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Frey syndrome--delayed clinical onset: a case report
Shelton Malatskey1, Iaron Rabinovich, Milo Fradis
1Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck Surgery, Bnai Zion Medical Center, Technion, and Rambam Medical Center, Technion, Haifa, Israel.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics
|September 27, 2002
Summary
Frey syndrome, characterized by facial sweating and flushing, can occur years after parotid surgery. This condition, resulting from nerve regeneration, highlights the importance of pre-operative patient discussion regarding potential long-term risks.
Area of Science:
- Otolaryngology
- Neurology
- Surgical Pathology
Background:
- Frey syndrome involves unilateral facial sweating and flushing during meals, often following parotidectomy.
- It results from aberrant regeneration of parasympathetic nerve fibers innervating cutaneous glands post-injury.
- The incidence of Frey syndrome after parotidectomy can be as high as 53%.
Observation:
- This report details a rare case of Frey syndrome manifesting 8.5 years after superficial parotidectomy.
- The patient presented with delayed-onset symptoms, underscoring the syndrome's potential for late presentation.
Findings:
- The pathogenesis involves misdirected regeneration of severed parasympathetic nerve fibers.
- High incidence rates (up to 96%) are reported in untreated patients evaluated via iodine-starch testing postoperatively.
- While most cases are mild, severe symptoms occur in 6% of patients.
Implications:
- This case emphasizes the critical need for pre-operative counseling regarding the potential for delayed Frey syndrome onset.
- Informed consent should include discussion of this long-term sequela of parotid region surgery.
- Awareness of late-onset Frey syndrome is crucial for accurate diagnosis and patient management.