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Auriculotemporal Syndrome
Gustatory Sweating Syndrome

Presentation

The combination of radical surgery, chemotherapy, and irradiation obscured the "textbook" presentation, leading to initial misdiagnosis. [ncbi.nlm.nih.gov]

It can present several weeks to years after the injury. [bjgpopen.org]

In the same way, four patients present with a dramatic decrease in Gustatory sweating. [jmatonline.com]

Auriculotemporal nerve syndrome (Frey syndrome) in two infants with bilateral presentation. Rev Pediatr Aten Primaria. 2008;10:643-8. [pap.es]

An unusual case is presented involving a patient with delayed onset of Frey’s syndrome 40 years after parotidectomy in childhood. [repository.up.ac.za]

Entire Body System

  • Asymptomatic

    Eleven patients remained asymptomatic. One patient had transient facial paresis following BT treatment on day 3. [scielo.br]

    This test can also be used to test for Frey syndrome in people without symptoms (i.e., asymptomatic patients). Although this test is accurate, it will not demonstrate the severity of the condition. [verywellhealth.com]

    Asymptomatic patients do not require any intervention.[19] When possible, prophylactic barriers should be employed during surgery, particularly for high-risk patients, including those with large (>4 cm) parotid tumors or extensive parotid injury.[19][ [statpearls.com]

  • Bullet Wound

    Baillarger in 1853 reported bilateral symptoms following bilateral suppurative parotitis which was not incised.1 Lucie Frey in 1923 reported a case produced by an infected bullet wound of the parotid gland, and she particularly noted that the resultant [jamanetwork.com]

    Frey published a report detailing her eponymous illness after treating a Polish soldier who experienced gustatory sweating after sustaining an infected bullet wound affecting the parotid gland. [verywellhealth.com]

  • Severe Pain

    The syndrome of ATN neuralgia (ATNa), which is characterized by attacks of paroxysmal, moderate to severe pain on the preauricular area, often spreading to the ipsilateral temple, is discussed in this article. [link.springer.com]

  • Malaise

    There are usually systemic signs of infection such as erythema (redness around the area), malaise (generalized weakness), tenderness, and fever. These disorders are highly communicable and adequate precaution should be taken to limit their spread. [kenhub.com]

Respiratoric

  • Dyspnea

    It was not associated with hyperhidrosis, pruritus, discomfort, lip swelling, wheezing, or dyspnea. The patient had not undergone surgery, nor had he had a personal history of atopy. [anaisdedermatologia.org.br]

Jaw & Teeth

  • Sialorrhea

    Clinical study of botulinum toxin-A in the treatment of sialorrhea in children with cerebral palsy. Laryngoscope 2002 ; 112 : 73 – 81 12 Jongerius, PH, Joosten, F, Hoogen, FJA, Gabreels, FJM, Rotteveel, JJ. [cambridge.org]

Eyes

  • Lacrimation

    […] glands, causing one to shed tears (lacrimation) during salivation while smelling foods or eating. [drahmetkoc.com]

    Treatment involves subtotal lacrimal gland excision, anticholinergics, transection of the facial or glossopharyngeal nerves, injection of alcohol to the sphenopalatine ganglion, or botulinum toxin injection into the lacrimal gland.[77][78] Gustatory rhinorrhea [statpearls.com]

    Paroxysmal lacrimation during eating as a sequel of facial palsy: Syndrome of crocodile tears. J Am Med Assoc. 1939;113(26):2310–1. Kamath RAD, Bharani S, Prabhakar S. [apcz.umk.pl]

    The superficial set of lymph nodes drains the external acoustic meatus, auricle (pinna), scalp, eyelids, and lacrimal glands in addition to the parotid gland. [kenhub.com]

Musculoskeletal

  • Fracture

    However, despite the proximity of these structures and the high incidence of condylar fracture (25% to 36% of mandibular fractures), Frey's syndrome is rare after this type of fracture (14,15). [scielo.br]

    Frey's syndrome after condylar fracture: Case report. Braz Dent J 2004;15:159-62. [Figure 1] [ijdvl.com]

    The mandible is the third most commonly fractured facial bone with most cases of mandibular fracture occurring as a direct result of trauma [34]. [cureus.com]

Skin

  • Sweating

    Frey syndrome results from synkinetic autonomic reinnervation by transected postganglionic parasympathetic nerve fiber within the parotid gland to the overlying sweat glands of the skin. [jhu.pure.elsevier.com]

    Flushing prevalent in females, sweating in males. It can persist for life. Some cases are congenital and probably due to birth trauma. [whonamedit.com]

    As a result of severance and inappropriate regeneration, the parasympathetic nerve fibers may switch course, resulting in “gustatory sweating” or sweating in the anticipation of eating, instead of the normal salivatory response. [drahmetkoc.com]

    […] of the forehead, upper lip, perioral region, or sternum subsequent to gustatory stimuli. 1, record 1, English, - gustatory%20sweating Record number: 1, Textual support number: 1 OBS The auriculotemporal syndrome features facial flushing or sweating limited [btb.termiumplus.gc.ca]

    In place of the salivary gland the nerve mistakenly attaches to nearby sweat glands or superficial blood vessels of the face. The result of this mistaken union is sweating and flushing instead of salivation. [ohniww.org]

  • Hyperhidrosis

    Maloney provides treatment for: Axillary (underarm) hyperhidrosis Palmar (hand) hyperhidrosis Plantar (foot) hyperhidrosis Craniofacial hyperhidrosis More information about hyperhidrosis can be found at www.sweathelp.org, the website of the International [dramandamaloney.com]

    Figure 1: Positive iodine starch test: gustatory hyperhidrosis became visible on the distribution of zigomaticofacial nerves Click here to view Frey's syndrome, which is also known as auriculo temporal syndrome or gustatory hyperhidrosis, was first described [ijdvl.com]

    Other conditions that may be considered in a patient with symptoms suggesting auriculotemporal syndrome include: Primary generalised hyperhidrosis Primary focal hyperhidrosis Facial herpes zoster Diabetic neuropathy (see Diabetic skin disease) Iatrogenic [dermnetnz.org]

    […] axillary hyperhidrosis; Botox for palmar/plantar hyperhidrosis; Botox for other hyperhidrosis; Systemic therapies for hyperhidrosis; Procedural approaches; Endoscopic thoracic sympathectomy; Emerging and investigative treatments; Resources for patients [books.google.com]

  • Erythema

    The erythema typically appears in the distribution of the auriculotemporal nerve, which carries sensory input from both skin and sympathetic fibers enervating salivary glands and blood vessels. [contemporarypediatrics.com]

    Clinial features- Sweating Erythema Redness Investigations- Starch iodine test Treatment- Aluminium chloride- antiperspirant Denervation by tympanic neuorectomy Inject Botulinum toxin into affected skin (latest treatment) Exam Important It is gustatory [medicoapps.org]

    Abstract Frey syndrome is characterized by erythema, flushing, and gustatory sweating in the preauricular area. It most commonly occurs after parotid surgery. [jcadonline.com]

    Auriculotemporal syndrome (AS) is an uncommon disorder that may present with facial erythema with chewing food. We report a patient referred to an allergist to rule out allergy as a reason for food-associated bilateral facial flushing. [ncbi.nlm.nih.gov]

  • Increased Sweating

    Increasing the thickness of the skin flap raised over the parotid gland during surgery by including fat and superficial musculoaponeurotic tissue can theoretically protect the sweat glands and their nerve fibers from being exposed. [statpearls.com]

Psychiatrical

  • Withdrawn

    Botulinum A toxin injected slowly intradermally as the needle is withdrawn. [medicine.uiowa.edu]

Neurologic

  • Gustatory Sweating

    Encyclopaedia Britannica / UIG / Getty Images However, sweating from the face after eating any type of food is indicative of a condition called gustatory sweating, or gustatory hyperhidrosis. [verywellhealth.com]

    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. [ncbi.nlm.nih.gov]

    Head Neck. 2003 Aug; 25(8): 624-8. sweating gustatory sweating in diabetes mellitus [gpnotebook.com]

    Five patients have no Gustatory sweating. In the same way, four patients present with a dramatic decrease in Gustatory sweating. [jmatonline.com]

  • Paresthesia

    Between attacks of pain there is sometimes numbness or altered sensations (anesthesia or paresthesia). This is termed “gustatory neuralgia”. [drahmetkoc.com]

    Between attacks of pain there may be numbness or other altered sensations (anesthesia or paresthesia). This is sometimes termed "gustatory neuralgia". [en.wikipedia.org]

    Between the painful bouts or attacks, the patient can experience a temporary form of numbness or altered sensations like burning in the affected area (paresthesia sensation often as a result of “gustatory neuralgia”). [icliniq.com]

  • Peripheral Neuropathy

    Peripheral Nerve Disorders Also called: Neuritis, Peripheral neuritis, Peripheral neuropathy Your peripheral nerves are the ones outside your brain and spinal cord. [icdlist.com]

  • Agitation

    Neurological symptoms may also occur during or following CRS, are variable between patients, and may include delirium, agitation, lethargy, aphasia, and seizures. Guidelines for the treatment of neurological symptoms have also been proposed [41]. [jhoonline.biomedcentral.com]

Workup

4 Bilateral forms appear to be largely idiopathic, but a familial bilateral syndrome has already been described.5 The outcome is overall favorable in unilateral cases, with regression in around 57% of cases, at a median age of 27 months.3 No further workup [anaisdedermatologia.org.br]

Completeness of reporting—analysis Completeness of reporting was judged for each included case using the following three components [6]: (1) detailed description of history, symptoms, and findings; (2) information on diagnostic workup, and (3) management [link.springer.com]

Treatment

One patient had transient facial paresis following BT treatment on day 3. [scielo.br]

There is no definitive /curative treatment. Explain the different treatment options. The treatment is only supportive. All the treatment options have been used with variable success rates. [dermatologyadvisor.com]

Clinial features- Sweating Erythema Redness Investigations- Starch iodine test Treatment- Aluminium chloride- antiperspirant Denervation by tympanic neuorectomy Inject Botulinum toxin into affected skin (latest treatment) Exam Important It is gustatory [medicoapps.org]

According to a recent study, the treatment of Frey’s syndrome has no treatment of choice. The authors investigated the effectiveness of botulinum toxin type A in the treatment of Frey’s syndrome for the first time in Thai patients. [jmatonline.com]

Treatment There is no definitive treatment but various options are described:injection of Botulinum toxin A, surgical transection of the nerve fibers (only a temporary treatment), application of an ointment containing an anticholinergic drug such as scopolamine [drahmetkoc.com]

Prognosis

[…] the discomfort it causes, and the tolerance level of an individual Please find comprehensive information on Frey's Syndrome regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]

Sections Continuing Education Activity Introduction Etiology Epidemiology Pathophysiology Histopathology History and Physical Evaluation Treatment / Management Differential Diagnosis Treatment Planning Toxicity and Side Effect Management Prognosis Complications [pubmed.ncbi.nlm.nih.gov]

Prognosis is generally good in otherwise uncomplicated cases without any systemic involvement; however, some severe cases may require several surgical interventions as early as from birth. [ajnr.org]

As the method of parotidectomy (4) and prognosis (33) are influenced by benign and malignant tumors, diagnosis of parotid gland lesions prior to parotidectomy is important. [spandidos-publications.com]

[…] contraindicated in patients with motor neuron disease, myasthenia gravis, Eaton-Lambert syndrome, neuropathies, psychological instability, history of an allergic reaction to the toxin or albumin, pregnancy, and infection at the affected skin site.[84] Prognosis [statpearls.com]

Etiology

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

The basic etiology of the syndrome is unknown. Certain physiologic considerations are discussed. The condition is benign, nonprogressive and one in which surgical division of the auriculotemporal nerve should be curative. [pediatrics.aappublications.org]

Etiology In infants, trauma to the auriculotemporal nerve during forceps-assisted delivery has been implicated in 50% of cases. [dermatologyadvisor.com]

Lucja Frey, who was the first individual to not only describe the symptoms, but also elucidate the correct underlying neuroanatomy of the condition in 1923.[4] Etiology. [jcadonline.com]

Frey’s Syndrome Consequent to an Unusual Pattern of Temporomandibular Joint Dislocation: Case Report with Review of Its Incidence and Etiology. Craniomaxillofac Trauma Reconstr. 2013;6(1):1–7. Laage-hellman JE. [apcz.umk.pl]

Epidemiology

The discussion covers the phenotype spectrum, epidemiology, mode of inheritance, pathogenesis, and clinical profile of each condition, all of which is accompanied by a wealth of illustrations. [books.google.com]

Neurology and Neurosurgery Czech and Slovak Ophthalmology Czech and Slovak Psychiatry Czech Geriatric Review Czech Gynaecology Czech Rheumatology Czech Dental Journal Czech Urology Czech-Slovak Dermatology Czecho-Slovak Pathology Czech-Slovak Pediatrics Epidemiology [prolekare.cz]

Sections Continuing Education Activity Introduction Etiology Epidemiology Pathophysiology Histopathology History and Physical Evaluation Treatment / Management Differential Diagnosis Treatment Planning Toxicity and Side Effect Management Prognosis Complications [pubmed.ncbi.nlm.nih.gov]

Epidemiology[edit] The condition is rare, although the exact incidence is unknown.[9] The disorder most often occurs as a complication of the surgical removal of a parotid gland (parotidectomy). [en.wikipedia.org]

Molecular medicine reports. 2012 Apr; [PubMed PMID: 22266670] [18] Hohman MH,Bhama PK,Hadlock TA, Epidemiology of iatrogenic facial nerve injury: a decade of experience. [statpearls.com]

Pathophysiology

The pathophysiology of the syndrome, with particular reference to pain, and possible treatment modalities are discussed. [ncbi.nlm.nih.gov]

It is the purpose of this paper to describe the anatomy and pathophysiology involved and the historical evolution of therapy in order to demonstrate the efficacy of a middle ear surgical procedure which eliminates the distressing symptoms of Frey's syndrome [jamanetwork.com]

The correct pathophysiology was elucidated by the French pediatric neurologist André-Thomas (1867-1963) 8 who formulated his aberrant regeneration theory, which was published in 1927 6. Curiously Dr. [radiopaedia.org]

Andre Thomas theorized that the pathophysiology of the disease involved aberrant nerve regeneration. Five years later, Dr. [pubmed.ncbi.nlm.nih.gov]

Prevention

Some of the current methods to prevent and treat symptomatic Frey syndrome are reviewed. [jhu.pure.elsevier.com]

SURGICAL METHODS FOR THE PREVENTION OF FREY SYNDROME Prevention of Frey syndrome has been guided by the alteration of surgical techniques or the addition of procedures focused on preventing synkinesis. [ncbi.nlm.nih.gov]

Sternocleidomastoid muscle flap preventing Frey syndrome following parotidectomy. World J Surg. 2004; 28: 361-364 Curry J. King N. Reiter D. et al. Meta-analysis of surgical techniques for preventing parotidectomy sequelae. [oto.theclinics.com]

Minimally invasive technique with reconstruction remains the gold standard for preventing and treating Frey’s Syndrome. Key Points: Frey’s Syndrome is a rare, yet preventable, surgical complication of traditional parotid surgery. [ohniww.org]

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