Abstract:Frey's syndrome is a phenomenon of hemifacial flushing and sweating after gustatory stimulus, usually secondary to surgical trauma over the parotid gland, although other injury mechanisms may be seen. It is accepted as a result of aberrant regeneration of facial autonomic nerve fibers. Treatment evolved from ineffective medical and surgical approaches to botulinum toxin. We evaluate the effectiveness and safety of botulinum toxin in the treatment of this complication in two patients.
“…Consequently, gustatory stimulus will cause sweating of the skin in the pre-auricular area. [714] Many therapeutic approaches have been tried for managing Frey's syndrome including medical and surgical procedures. While medical therapies like systemic anti-cholinergics are not well-tolerated, surgical procedures seem disproportionate to symptomatology and ineffective.…”
Section: Applicationsmentioning
confidence: 99%
“…Pornprasit M injected 2 unit or 0.1 ml intradermal BT type A at every 1 cm 2 affected area determined using starch-iodine test as a diagnostic criterion. [914] The author noted significant improvement in the symptoms and concluded that intradermal injection of botulinum toxin type A for patients with Frey's syndrome is not only effective with no side-effect but also minimally invasive. After toxin injection, duration of symptom-free periods is variable.…”
Botulinum Toxin (BT) is a natural molecule produced during growth and autolysis of bacterium called Clostridium botulinum. Use of BT for cosmetic purposes has gained popularity over past two decades, and recently, other therapeutic uses of BT has been extensively studied. BT is considered as a minimally invasive agent that can be used in the treatment of various orofacial disorders and improving the quality of life in such patients. The objective of this article is to review the nature, mechanism of action of BT, and its application in various head and neck diseases.
“…Consequently, gustatory stimulus will cause sweating of the skin in the pre-auricular area. [714] Many therapeutic approaches have been tried for managing Frey's syndrome including medical and surgical procedures. While medical therapies like systemic anti-cholinergics are not well-tolerated, surgical procedures seem disproportionate to symptomatology and ineffective.…”
Section: Applicationsmentioning
confidence: 99%
“…Pornprasit M injected 2 unit or 0.1 ml intradermal BT type A at every 1 cm 2 affected area determined using starch-iodine test as a diagnostic criterion. [914] The author noted significant improvement in the symptoms and concluded that intradermal injection of botulinum toxin type A for patients with Frey's syndrome is not only effective with no side-effect but also minimally invasive. After toxin injection, duration of symptom-free periods is variable.…”
Botulinum Toxin (BT) is a natural molecule produced during growth and autolysis of bacterium called Clostridium botulinum. Use of BT for cosmetic purposes has gained popularity over past two decades, and recently, other therapeutic uses of BT has been extensively studied. BT is considered as a minimally invasive agent that can be used in the treatment of various orofacial disorders and improving the quality of life in such patients. The objective of this article is to review the nature, mechanism of action of BT, and its application in various head and neck diseases.
“…The majority of patients postparotidectomy will have a positive starch–iodine test, but not all are symptomatic. Severe symptoms occur in about 15% . Surgical treatments for Frey syndrome, either as prophylaxis at the time of parotidectomy or subsequently to block nerve conduction mechanically, have also been reported .…”
Section: Summary Of Cases Including Patient Characteristics Site Anmentioning
confidence: 99%
“…Surgical treatments for Frey syndrome, either as prophylaxis at the time of parotidectomy or subsequently to block nerve conduction mechanically, have also been reported . Treatment of Frey syndrome with botulinum toxin has been described in a number of case reports and series, using varying amounts of botulinum toxin, with relief from symptoms for several months …”
Section: Summary Of Cases Including Patient Characteristics Site Anmentioning
“…1 It frequently presents with moderate manifestations, however, several patients may experience severe discomfort accompanied by a significant social burden; 2 male to female ratio is estimated to be 1:1. 3,4 The syndrome was initially described by Duphenix 5 in 1757, and later by Baillarger 6 in 1853. However, it was named after Lucja Frey, a Polish neurologist, who published in 1923 the case of a 25-year-old patient suffering from facial sweating and local skin flushing during meals, as a consequence of a gunshot wound that affected his parotid gland.…”
Background: Frey’s syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. Methods: We conducted a 20-year retrospective study including the patients who had undergone “formal” (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. Results: We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey’s syndrome was found after the use of dermal collagen interpositional barrier ( P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor’s test was positive at an incidence of 59.09% in Group A and 21.87% in Group B ( P = .004, 95% CI). Severe Frey’s syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B ( P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey’s syndrome in the compared groups, Conclusion: Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey’s syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.
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