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Published on: October 13, 2023
Incidence of Frey's syndrome after submandibular gland excision: Minor's test-based evaluation
Yeon Seok You1, Yong Tae Hong1
1Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
Objective:
To evaluate the incidence and clinical characteristics of Frey's syndrome following submandibular gland excision using objective diagnostic methods.
Methods:
Medical records of 28 patients who underwent submandibular gland excision between January 2016 and December 2018 were reviewed. Frey's syndrome was diagnosed using the Minor's starch-iodine test, and symptom severity was graded according to the Luna-Ortiz scoring system, which incorporates symptom perception, affected area, and sweating intensity. Patients with less than six weeks of follow-up or with a history of head and neck trauma or unrelated surgical procedures were excluded.
Results:
Frey's syndrome was identified in 3 of 28 patients (10.7%). Two cases were classified as mild (7.1%) and one as severe (3.6%). While one patient reported subjective symptoms, the other two were diagnosed solely through Minor's starch-iodine test. The average time to diagnosis was 31.7 months postoperatively. No association was observed between Frey's syndrome and patient age, sex, or underlying pathology. The severe case responded well to botulinum toxin injection, resulting in complete resolution of symptoms.
Conclusion:
Although Frey's syndrome is a well-known complication of parotid gland surgery, it may also occur after submandibular gland excision, often in subclinical forms that are easily overlooked. This study highlights the diagnostic value of Minor's starch-iodine test in detecting such cases. Future studies should focus on identifying surgical techniques and patient factors associated with increased risk to guide selective postoperative surveillance and informed patient counseling following submandibular gland excision.
