Frey’s Syndrome: A Review of Aetiology and Treatment

Abstract

First described by Polish Neurologist Łucja Frey in 1923, Frey’s syndrome (FS), or auriculotemporal syndrome, is a rare condition characterised by gustatory sweating, typically encountered as sequelae following invasive head and neck surgery. The pathophysiology of FS can be described by aberrant reinnervation of postganglionic parasympathetic neurons to the surrounding denervated sweat glands and cutaneous blood vessels. Multiple invasive procedures have been associated with FS ranging from salivary gland surgery to burn reconstruction and thoracoscopic sympathectomies. Rarely, FS can be secondary to trauma or non-surgical aetiologies, including diabetes and infection. Physical symptoms vary based on the severity and surface area affected by FS and range from mild symptoms to severe psychosocial morbidity for patients. Surgeons operating in the head and neck, including otolaryngologists, maxillofacial surgeons, and plastic surgeons, should be aware of this potential complication and be up to date with diagnosis and treatment strategies for FS. This review article summarises the literature relating to FS focusing on its aetiologies, symptomatology, prevention, and available treatments, aiming to provide an up-to-date review of this condition for surgeons operating in the head and neck region. Although various treatment options have been suggested, these are often limited to topical agents that require life-long administration for symptom control. Further research is recommended to identify the optimal treatment for this condition and the role of surgery as a treatment for severe or refractory cases.

A Case Report of Early-Onset Frey's Syndrome in an Infant

“…The physiopathology of Frey's syndrome is still controversial, and the generally accepted hypothesis is that it occurs as the result of injury to the auriculotemporal nerve. [1][2][3][4] The auriculotemporal nerve is a branch of the mandibular division of the trigeminal nerve complex. It contains somatosensory, secretomotor, and vasomotor fibers.…”

“…3 In adults, this condition has been widely reported as a sequela of parotidectomy, invasive head and neck surgeries, and also can secondary to trauma, diabetes, or infection. 4 In children, the incidence of Frey's syndrome is low, with 105 pediatric cases listed in the PubMed database from March 1948 to December 2021.…”

Frey syndrome

“…[4][5][6] The large variation in symptom intensity, reporting and being diagnosed is the reason for the sizable range of indicators. [3,4,7] In about 80% of patients undergoing parotid removal, the syndrome is detected by the starch-iodine minor test. The percentage of patients reporting symptoms is in the range of 30-60%, which can indicate that some patients are without symptoms.…”

“…[1] Other conditions highly connected to this condition are: submandibular gland surgery, radical neck dissection, infection, traumatic injuries in the parotid region, forceps delivery, thoracic sympathectomy or burns. [2,7] It is caused by aberrant regrowth of facial autonomic nerve fibres. [3] The most common symptoms includes unilateral sweating, flushing of the cheek skin occurred during eating and heating sensation of the facial skin.…”

“…This syndrome may significantly worsen the quality of life of the patients and this is why it should be well diagnosed and clinicians should aim to completely cure patients suffering from this disease. [7]…”