently, the debate continues as to what constitutes the gold standard of care for benign parotid tumours.
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Affiliation(s)
- H Martin
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - J Jayasinghe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - T Lowe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
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Abstract
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 have been reported of its occurrence following herpetic infection. 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. It is diagnosed on clinical presentation and confirmed by objective testing methods. The treatment ranges from topical application of glycopyrrolate to local injections of botulinum toxin and lastly to surgical intervention. An interesting case of Frey's syndrome is presented in a young patient having the previous history of herpes zoster infection, which was diagnosed clinically and confirmed by starch-iodine test and was successfully treated with topical application of glycopyrrolate.
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Affiliation(s)
- Jigna S Shah
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Vijay K Asrani
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
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Nofal AAF, Mohamed M. Sternocleidomastoid Muscle Flap after Parotidectomy. Int Arch Otorhinolaryngol 2015; 19:319-24. [PMID: 26491478 PMCID: PMC4593913 DOI: 10.1055/s-0035-1549155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/23/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.
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Affiliation(s)
| | - Morsi Mohamed
- Department of General Surgery, Zagazig University, Zagazig, Egypt
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de Carvalho LRT, Nina CSR, Fernandes MHL, Parro YM, Macedo SB, Lia EN. Frey's syndrome: diagnosis in geriatric dentistry. Gerodontology 2013; 31:153-5. [PMID: 23534673 DOI: 10.1111/ger.12040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Abstract
Frey's syndrome, is characterized by warmth, flushing and sweating of the face, most of time in the preauricular region, initiated by any gustatory stimulus. It is frequently related to parotid surgery. A case of Frey's syndrome in a 81-year-old female whose long-delayed clinical onset post-parotidectomy is presented.
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Nadershah M, Salama A. Removal of Parotid, Submandibular, and Sublingual Glands. Oral Maxillofac Surg Clin North Am 2012; 24:295-305, x. [DOI: 10.1016/j.coms.2012.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
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.
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Zeng XT, Tang XJ, Wang XJ, Li MZ, Guo Y, Huang W, Niu YM, Leng WD. AlloDerm implants for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis. Mol Med Rep 2012; 5:974-80. [PMID: 22266670 PMCID: PMC3493056 DOI: 10.3892/mmr.2012.762] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/18/2012] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Xian-Tao Zeng
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, PR China
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Sanabria A, Kowalski LP, Bradley PJ, Hartl DM, Bradford CR, de Bree R, Rinaldo A, Ferlito A. Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: A systematic review. Head Neck 2011; 34:589-98. [DOI: 10.1002/hed.21722] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2010] [Indexed: 11/09/2022] Open
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Botulinum toxin A for quality of life improvement in post-parotidectomy gustatory sweating (Frey's syndrome). The Journal of Laryngology & Otology 2008; 122:1100-4. [DOI: 10.1017/s0022215108001771] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To measure patient-reported quality of life before and after botulinum toxin A treatment of post-parotidectomy Frey's syndrome (gustatory sweating).Patients and methods:A questionnaire concerning functional, social and emotional aspects of Frey's syndrome (14 questions, with responses on a zero to three point scale) was administered to 17 patients (13 women and four men) before and one month after intradermal injection of botulinum toxin A. Parotidectomy had been performed one to 19 years previously, for benign (n = 10) or malignant (n = 7) tumours, with gustatory sweating occurring a median of 15 months after surgery (range: one month to 14 years). Pre- and post-treatment quality of life scores were compared using Wilcoxon's test (p < 0.05).Results:Patients' reported functional quality of life improved significantly (p = 0.0004). Their social and emotional scores were not significantly modified (p = 0.155 and 0.142, respectively). Seven patients (41 per cent) found the injections painful, but all patients said that the effects were beneficial, that they would undergo new injections if necessary and that they would recommend this treatment to other patients. The benefit lasted over 1.5 years for 60 per cent of patients. No correlation was found between duration of the effect and the extent of parotidectomy (p = 0.067).Conclusions:Botulinum toxin A significantly improved patients' functional quality of life, without significant improvement in their social or emotional quality of life, according to our questionnaire results. The duration of the effect was longer than the reported physiological effect of botulinum toxin A on acetylcholine receptors.
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Abstract
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.
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Affiliation(s)
- Remco de Bree
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Bakke M, Max Thorsen N, Bardow A, Dalager T, Eckhart Thomsen C, Regeur L. Treatment of gustatory sweating with low-dose botulinum toxin A: a case report. Acta Odontol Scand 2006; 64:129-33. [PMID: 16809188 DOI: 10.1080/00016350600555743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Frey's syndrome, gustatory sweating in the preauricular area, is an unpleasant phenomenon occurring during meals after surgery on the parotid gland. Recently, botulinum toxin A (BTX) has been shown to reduce the symptoms, but the variation in the reported doses is large. OBJECTIVE To quantify the effect of treatment with low-dose BTX in a case of Frey's syndrome over a period of 6 months. MATERIAL AND METHODS A 56-year-old woman was treated with 10 U Botox given as 20 single, intracutaneous injections of 0.5 U, one for each cm(2), 3 years after resection of the parotid gland. Before treatment and repeatedly during the 6-month period, the sweating was rated subjectively on a 100-mm visual analog scale (VAS) and by a severity index, and objectively by assessment of the extent of the involved skin area using Minor's iodine-starch test, staining the area of sweating dark. RESULTS The treatment decreased the involved area from 20 to 5 cm(2) and the VAS ratings from 98 to 8 mm. The index showed that treatment affected the sweating intensity, not the frequency. After the 6-month period the patient was still satisfied, but the involved skin area had increased; however, not entirely to pretreatment values. CONCLUSIONS The effect of BTX injections for gustatory sweating obtained in this case was comparable to results reported using higher doses. Low doses of BTX can therefore be used in the treatment of Frey's syndrome, but studies to clarify the dose-response relationship, in terms of both time-course and obtained effect, are needed.
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Affiliation(s)
- Merete Bakke
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Costa Orvay JA, González Enseñat MA, Vicente Villa MA, Morales Castillo E, Campistol Plana J. Síndrome de Frey en la infancia: una enfermedad muy infrecuente. An Pediatr (Barc) 2006; 64:595-6. [PMID: 16792970 DOI: 10.1157/13089928] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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