A 55-year-old woman undergoes superficial parotidectomy for pleomorphic adenoma. Six months later, she notices flushing and sweating over the parotid region while eating. What is the underlying mechanism of this complication?
- A Fistula formation between the parotid duct and skin
- B Injury to the great auricular nerve with neuroma formation
- C Injury to the auriculotemporal nerve with aberrant parasympathetic innervation of sweat glands ✓
- D Recurrent tumor causing autonomic dysfunction
Correct answer: C. Injury to the auriculotemporal nerve with aberrant parasympathetic innervation of sweat glands
Explanation
This describes Frey's syndrome (gustatory sweating), which occurs in up to 10-40% of patients after parotidectomy. The auriculotemporal nerve carries parasympathetic fibers to the parotid gland. After surgery, aberrant regeneration causes these parasympathetic fibers to innervate sweat glands and cutaneous blood vessels in the skin flap. This results in flushing and sweating over the cheek during eating. The great auricular nerve injury causes ear numbness, not gustatory symptoms. Parotid duct fistula would present as saliva drainage, not sweating.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.