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Modern therapeutic options for Frey syndrome – analysis of five cases


Authors: M. Hudečková 1 ;  E. Minks 2 ;  P. Urbánková 1 ;  B. Gál 1
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku LF MU a FN u sv. Anny v Brně 1;  I. neurologická klinika LF MU a FN u sv. Anny v Brně 2
Published in: Otorinolaryngol Foniatr, 72, 2023, No. 2, pp. 91-100.
Category: Case Reports
doi: https://doi.org/10.48095/ccorl202391

Overview

Introduction: Frey‘s syndrome (SF), auriculotemporal syndrome, is an often neglected complication occurring in 6–96% of patients after parotid gland surgery according to recent studies. It arises on the basis of aberrant ingrowth of parasympathetic fi bers into the sheaths of denervated sweat glands after auriculotemporal nerve damage. The syndrome is characterized by a triad of symptoms: sweating, redness and burning or even pain in connection with food intake. Diagnosing these problems is not a time-consuming process and there are a number of therapeutic options. However, the vast majority of approaches, whether surgical or non-surgical, have only a short-term effect and carry a number of complications. The application of botulinum toxin A (BTXA) represents a relatively simple, effective and safe treatment option consisting of intradermal application of the solution according to a predetermined Frey syndrome activation map. Objectives: Presentation and evaluation of pilot results of therapeutic application of BTXA in patients dia gnosed with Frey‘s syndrome. Material and methods: Retrospective analysis of a group of 5 patients who underwent parotid gland surgery of various extents at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital at St. Anny in Brno between 2006 and 2019, in whom there was a signifi cant manifestation of SF symptoms on the basis of which BTXA was therapeutically applied. Results: Evaluating the subjective manifestations of SF in all patients in our cohort, after the application of BTXA, showed that the problems signifi cantly decreased from “annoying and reducing their quality of life” to “never” or “almost never” occurring. Objective results of the Minor test interpreted by SketchAndCalc showed a decrease in SF activation of 91.6% on average. Only two patients required re-administration of BTXA at 6 and 19 months intervals. No adverse reactions to BTXA were reported or observed with any of the patients. Conclusion: BTXA is an eff ective and safe way to treat patients with Frey‘s syndrome.

Keywords:

parotidectomy – Frey syndrome – auriculotemporal syndrome – gustatory sweating – botulinum A toxin


Sources

1. Frey L. Le syndrome du nerf auriculo-temporal. Rev Neurol 1923; 30: 97–104.

2. Stárek I. Pooperační komplikace chirurgické léčby slinných žláz. In: Stárek I, Černý L, Simpson RW (eds). Choroby slinných žláz. 1. vyd. Praha: Grada Publishing 2000: 253–256.

3. Bremerich A, Eufi nger H, Rustemeyer J et al. Frey Syndrom. Mund-, Kiefer- und Gesichtschirgie 2001; 5(1): 33–36. Doi:10.1007/ s100060000251.

4. Gál B, Kadaňka Z, Hložková T et al. Syndrom Freyové (aurikulotemporální syndrom) po parotidektomii a jeho prevence. Cesk Slov Neurol N 2015; 78(4): 463–467.

5. Singleton GT, Cassisi NJ. Frey‘s syndrome: incidence related to skin fl ap thickness in parotidectomy. Laryngoscope 1980; 90(10 Pt 1): 1636–1639.

6. Kornblut AD, Westphal P, Miehlke A. The eff ectiveness of a sternomastoid muscle fl ap in preventing post-parotidectomy occurrence of the Frey syndrome. Acta Otolaryngol 1974; 77(5): 368–373. Doi: 10.3109/ 00016487409124638.

7. Drobik C, Laskawi R. Frey‘s syndrome: treatment with botulinum toxin. Acta Otolaryngol 1995; 115(3): 459–461. Doi: 10.3109/ 00016489 509139348.

8. Green RJ, Endersby S, Allen J et al. Role of medical thermography in treatment of Frey‘s syndrome with botulinum toxin A. Br J Oral Maxil lofac Surg 2014; 52(1): 90–92. Doi: 10.1016/ j.bjoms.2013.09.013.

9. Dulguerov P, Quinodoz D, Cosendai G et al. Frey syndrome treatment with botulinum toxin. Otolaryngol Head Neck Surg 2000; 122(6): 821–827. Doi: 10.1016/ s0194-5998(00)70008-8.

10. Eckardt A, Kuettner C. Treatment of gustatory sweating (Frey‘s syndrome) with botulinum toxin A. Head Neck 2003; 25(8): 624–628. Doi: 10.1002/ hed.10262.

11. Schulze-Bonhage A, Schroder M. Ferbert A. Botulinum toxin in the therapy of gustatory sweating. J Neurol 1996; 243: 143–146. Doi: 10.1007/ bf02444005.

12. Závodová M. Neurotoxické klostridie. In: Bednář M, Souček A, Fraňková V et al. Lékařská mikrobio logie: Bakteriologie, virologie, parazitologie. 1. vyd. Praha: Marvil 1999: 234–235.

13. Kulíková Z. Botulotoxin a jeho využití v dermatologii. Dermatol praxi 2009; 3(3): 136–138.

14. Xie S, Wang K, Xu T et al. Effi cacy and safety of botulinum toxin type A for treatment of Frey‘s syndrome: evidence from 22 published articles. Cancer Med 2015; 4(11): 1639–1650. Doi:10.1002/ cam4.504.

15. Quer M, Guntinas-Lichius O, Marchal F et al. Classifi cation of parotidectomies: a proposal of the European Salivary Gland Society. Eur Arch Otorhinolaryngol 2016; 273(10): 3307–3312. Doi: 10.1007/ s00405-016-3916-6.

16. Beerens AJ, Snow GB. Botulinum toxin A in the treatment of patients with Frey syndrome. Br J Surg 2002; 89(1): 116–119. Doi: 10. 1046/ j.0007-1323.2001.01982.x.

17. Luna Ortiz K, Rascon Ortiz M, Sanson Riofrio JA et al. Control of Frey‘s syndrome in patients treated with botulinum toxin type A. Med Oral Patol Oral Cir Bucal 2007; 12(1): E79–84.

18. Marchese MR, Bussu F, Settimi S et al. Not only gustatory sweating and flushing: Signs and symptoms associated to the Frey syndrome and the role of botulinum toxin A therapy. Head Neck 2021; 43(3): 949–955. Doi: 10.1002/ hed.26 561.

19. Guntinas-Lichius O. Increased botulinum toxin type A dosage is more eff ective in patients with Frey‘s syndrome. Laryngoscope 2002; 112(4): 746––749. Doi:10.1097/ 00005537-200 204000-00 027.

20. Státní ústav pro kontrolu léčiv. 2020 [online]. Souhrn údajů o přípravku Dysport. Dostupné z: https:/ / www.sukl.cz/ modules/ medication/ download.php?fi le= SPC167577.pdf&type=spc &as=dysport-spc

21. Naumann M, Zellner M, Toyka KV et al. Treatment of gustatory sweating with botulinum toxin. Ann Neurol 1997; 42(6): 973–975. Doi: 10.1002/ ana.410420619.

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