Auriculotemporal syndrome after combined modality therapy for cancer

Auriculotemporal syndrome frequently follows trauma to the auriculotemporal nerve, a branch of the mandibular nerve. Classic symptoms are gustatory sweating and hyperemia, with pain occurring in less than 10% of cases. We have treated six patients for a variant of auriculotemporal syndrome following combined modality therapy for head and neck cancers. Unique was the presence of pain and the absence of gustatory sweating in all cases. The combination of radical surgery, chemotherapy, and irradiation obscured the "textbook" presentation, leading to initial misdiagnosis. Long-term relief (one year) from this atypical presentation of auriculotemporal syndrome was afforded by a simple mandibular nerve block, a technic that is of no sustained therapeutic benefit in the classic cases.