Frey's syndrome: treatment with botulinum toxin

Frey's syndrome, i.e. gustatory sweating on the cheek, is a fairly common embarrassment after parotid gland surgery. New surgical techniques have been proposed to avoid this complication, but are not widely in use. Hence, there is need for treatment of Frey's syndrome. All surgical and topical treatments have drawbacks. This study was set up in order to evaluate a recently described treatment. One hundred and two patients were interviewed after parotidectomy. Thirty-one of them had noticed gustatory sweating and 15 patients underwent Minor's starch iodine test before, and after, treatment with intracutaneous injections of botulinum toxin A (Botox, Allergan Inc., USA). Thirteen of the patients did not experience any gustatory sweating at follow-up (one to 13 months). Minor's starch test showed total disappearance of gustatory sweating in 12 of the 15 treated patients. The only side effect was a discreet, transitory affection of the orbicularis oris muscle in one patient. As this treatment is minimally invasive it could be an attractive treatment for Frey's syndrome if the effect is maintained. Complaints of local hypoaesthesia and pain were also common after parotid surgery.