Frey's syndrome
| Frey's syndrome | |
|---|---|
| Classification and external resources | |
| Specialty | neurology |
| DiseasesDB | 29310 |
Frey's syndrome (also known as Baillarger’s syndrome, Dupuy’s syndrome, auriculotemporal syndrome,[1] or Frey-Baillarger syndrome) is a rare neurological disorder resulting from damage to or near the parotid glands responsible for making saliva, and from damage to the auriculotemporal nerve often from surgery.[1][2]
The symptoms of Frey's syndrome are redness and sweating on the cheek area adjacent to the ear (see focal hyperhidrosis). They can appear when the affected person eats, sees, dreams, thinks about or talks about certain kinds of food which produce strong salivation. Observing sweating in the region after eating a lemon wedge may be diagnostic.[2]
Signs and symptoms
Signs and symptoms include erythema (redness/flushing) and sweating in the cutaneous distribution of the auriculotemporal nerve, usually in response to gustatory stimuli. There is sometimes pain in the same area, often of a burning nature. Between attacks of pain there is sometimes numbness or other alterred sensations (anesthesia or paresthesia). This is sometimes termed "gustatory neuralgia".
Causes
Frey's syndrome often results as a side effect of surgeries of or near the parotid gland or due to injury to the auriculotemporal nerve, which passes through the parotid gland in the early part of its course. The Auriculotemporal branch of the Trigeminal nerve carries parasympathetic fibers to the sweat glands of the scalp and the parotid salivary gland. As a result of severance and inappropriate regeneration, the parasympathetic nerve fibers may switch course, resulting in "gustatory Sweating" or sweating in the anticipation of eating, instead of the normal salivatory response.[2] It is often seen with patients who have undergone endoscopic thoracic sympathectomy, a surgical procedure wherein part of the sympathetic trunk is cut or clamped to treat sweating of the hands or blushing. The subsequent regeneration or nerve sprouting leads to abnormal sweating and salivating. It can also include discharge from the nose when smelling certain food.
Rarely, Frey's syndrome can result from causes other than surgery, including accidental trauma,local infections, sympathetic dysfunction and pathologic lesions within the parotid gland.[3] An example of such, rare trauma or localized infection; can be seen in situations where a hair follicle has become ingrown and is causing trauma or localized infection near or over one of the branches of the auriculotemporal nerve.
Diagnosis
Diagnosis is made based on clinical signs and symptoms and a starch iodine test, called the Minor Iodine-Starch test. The affected area of the face is painted with iodine which is allowed to dry, then dry corn starch is applied to the face. The starch turns blue on exposure to iodine in the presence of sweat.[4]
Treatments
There is no effective treatment, but various options are described:
- Injection of Botulinum Toxin A[5]
- Surgical transection of the nerve fibers (only a temporary treatment)
- Application of an ointment containing an anticholinergic drug such as scopolamine
Epidemiology
The condition is rare.
Affected Populations[6]
The exact incidence of Frey syndrome is unknown. The disorder most often occurs as a complication of the surgical removal of a parotid gland (parotidectomy). The percentage of individuals who develop Frey syndrome after a parotidectomy is controversial and reported estimates range from 30-50 percent. In follow-up examinations, approximately 15 percent of affected individuals rated their symptoms as severe. Frey syndrome affects males and females in equal numbers.
History
It is named after Łucja Frey-Gottesman.[7][8] The disorder was first reported in the medical literature by Baillarger in 1853. A neurologist from Poland, Dr. Lucja Frey, provided a detailed assessment of the disorder and coined the term “auriculotemporal syndrome” in 1923.
References
- 1 2 Office of Rare Diseases Research (2011). "Frey's syndrome". National Institutes of Health. Retrieved 17 December 2012.
- 1 2 3 "Frey's Syndrome". New England Journal of Medicine. 2006. Retrieved 17 December 2012.
- ↑ Kragstrup, Tue W.; Christensen, Jennifer; Fejerskov, Karin; Wenzel, Ann (August 2011). "Frey Syndrome—An Underreported Complication to Closed Treatment of Mandibular Condyle Fracture? Case Report and Literature Review". Journal of Oral and Maxillofacial Surgery. 69 (8): 2211–2216. doi:10.1016/j.joms.2010.12.033.
- ↑ Choi, Hyo Geun; Kwon, Sae Young; Won, Jung Youn; Yoo, Seung Woo; Lee, Min Gu; Kim, Si Whan; Park, Bumjung (2013). "Comparisons of Three Indicators for Frey's Syndrome: Subjective Symptoms, Minor's Starch Iodine Test, and Infrared Thermography". Clinical and Experimental Otorhinolaryngology. 6 (4): 249. doi:10.3342/ceo.2013.6.4.249. ISSN 1976-8710.
- ↑ "Onabotulinumtoxina (Injection Route, Intradermal Route, Intramuscular Route)". Mayo Clinic. 2011. Retrieved 18 December 2012.
- ↑ http://rarediseases.org/rare-diseases/frey-syndrome/
- ↑ synd/390 at Who Named It?
- ↑ L. Frey. Zespól nerwu uszno-skroniowego. 1923.