Clinical analysis of Frey syndrome incidence of 202 cases after parotidectomy / 实用口腔医学杂志

Clinical data of Frey syndrome of 202 cases after excision of parotid gland were analysed.Frey syndrom was observe in 22 out off 1 49 cases(1 4.7%)received block processing of sympathetic (SN)and parasympathetic (PN)nerve anastomosis and in 1 4 out off 53 (26.4%)without the block processing(P≤0.01 ).The block processing of SN and PN anastomosis is effective for the prevention of postop-erative Frey syndrome after parotidectomy.

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

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 (chi2=22.5, P<0.001). Using infrared thermography, the mean temperature difference in the positive group for the iodine test was 0.82degrees C+/-0.26degrees C, and that in the negative group was 0.10degrees C+/-0.47degrees C. With increased thermal differences, more patients showed positivity in the iodine test (chi2=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.

Frey Syndrome after Retromandibular Approach for Condyle Fracture Reduction

Clinical research of bioabsorbable membrane in prevention of Frey syndrome after parotidectomy / 中国基层医药

Objective To evaluate the effect of bioabsorbable membrane in prevention of Frey syndrome after parotidectomy.Methods 105 patients who suffering from benign tumor of parotid gland were divided into experimental group and control group randomly.53 cases in experimental group underwent insertion of bioabsorbable membrane after parotidectomy,while 52 cases in control group underwent parotidectomy without bioabsorbable membrane.After operation 6 to12 months,all 105 patients were evaluated for gustatory sweating by both questionnaire and minor starchiodine test.Results Subjective evaluation of Frey syndrome revealed that the incidence rate of experimental group and control group were 3.8％(2/53),28.9％(15/52)respectively(P ＜ 0.05).Objective evaluation of Frey syndrome revealed that the incidence rate of experimental group and control group were 9.4％(5/53),55.8％(29/52)(13/21)respectively(P ＜0.05).Conclusion Insertion of bioabsorbable membrane is an effective method for prevention of Frey's syndrome after parotidectomy.

Effect of fascia parotideomasseterica reconstruction in the prevention of Frey syndrome / 中国基层医药

Objective To study the effect of fascia parotideomasseterica reconstruction in the prevention of Frey syndrome.Methods 45 patients who suffered parotidectomy with parotid fascia maintained and reconstructed were followed-up,the OccurrenCe rate of Frey syndrome wasobserved.Results The occurrence rate of the subjective symptom8 with Frey syndrome Was 6.7%(3/45)6 montes after surgery;the occurrence rate of Frey syndrome was 11.1%(5/45)by Minor test review 1 year after surgery;the remaining 41 cases were non-induced reactlons.Condusion Fascia parotidcomassetefica could reduce the development of Frey syndrome in the parotid gland surgery in pafients with benign tumors.

Effectiveness of Botulinum Toxin A in Treatment of Frey's Syndrome

PURPOSE: Several therapeutic approaches have been introduced and tried to treat Frey syndrome following parotidectomy. However they were not proved as an effective treatment. A new therapeutic modality using botulinum toxin injections was presented previously by several study groups. But, the duration of the demonstrated positive effect was essentially unknown so far. The purpose of this clinical investigation is to demonstrate the effectiveness of Botulinum toxin type A(BTXA) in patients with Frey syndrome. METHODS: For this study, 12 patients were treated, They were assessed with the Minor's iodine-starch test and interviewed before and after treatment. Botulinum toxin is injected with 1.0cm2 apart into the skin where symptoms of Frey's syndrome has manifestated. The patients were classified according to the concentration of botulinum toxin and dosage of botulinum toxin. RESULTS: The outcome measures were the time of reappearance of gustatory sweating(subjective study), and the results of an Minor's iodine-starch test(objective study) of 3 weeks, 3 months, 6 months, 9 months, 12 months after treatment. This treatment was effective in all groups of patients. The concentrations and the amount of dosages did not affect the treatment. But high concentration produced faster effectiveness in subjective. CONCLUSION: Botulinum toxin type A(BTXA) for Frey syndrome is easy, convenient and effective withouts severe complication. And the patients has no difficulty and limitation in their life.

Effectiveness of Botulinum Toxin A in Treatment of Frey's Syndrome

PURPOSE: Several therapeutic approaches have been introduced and tried to treat Frey syndrome following parotidectomy. However they were not proved as an effective treatment. A new therapeutic modality using botulinum toxin injections was presented previously by several study groups. But, the duration of the demonstrated positive effect was essentially unknown so far. The purpose of this clinical investigation is to demonstrate the effectiveness of Botulinum toxin type A(BTXA) in patients with Frey syndrome. METHODS: For this study, 12 patients were treated, They were assessed with the Minor's iodine-starch test and interviewed before and after treatment. Botulinum toxin is injected with 1.0cm2 apart into the skin where symptoms of Frey's syndrome has manifestated. The patients were classified according to the concentration of botulinum toxin and dosage of botulinum toxin. RESULTS: The outcome measures were the time of reappearance of gustatory sweating(subjective study), and the results of an Minor's iodine-starch test(objective study) of 3 weeks, 3 months, 6 months, 9 months, 12 months after treatment. This treatment was effective in all groups of patients. The concentrations and the amount of dosages did not affect the treatment. But high concentration produced faster effectiveness in subjective. CONCLUSION: Botulinum toxin type A(BTXA) for Frey syndrome is easy, convenient and effective withouts severe complication. And the patients has no difficulty and limitation in their life.

Treatment of Frey's Syndrome Patients with Botulimum Toxin A

PURPOSE: Frey's syndrome is a common complication after parotid surgery and characterized by gustatory sweating and flushing in the periauricular area during meals. Although a variety of methods were proposed to prevent this postoperative problem, they were unsatisfactory. We used botulinum toxin A to treat 9 patients with Frey's syndrome and investigated the duration effect after the injection. METHODS: Nine patients became the object of study about the effect of botulinum toxins as treatment of Frey's syndrome. Age of patients ranged from 25 to 78 years (mean, 43.7 years). Six of nine patients had both symptoms of gustatory sweating and flushing. And the others had only gustatory sweating symptom. Using Minor starch iodine test, the affected skin area was detected, and it was marked by 1 cm2 sized grid appearance. After application of EMLA cream on the gustatory sweating area, botulinum toxin A was injected intracutaneously into the affected skin area (2.5 U/cm2). Patients were followed up from six to fifteen months (mean, about 12 months) and asked about improvement of their symptoms. RESULTS: The treatment with botulinum toxin A had an effect within 2 days after the injection. Six months after injection, gustatory sweating disappeared completely in all patients, and 5 of six patients who had gustatory flushing improved in their symptom. At the last follow-up, no patients complained of recurrent gustatory sweating and flushing except one. One patient, seven months after initial injection, was retreated with botulinum toxin A because of recurrence, and the result was successful. The duration of the effect after botulinum toxin A treatment was ranged from seven to thirteen months. One patient in our series experienced the upper eyelid weakness as adverse effect, but it improved spontaneously. CONCLUSION: Local injection of botulinum toxin A is an effective, safe and long-lasting method for treatment of Frey's syndrome. Hereafter, however, additional study is required to evaluate the duration effect of botulinum toxin A as to frequency in use and dosage

Síndrome de Frey simulando eritema malar por alergia alimentar / Frey's syndrome simulating malar flushing by food allergy

OBJETIVO: Relatar um caso de síndrome de Frey em lactente, cujo eritema malar foi inicialmente associado à alergia alimentar. DESCRIÇÃO DO CASO: Lactente de um ano de idade, encaminhado ao ambulatório de alergia alimentar com eritema malar unilateral, localizado na área de distribuição do nervo auriculotemporal, após a ingestão de frutas e legumes. Nesta época, o paciente encontrava-se em dieta de restrição destes alimentos devido ao diagnóstico clínico de alergia alimentar. O paciente apresentava história de parto vaginal e tocotraumatismo. COMENTÁRIOS: O diagnóstico da síndrome de Frey (síndrome auriculotemporal ou de sudorese gustativa) foi estabelecido com base nas características clínicas do eritema malar desencadeado após a ingestão de alimentos e exclusão do diagnóstico de alergia alimentar. Nestes pacientes, o dano ao nervo auriculotemporal decorre, em geral, de tocotraumatismo, com regeneração alterada das fibras nervosas, resultando no eritema malar com a estimulação gustativa. Este caso ressalta a necessidade do diagnóstico correto da alergia alimentar, de tal modo que não sejam impostas dietas restritivas desnecessárias ao paciente. Em pacientes com eritema malar na trajetória do nervo auriculotemporal após ingestão de alimentos, a possibilidade da síndrome de Frey deve ser considerada.

OBJECTIVE: To report a case of Frey syndrome in a child, whose malar flushing has been initially associated with food allergy. CASE DESCRIPTION: One year-old child referred to the food allergy out-patient clinic. The patient has been presenting unilateral facial flushing localized in the auriculotemporal nerve pathway after the ingestion of fruits and vegetables. At this time, these foods were excluded from patient's diet due to the clinical diagnosis of food allergy. The child was born by vaginal delivery and had obstetrical trauma. COMMENTS: The diagnosis of Frey syndrome (auriculotemporal syndrome or gustatory sweating) was established considering the clinical characteristic of facial flushing triggered after ingestion of foods and the exclusion of food allergy diagnosis. The damage to the auriculotemporal nerve caused by obstetrical trauma may misdirect the regeneration of the nerve fibers that results in facial flushing with gustatory stimulation. The present case points out to the importance of appropriate differential diagnosis of food allergy in order to avoid unnecessary restrictive diets. In patients with malar flushing in the auriculotemporal nerve pathway after food ingestion the possibility of Frey syndrome should be considered.

Síndrome de Frey por submaxilectomía y tratamiento con toxina botulínica / Frey syndrome secondary to submaxillectomy and botulinic treatment

El síndrome de Frey (SF) se caracteriza por rubor, calor y sudación en la región maseterina y geniana durante las comidas. El SF se observa en el 20-60% de los pacientes sometidos a parotidectomía. Presentamos un caso con SF secundario a la ablación de la glándula submaxilar en un varón de 30 años de edad, sin antecedentes patológicos, que consultó en el año 2000 por adenopatía cervical izquierda. La misma fue biopsiada y la anatomía patológica informó carcinoma medular de tiroides. El paciente presentaba múltiples metástasis hepáticas y pulmonares, motivo por el cual recibió tratamiento quimioterápico con cisplatino plus doxorrubicina (seis ciclos) con respuesta completa, finalizando dicho esquema en marzo del 2002. En julio del 2002 se realizó tiroidectomía total más vaciamiento ganglionar izquierdo con resección de la glándula submaxilar. Durante la cirugía se lesionó la rama mentoniana del nervio cervicofacial, rama del VII par craneal. En septiembre del 2004 consultó por episodios de sudación durante las comidas en la región submaxilar izquierda. Se realizó prueba de Minor y luego se procedió a aplicar toxina botulínica tipo A en la región afectada, a razón de 2.5 UI por punto (cm2), a un total de 17 puntos. El control a los 21 días demostró más de un 95% de efectividad en la resolución del SF. El efecto duró un año, y una segunda reinfiltración mostró similar respuesta. No hallamos descripciones anteriores de SF en región submaxilar; se presenta su tratamiento satisfactorio con toxina botulínica tipo A.

A case of Frey syndrome (FS) secondary to submaxillar gland exeresis is presented and the results of the treatment with botulinum toxin (BTX) type A. FS is a condition of sweating cheek and preauricular area during mealtime as a sequel detected in about 20-60% of patients after parotidectomy. The clinical symptoms include swelling, flushing and hyperhidrosis. The treatment choice for this condition is intracutaneous injection of BTX type A which blocks acetylcholine release at the sweat glands. A 30-year-old man, with thyroid medullar carcinoma diagnosed in 2002 received 6 cicles of cisplatin plus doxorubicin previous to the thyroidectomy with anterolateral neck dissection. During surgery the left ramus marginalis mandibulae was damaged. Two years later the patient referred sweating in submaxillar region during meals. CT scan demonstrated the absence of left submaxillar gland. Minor's test disclosed the affected area and BTX type A was injected (2.5 U/cm2/17 points). A twenty-one-day control showed a 95% reduction of the affected skin area. Persistent efficacy was observed up to one year followup time when he was reinjected. The FS, also known as "gustatory hyperhidrosis", was probably first reported by M. Duphenix in 1757. Lucja Frey considered its physiopathology as a disorder of both sympathetic and parasympathetic innervation. In our case the FS was caused by a misdirected regeneration of postganglionic parasympathetic nerve fibers that arrised from the nervus lingualis rami ganglionares of the nervus trigeminus. After nerve injury the colinergic parasympathetic fibers seek out colinergic receptors -sympathetic receptors of the skin- innervating sweat glands and small skin vessels. All previous cases were located at masseter region post-parotidectomy. We have not found any description of FS in the submaxillary region. The self-assessed efficacy of the treatment with a hyperhidrosis disease severity scale revealed a very satisfied patient at 20 months follow-up after being injected twice with BTX type A.

The Effectiveness of Sternocleidomastoid Muscle Flap in Preventing Frey's Syndrome Following Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Frey's syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid (SCM) muscle flap, have been used to prevent this condition. The purpose of this study was to evaluate the preventive impact of using this flap on the incidence of Frey's syndrome and to identify the degree of severity in this syndrome between the use of SCM flap and no muscle flap. SUBJECTS AND METHOD: 40 patients who underwent superficial parotidectomy from June 1996 to August 2003 were divided into two groups. One group had SCM flap reconstruction (n=20), and the other did not (n=20). A subjective clinical questionnaire and the objective Minor's starch test were used to evaluate the incidence of this syndrome. A grading system was used to divide Frey's syndrome into mild or severe Frey's syndrome to determine its severity. The test of Pearson-x2 was applied. RESULTS: The association between sweating, flushing, or pain and the use of the flap was not significant. Also, there was no significant association with Minor's starch test and the use of the flap. There was a significant association with mild Frey's syndrome and the presence of the flap (p=0.014). CONCLUSION: It would seem that the sternocleidomastoid muscle flap does not reduce the incidence of Frey's syndrome, but does decrease the degree of severity in Frey's syndrome.

Variable Methods of Protection for the Exposed Facial Nerves after Parotidectomy

Two significant unsolved problems in parotidectomy procedures are Frey's syndrome and postoperative depression deformity. The recent trend in the management of these problems has been the use of the prophylatic procedures performed at the time of parotidectomy to prevent its postoperative symptoms or complaints. We used a tissue barrier between the elevated cheek skin flap and the exposed facial nerve in order to prevent Frey's syndrome and depression deformity on the cheek. We used buccal fat, dermis fat graft or flap, superficial temporal fascia(STF) island flap and skin island or free flap as a tissue barrier. Thirty-nine patients had been operated and reviewed for over 3 years and 23 of them were treated with various kinds of tissue barriers. Frey's syndrome, depression deformity and other complications were reviewed. As a result, there was no permanent facial nerve palsy, Frey's syndrome and dissatisfaction with facial contour excluding minor complications of hematoma, scar and temporary facial palsy compared to the cases without the barrier. We concluded that the buccal fat is easy and simple to perform and it can be the first choice in children and young women. The dermis fat graft or flap is suitable for the old patient who requires pertinent volume. STF island flap is a pliable, wide and well vascularized flap, so it is well fit to cover the wide defect in man or old patient. In malignant or extensive lesions, skin island or free flap is recommendable for the simultaneous reconstruction of skin resurfacing and volume filling after the radical resection including the parotid gland. Various autogenous tissue barriers can be effectively and properly applicable to prevent the serious complications after the parotidectomy depending on the cases.

Variable Methods of Protection for the Exposed Facial Nerves after Parotidectomy

Two significant unsolved problems in parotidectomy procedures are Frey's syndrome and postoperative depression deformity. The recent trend in the management of these problems has been the use of the prophylatic procedures performed at the time of parotidectomy to prevent its postoperative symptoms or complaints. We used a tissue barrier between the elevated cheek skin flap and the exposed facial nerve in order to prevent Frey's syndrome and depression deformity on the cheek. We used buccal fat, dermis fat graft or flap, superficial temporal fascia(STF) island flap and skin island or free flap as a tissue barrier. Thirty-nine patients had been operated and reviewed for over 3 years and 23 of them were treated with various kinds of tissue barriers. Frey's syndrome, depression deformity and other complications were reviewed. As a result, there was no permanent facial nerve palsy, Frey's syndrome and dissatisfaction with facial contour excluding minor complications of hematoma, scar and temporary facial palsy compared to the cases without the barrier. We concluded that the buccal fat is easy and simple to perform and it can be the first choice in children and young women. The dermis fat graft or flap is suitable for the old patient who requires pertinent volume. STF island flap is a pliable, wide and well vascularized flap, so it is well fit to cover the wide defect in man or old patient. In malignant or extensive lesions, skin island or free flap is recommendable for the simultaneous reconstruction of skin resurfacing and volume filling after the radical resection including the parotid gland. Various autogenous tissue barriers can be effectively and properly applicable to prevent the serious complications after the parotidectomy depending on the cases.

Botulinum Toxin Treatment in a Patient with Frey Syndrome After Upper Thoracic Sympathicotomy / 대한피부과학회지

Frey syndrome is characterized by profuse facial sweating which is provoked by the taste of food. It has been described as a consequence of upper thoracic sympathicotomy. Botulinum toxin injection is a relatively new treatment modality for Frey syndrome. Botulinum toxin type A (Botox , Allergan, USA) had been successfully used to treat Frey syndrome occurring in a 38-year-old patient following thoracic sympathicotomy for palmar hyperhidrosis. A total dose of 100U of botulinum toxin (1.0U/0.1ml/cm2) injection resulted in a 6 months' resolution of sweating, burning, and flushing sensation on eating. During the follow-up period, no systemic side effects were experienced.

A parotidectomy with the reservation and reconstruction of parotid fascia / 实用口腔医学杂志

Objective:To evaluate the possibility of prevention of Frey's syndrome by reservation and reconstruction of parotid fascia in parotidectomy.Methods:Parotidectomy with parotid fascia reservation and reconstruction was conducted in 31 cases. 12 months-12 years after operation the patients were examined by Minor test.Result:Positive reaction of Minor test was observed in 3 out of the 31 cases(9.67%).Conclusion:A parotidectomy with reservation and reconstruction of parotid fascia can efficiently prevent Frey's syndrome.

Clinical significance in reserving and reconstructing parotid fascia / 第三军医大学学报

Objective To evaluate whether it can prevent Frey's syndrome by reserving parotid fascia or reconstructing parotid fascia with sternocleidomastoid muscle and remaining of parotid fascia in parotidectomy. Methods Fifty-two patients undergoing parotidectomy with maintained and reconstructed parotid fascia were followed up. A test of chewing vitamin C slice guidance and iodine-amylum pilot was conducted for observing the incidence of postoperative Frey's syndrome. Results Flush with perspires was found only in 5 out of the 52 patients (9.61%), which was lower than the incidence after traditional parotidectomy. Conclusion The method of reserving and reconstructing parotid fascia with sternocleidomastoid muscle and remaining of parotid fascia in parotidectomy can efficiently prevent Frey's syndrome, and can also repair the hollow abnormity of the face.