Frey's syndrome is a recognized complication following parotidectomy. What is the mechanism and most effective treatment?

• A Scarring of auriculotemporal nerve branches causing pain on eating; treated by cervical sympathectomy
• B Injury to great auricular nerve causing numbness; treated by nerve grafting
• C Aberrant reinnervation of sweat glands by parasympathetic secretomotor fibers from the auriculotemporal nerve causing gustatory sweating; treated by botulinum toxin injection ✓
• D Salivary fistula formation from residual parotid tissue; treated by irradiation

Explanation

Frey's syndrome (auriculotemporal nerve syndrome, gustatory sweating) occurs when regenerating parasympathetic secretomotor fibers from the auriculotemporal nerve aberrantly reinnervate sweat glands and cutaneous vessels in the preauricular skin instead of the parotid acini. This results in sweating and flushing of the preauricular skin during eating or thinking about food. Minor's starch-iodine test confirms the diagnosis. Botulinum toxin A injection into the affected skin is the most effective and widely used treatment, providing relief for 6–12 months per injection.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.