Comparisons of Three Indicators for Frey's Syndrome: Subjective Symptoms, Minor's Starch Iodine Test, and Infrared Thermography

Mitigating complications rate in parotid gland tumor surgery by reconstruction technique with SurgiMend®: a retrospective, single-center, observational study on 300 consecutive patients

BACKGROUND

Salivary gland tumors have an incidence of 1 out of 100,000 people every year, representing 2-4 % of the head and neck tumors. Consensually, radical surgery is the choice in parotid tumors. Despite improvements in surgical and anatomy-preserving strategies, several complications exist in this surgery. Frey Syndrome is caused by an aberrant regeneration of parasympathetic nerve fibers of the auriculotemporal nerve after parotidectomy.

PURPOSE

The purpose of the present study was to compare the surgical complication rate differences between patients undergone parotid gland tumor surgery with reconstruction performed by traditional methods (Group A), and by SurgiMend (Group B).

STUDY DESIGN, SETTING, AND SAMPLE

The clinical, surgical, and monitoring data of 300 consecutive patients operated at our Institution between 2017 and 2020 were assessed for statistical deductive purposes, shaping a cohort retrospective monocentric observational study.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE/MAIN OUTCOME VARIABLE

The primary outcome variable was the rate of Frey Syndrome. Secondary outcomes were the other complication rates, including surgical site infections, dehiscence, hypertrophic scars, seromas, hematomas, and temporary and permanent facial nerve palsy.

ANALYSES

To conduct the statistical study, we used descriptive and deductive analyses. We employed the Fisher's Exact test for both analyses. All statistical tests were "two-tailed", and significance was set to an α-error <0.05. Statistical differences between groups A and B on the categorical postoperative complications were investigated for deductive purposes.

RESULTS

This study demonstrated the SurgiMend reconstruction to be significantly associated with a lower rate of Frey Syndrome and hypertrophic scar for parotid gland tumor surgery.

CONCLUSION

and relevance: Our study, through sustained and homogeneous follow-up on patients with benign tumors of the parotid gland, associated with a large, representative, and homogeneous sample, allows us to assert the genuineness and reliability of the minor Frey Syndrome and hypertrophic scars rates for benign parotid tumor surgery.

Surgical management of benign tumors of the parotid gland: the advantages of extracapsular dissection compared to traditional surgical techniques

INTRODUCTION

Salivary gland tumors represent only 3%-6% of all head and neck neoplasms, and approximately 70% of these tumors are located in the parotid gland. Most of these tumors are found in the more abundant superficial portion of the parotid gland, lateral to the facial nerve (FN). For many years, the location of the facial nerve between the superficial and deep segments of the parotid gland hindered adequate tumor extirpation. Several surgical options are available for the treatment of benign tumors in the parotid gland, but there remains no universal agreement on what the optimal surgical treatment is. In the early twentieth century, tumor enucleation was the standard treatment for parotid tumors to preserve the facial nerve, but high recurrence rates were the main downside of this procedure. To improve the outcome, superficial parotidectomy (SP) was implemented, which involves excision of the entire lateral segment of the parotid gland, superficial to the facial nerve. However, this surgical procedure may lead to severe postoperative complications, including facial nerve paralysis, in a significant number of patients. In recent years, more gland-preserving techniques were developed to reduce complication rates and improve the safety of procedures and patients' satisfaction, without increasing the risk of recurrence.

MATERIALS AND METHOD

This study compares our surgical experience with extracapsular dissection gland-sparing surgery (ECD) to traditional superficial parotidectomy in 56 patients who underwent surgery performed by the same surgical team.

RESULTS

The superiority of ECD procedures compared to SP procedures was shown as far as total complication rates are concerned. In this case, Fisher's exact test statistic value was 0.0043 (significant at P < 0.05).

CONCLUSION

ECD should be applied in properly selected cases and further prospective studies are needed to clarify the optimal indications.

To Evaluate the Success of Sialendoscopy Assisted Intraoral Approach for Removal of Submandibular Hilar Stones

To assess the success of sialendoscopy assisted intraoral approach for removal of hilar stone of submandibular gland. To evaluate the ductal system for any concomitant pathology. Conventionally the treatment for submandibular hilar stones has been gland excision. Being an open procedure, sialadenectomy has its own range of complications. After the advent of sialendoscopy there has been a paradigm shift in the management of hilar stones. The current study was done to evaluate the success of sialendoscopy assisted intraoral approach for removal of submandibular hilar stones. The sample size was 30. A diagnostic sialendoscopy was performed followed by intraoral dissection using "the surgical triangle approach" defined by Park et al. The light of sialendoscope was used as a marker of intraoral incision which was given lateral to sublingual gland in the floor of mouth corresponding to the last three teeth. The surgical triangle was exposed which was bounded by the lingual nerve, medial border of mandible and posterior border of mylohyoid muscle. The hilum lies within this triangle and hence incision was given on the duct and stone retrieval was done. 88.8% of palpable submandibular hilar stones and 66.7% of the non palpable stones could be removed. 87.5% of hilar stones and 83.3% of hiloparenchymal stones could be removed. 86.7% of the glands can be preserved by this approach for management of large submandibular hilar and hiloparenchymal stones. Using this approach non palpable stones can also be removed.

Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix

BACKGROUND

Frey syndrome, also known as ototemporal nerve syndrome or gustatory sweating syndrome, is one of the most common complications of parotid gland surgery. This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes, visual stimuli, or eating.

AIM

To investigate the preventive effect of acellular dermal matrix (ADM) on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection.

METHODS

Retrospective data from 82 patients were analyzed to assess the correlation between sex, age, resection sample size, operation time, operation mode, ADM usage, and occurrence of postoperative Frey syndrome.

RESULTS

Among the 82 patients, the incidence of Frey syndrome was 56.1%. There were no significant differences in sex, age, or operation time between the two groups (P > 0.05). However, there was a significant difference between ADM implantation and occurrence of Frey syndrome (P < 0.05). ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes.

CONCLUSION

ADM can effectively prevent Frey syndrome and delay its onset.

Prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures: a systematic review and meta-analysis

Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.

Prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures: a systematic review and meta-analysis

Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.

The Current State of Optical Sensors in Medical Wearables

Optical sensors play an increasingly important role in the development of medical diagnostic devices. They can be very widely used to measure the physiology of the human body. Optical methods include PPG, radiation, biochemical, and optical fiber sensors. Optical sensors offer excellent metrological properties, immunity to electromagnetic interference, electrical safety, simple miniaturization, the ability to capture volumes of nanometers, and non-invasive examination. In addition, they are cheap and resistant to water and corrosion. The use of optical sensors can bring better methods of continuous diagnostics in the comfort of the home and the development of telemedicine in the 21st century. This article offers a large overview of optical wearable methods and their modern use with an insight into the future years of technology in this field.

Frey's Syndrome: A Review of Aetiology and Treatment

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.

Moisture Response Films Versus the Starch Iodine Test for the Detection of Palmar Hyperhidrosis

BACKGROUND

The starch iodine test (SIT) is the gold-standard diagnostic tool for primary palmar hyperhidrosis (PPH).

OBJECTIVE

This study aimed to evaluate the clinical effectiveness and safety profile of a novel approach for the detection of PPH by moisture response films (MRF) in comparison to the SIT.

METHODS

This prospective comparative study of the 2 tests was conducted on 17 patients with PPH. Disease severity was evaluated by the SIT and the MRF methods during 4 sessions (twice before and twice after botulinum toxin [BTX] injections) on different days and by different investigators. The physician's global assessment (PGA) scoring of the comparable visual results was evaluated by 2 blinded independent dermatologists. The Hyperhidrosis Disease Severity Scale (HDSS) scores of the patients at baseline and after the BTX injections were correlated with the SIT and MRF results.

RESULTS

The objective PGA scoring of the SIT results demonstrated poor correlation, whereas the objective PGA scoring of the MRF results correlated highly with the patients' HDSS scores both at baseline and after the BTX injections.

CONCLUSION

Analysis of palmar hyperhidrosis by means of MRF was superior to SIT and was demonstrated to be more efficient, convenient, and accurate.

Autonomic Cross-Innervation in Patients With Neurofibromatosis Type 2: Frey Syndrome and Unilateral Epiphora With Rhinorrhea

The authors present 2 cases of cross-innervation in patients with neurofibromatosis type 2. In the first case, an iodine test was performed to demonstrate Frey syndrome in a 28-year-old female with neurofibromatosis type 2 who developed symptoms at age 10 years. The second patient is an 18-year-old female with neurofibromatosis type 2, 2 years status post left vestibular schwannoma subtotal resection who presented with paradoxical unilateral lacrimation and rhinorrhea triggered by heat stress and exercise. The pathophysiology of these cases is discussed.

[Diagnostic test for detection of cervical lymph node metastasis from oral squamous cell carcinoma via infrared thermal imaging]

OBJECTIVE

To evaluate the diagnostic performance of a non-invasive, non-radiating, economical and convenient infrared thermal imaging in the detection of oral squamous cell carcinoma (OSCC) cervical lymph node metastasis, and evaluate its applicability via parallel test and series test.

METHODS

This study was a prospective clinical study which passed the ethical review by the Biomedical Ethics Committee, Hospital of Stomatology, Peking University, and had been submitted for clinical trial registration. Totally 74 OSCC patients who were to undergo a neck dissection were included in this study. The inclusion criteria were patients who: (1) were pathologically diagnosed as malignant tumors and planned to undergo surgical treatment including neck dissection; (2) agreed to participate in this study. The exclusion criteria were those who: (1) had undergone surgeries at head and neck previously; (2) with a history of systemic tumor adjuvant therapies such as radiotherapy or chemotherapy etc; (3) were unwilling or unable to cooperate. Basal information as well as clinical examination results were collected, such as physical examination and contradictive enhanced CT. Besides, infrared thermal imaging was done ahead of surgery. Analysis of the diagnostic power of infrared thermal imaging followed the principles of diagnostic test. The positive signs of infrared thermal imaging were: (1) asymmetric thermographic pattern including vascular pattern in ROI; (2) thickening image of unilateral facial artery/vein, submental artery/vein or external carotid artery; (3) surface temperature of ROI raised over 1 °C compared with the opposite side; (4) changes of neck profile with abnormal temperature pattern. The gold standard of this diagnostic test was pathology diagnosis of cervical lymph nodes.

RESULTS

The sensitivity of infrared thermal imaging was 75.0%, while the specificity was 69.0%, accuracy was 71.6%, positive predictive value was 64.9% and negative predictive value was 78.4%. The sensitivity of parallel test which stood for the combination of infrared thermal imaging and conventional clinical examinations was 87.9% while the specificity of series test was 97.6%.

CONCLUSION

Infrared thermal imaging is a promising non-invasive, non-radiating and economical tool in the detection of cervical lymph node metastasis from OSCC when combined with conventional pre-operative examination.

Auriculotemporal nerve syndrome (Frey's syndrome): A literature review and case report

Frey's syndrome in children is rare and often erroneously attributed to food allergy. A description of a case of Frey's syndrome in a child and a review of the literature is provided. Awareness of this condition is important for the pediatric dentist to avoid unnecessary medical procedures and provide reassurance to the dental team in the setting of this benign condition.

Challenges to Global Implementation of Infrared Thermography Technology: Current Perspective

Medical infrared thermography (IT) produces an image of the infrared waves emitted by the human body as part of the thermoregulation process that can vary in intensity based on the health of the person. This review analyzes recent developments in the use of infrared thermography as a screening and diagnostic tool in clinical and nonclinical settings, and identifies possible future routes for improvement of the method. Currently, infrared thermography is not considered to be a fully reliable diagnostic method. If standard infrared protocol is established and a normative database is available, infrared thermography may become a reliable method for detecting inflammatory processes.

Acute autonomic neuropathy with severe gastrointestinal symptoms in children: a case series

Background

Acute autonomic neuropathy (AAN) is rare disorder with anecdotal report, especially for childhood onset patients. Misdiagnosis or delays in treatment can always be found in clinical practice. We conducted this study to give a description of the manifestations and treatment of AAN in children and therefore help clinicians to make the accurate diagnosis early so that the prognosis of the patients can be improved.

Methods

A systematic record from 3 clinical centers was used to identify 11 subject, 3 males and 8 females, with clinical diagnosed AAN.

Result

The age ranged from 2 years and 4 months to 14 years and 6 months (mean, 9 ± 3.6 years old) and the course from onset to diagnosis ranged from 7 days to 8 months. All children shared prominent initial symptoms, 7 with frequent vomiting and 4 with motor dysfunctions. The condition of 9 patients improved after treatment of IVIg and intravenous glucocorticoid.

Conclusion

The clinical manifestations of AAN are diverse, generalized, and non-specific. Gastrointestinal disorders were the most common initial symptoms. Symptoms of gastrointestinal system and abnormal secretion of glands were severe and more common than other symptoms. The mechanism of AAN remains unknown. Although IVIg and intravenous glucocorticoid can be used in clinical practice, there is still no treatment recommendation and further study is needed.

Minor's Test: Objective Demonstration of Horner's Syndrome

To highlight the Minor's test, which is useful in demonstrating anhidrosis of Horner's syndrome. A 39 year old female presented to us with a slow growing neck swelling which was provisionally diagnosed as a probable case of cervical sympathetic chain (CSC) Schwannoma. Intra operatively, the mass was found arising from the CSC which was sacrificed. Post operatively, Horner's syndrome was expected, but was difficult to demonstrate clinically. On performing the Minor's test, the presence of anhidrosis, and thus Horner's syndrome was confirmed. Minor's test is a simple objective test to demonstrate Horner's syndrome, especially because diagnosis from the eye signs can be difficult.