Localized facial flushing in infancy. Auriculotemporal nerve (Frey) syndrome

Patients with auriculotemporal nerve syndrome (Frey syndrome) have facial flushing, sweating, or both localized to the distribution of the auriculotemporal nerve that occurs in response to gustatory stimuli. In adults, the syndrome usually results from surgical injury or trauma to the parotid gland. The condition is rare in infants, but usually manifests during infancy with the introduction of solid food, thus leading to the misdiagnosis of food allergy by physicians unfamiliar with the syndrome.

We describe 8 children with auriculotemporal nerve syndrome who manifested with flushing only. The reaction was erroneously attributed to food allergy in most cases. Six of the 8 patients were delivered with forceps assistance. The remaining 2 patients, with disease onset during the first 3 months of life, had bilateral involvement without known trauma.

Auriculotemporal nerve syndrome may manifest during infancy as flushing with eating food. In contrast to the syndrome in adults, gustatory sweating is rarely associated. The known use of forceps to assist in the delivery of at least 14 of the 28 previously reported pediatric cases and in 6 of our 8 patients suggests that trauma to the parotid region may be responsible for the condition in most infants, as it is in adults. Auriculotemporal nerve syndrome in infancy should be recognized as a benign condition that often resolves spontaneously. Treatment is ineffective and unnecessary.