Frey's syndrome: prevention with conservative parotidectomy and superficial musculoaponeurotic system preservation

Between 1980 and 1990, 35 patients underwent conservative parotidectomy combining a rhytidectomy incision and a superficial musculoaponeurotic system preservation technique to reduce the postoperative incidence of Frey's syndrome. All patients were evaluated by questionnaire for subjective symptoms of gustatory sweating and flushing as well as satisfaction with the aesthetic appearance of their cheek. Six percent of patients (2 of 35) complained of symptoms of Frey's syndrome. Ninety-four percent of patients (33 of 35) noticed minimal or no contour deformity of the surgical area. Twenty patients underwent Minor's starch iodine testing to identify objective evidence of aberrant nerve regeneration at the postoperative site. Fifteen percent of these patients (3 of 20) demonstrated a positive starch iodine test; however, one of these three patients was unaware of symptoms of Frey's syndrome. Symptoms of gustatory sweating are a reliable indicator of aberrant nerve regeneration. Conservative parotidectomy with superficial musculoaponeurotic system preservation for benign parotid disease produces a low incidence of Frey's syndrome and satisfactory cosmetic results.