The auriculotemporal nerve is a branch of CN V3 that is particularly involved in Frey's syndrome after parotid surgery. It carries which nerve fibers post-operatively that cause gustatory sweating?

• A Sympathetic fibers from the superior cervical ganglion reaching the parotid via the auriculotemporal nerve
• B Misdirected post-ganglionic sympathetic fibers that aberrantly innervate the parotid gland
• C Misdirected post-ganglionic parasympathetic fibers from the otic ganglion that aberrantly reinnervate facial sweat glands ✓
• D Somatic sensory fibers from the mandibular nerve activating sweat glands via axon reflex

Explanation

In Frey's syndrome (auriculotemporal nerve syndrome), after parotidectomy, the severed postganglionic parasympathetic fibers (originally from the otic ganglion that innervated the parotid) regenerate aberrantly and instead reinnervate the overlying facial sweat glands and skin vessels. Since the stimulus for salivation (eating/thought of food) now also activates these misdirected parasympathetic fibers, patients experience gustatory sweating and flushing of the preauricular skin. Treatment includes Botulinum toxin injection, topical anticholinergics (scopolamine cream), or tissue interposition at original surgery.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.