Information about Frey Syndrome

Li Liu, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
My husband recently had a surgery to remove cancer in his parotid gland. Ever since, he has been having problems with excessive sweating and flushing in his cheek and behind his ear. His doctor told him that this is Frey Syndrome and suggested surgery to cut his nerve. What exactly is Frey Syndrome? Are there any other treatments without cutting?  
Thank you.

Li Liu, MD, OncoLink editorial assistant, responds:

Dear D:
Thank you for your interest and question.

Frey syndrome, also called auriculotemporal nerve syndrome, was first described by Baillarger in 1853, and publicized by Frey in 1923 (Rev Neurol. 1923; 2:97-99). The syndrome usually manifests as immediate unilateral or, rarely, bilateral flushing and sweating in the cheek, behind the ears, and the temporal regions (distribution of the auriculotemporal nerve) after eating. Pain also can occur initially as a preliminary sign or can be the only symptom present. Typically, the symptoms occur several weeks or months after surgery. Frey syndrome is well recognized as a common complication of parotid surgery in adults and may also occur after nonsurgical trauma to the parotid gland region (Int J Dermatol 1986 Oct; 25(8): 524-6) or after suppurative parotiditis (Brain. 1948; 71:16-25.). The precise pathophysiology of Frey syndrome remains unknown.

To date, numerous methods have been used to treat patients with Frey syndrome. These methods have shown varying degrees of effectiveness and basically are divided into surgical methods and noninvasive drug treatments. The surgical methods involve excision of the affected areas of skin and the fasia or muscle. The literature also mentioned intracranial transection of the glossopharyngeal nerve (Münch med Wschr 1978; 27:120).

In recent years, various reports have documented the effectiveness of the intracutaneous injection of botulinum toxin type A in patients with Frey syndrome (J Neurol 1996 Feb; 243(2): 143-6; J Laryngol Otol 1997 Sep; 111(9): 839-44). Some studies reported 100% effectiveness and virtually no side effect with this type of treatment (Cancer 2000 Oct 15; 89(8): 1659-1663). Longer follow up is needed to evaluate long-term complication. You should discuss with your husband's doctors to explore different treatment options.