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Frey's Syndrome

Last updated May 29, 2018

Approved by: Krish Tangella MD, MBA, FCAP

NIH

This image shows the typical gustatory sweating and flushing of Frey’s Syndrome post-parotidectomy.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Baillarger’s Syndrome
  • Dupuy’s Syndrome
  • Frey-Baillarger Syndrome

What is Frey's Syndrome? (Definition/Background Information)

  • Frey’s Syndrome, also known as Gustatory Sweating Syndrome, is a disorder that occurs due to a facial nerve injury, after a surgical procedure is performed (for various reasons), on the parotid gland
  • The parotid gland is located in the space between the ear and the cheek, on both sides of the face. They are the largest of the salivary glands
  • The proportion of the surgeries that lead to Frey’s Syndrome, vary from anywhere between 2-80%. The disorder induces mild to intense sweating, when any sensation pertaining to food (such as smell, taste, sound, sight, thought, including dreams) is present or comes about
  • A treatment of this condition is undertaken based on its intensity, the discomfort it causes, and the tolerance level of an individual

Who gets Frey's Syndrome? (Age and Sex Distribution)

  • Frey’s Syndrome may affect any individual regardless of age, sex, racial, or ethnic inclination. It mostly occurs due to any trauma caused, while surgically operating on the salivary glands (parotids)
  • Very infrequently, infants and newborns have also been observed to develop this condition

What are the Risk Factors for Frey's Syndrome? (Predisposing Factors)

  • The main risk factor for Frey’s Syndrome is a surgical procedure on the parotid gland, with or without a follow-up reconstructive surgery. The risk is reduced, if the gland or the region is surgically reconstructed
  • Any injury to the mandibular branch of the facial nerve (specifically the auriculotemporal branch) that serves the parotid gland region. Hence, Frey’s Syndrome is also known as Auriculotemporal Nerve Syndrome
  • A birth defect involving the parotid salivary glands, or a facial nerve injury that occurs in an infant, due to delivery using forceps (though this event is extremely rare)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Frey's Syndrome? (Etiology)

  • The most frequent cause of Frey’s Syndrome is a partial or complete parotidectomy - a surgical procedure performed on the parotid gland, to remove tumors, or resolve an inflammation
  • There are many facial nerves that run past the parotid gland, which may get affected (or dissected) by this surgical intervention. Frey’s Syndrome is a post-surgical complication of the facial nerve that is affected or realigned, and thereby rendered dysfunctional
  • The auriculotemporal nerve branch of the facial nerve that originally stimulates the salivary glands, post-operation, excites the sweat glands located in the region, giving rise to gustatory (taste-related) sweating. The effect of the surgical trauma is felt, may be a few months, or a few years after the procedure
  • Apart from a surgery, sometimes an injury to the face, or a congenital defect, or an injury caused during delivery, may adversely affect the nerve function, triggering the disorder
  • The degree of severity of the condition depends on the kind of operation, size of the tumor, gland, or tissue removed, incision length and region, and the quality of post-operative reconstruction

What are the Signs and Symptoms of Frey's Syndrome?

The key signs and symptoms of Frey’s Syndrome are:

  • The most common indication of Frey’s Syndrome is a spontaneous sweating in response to a food stimulus, which may be in any form. This is called gustatory sweating. The sweating (that may be mild or profuse) may be around the ears, on the forehead, cheeks, and neck region
  • Face appears flushed or reddened
  • Feeling of uneasiness, discomfort, embarrassment, at such an occurrence

How is Frey's Syndrome Diagnosed?

Diagnostic tests that are performed to analyze Frey’s Syndrome condition include:

  • Physical examination to recognize the characteristic signs of the disorder; evaluation of the patient’s medical history
  • Minor iodine starch test: The affected side of the face is coated with an iodine solution and starch powder, and the response of the person to a food stimulus is noted. Usually the individual is made to chew on a piece of lemon, which turns the applied paste, violet or purple color, on excessive sweating

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Frey's Syndrome?

Complications due to Frey’s Syndrome are the following:

  • Complications, if any that may arise, could be owing to the reconstructive surgical procedure, which is performed after the primary surgery
  • Complications, may also be as a result of any of the treatment measures employed - like the use of anticholinergic medications can cause a dry mouth, reducing function of the salivary glands
  • Excessive sweating may cause cosmetic issues. It may also occasionally, result in a social embarrassment

How is Frey's Syndrome Treated?

Symptomatic treatment approaches followed for Frey’s Syndrome are meant to bring a measure of relief to the patient. These include:

  • Use of deodorants and anti-perspirants
  • Use of anticholinergic ointments, such as scopolamine and glycopyrolate to suppress sweating; the use of antihydrotics (herbs that prevent excess perspiration)
  • Use of topical applications, like alpha-adrenergic agonist agents (e.g. clonidine)
  • A quick, easy, and safe way to provide relief is the use of botulinum toxin injections, which are effective for about a year
  • Reconstructive surgery: A permanent solution can be brought about, apart from setting right any facial scars and deformities that was brought about by the initial parotidectomy surgery. However, performing this surgery requires enormous skill and expertise, otherwise it might further complicate the condition
  • If the condition is mild and tolerable, no treatment is usually advised or required

How can Frey's Syndrome be Prevented?

  • In the case of Frey’s Syndrome, most preventive measures rest with the physician or surgeon (who performs the surgery on the parotid gland); the individual has only a lesser role (or no role at all) to play
  • In case the main surgery cannot be avoided, then keeping the dissection to a minimum is the best recourse a healthcare personnel should observe, in order to reduce or prevent the severity of Gustatory Sweating Syndrome
  • The key factor post-surgery, is the meticulous effort required to reconstruct the affected portion of the face, and skill level of the surgeon in averting possible complications of a parotidectomy (which includes Frey’s Syndrome)

What is the Prognosis of Frey's Syndrome? (Outcomes/Resolutions)

  • Frey’s Syndrome is an unintended consequence of a parotidectomy. Medical experts inform that all such surgery on the salivary gland, lead to some amount of facial nerve injury
  • Mild signs and symptoms may not require any treatment. Moderate to severe sweating and flushed face conditions may have to be treated, to improve the quality of life of an individual
  • Reconstructive surgery is the permanent solution for the syndrome. However, the experience, skill, and competency of the surgeon (which may be subjective), make reconstructive surgery a significant risk factor

Additional and Relevant Useful Information for Frey's Syndrome:

An invasive procedure on the salivary glands has the potential to cause many other medical complications. These include salivary leakage, numbness of ears, facial asymmetry, and facial nerve injury leading to paralysis, among many others.

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Jan. 8, 2014
Last updated: May 29, 2018