Frey’s syndrome is a common (10-40%) and important complication following parotid surgery. Gustatory sweating during oral stimulation can be embarrassing as it is accompanied by flushing and a sensation of heat. This is as a direct result of regenerated parasympathetic innervation of eccrine facial skin sweat glands by aberrant fibres from residual parotid bed salivary tissue. This article briefly outlines the non-surgical and surgical techniques to treat the condition, should it occur. However, its main focus is avoiding the complication in the first instance. They outline the broad options which include local tissue transfer (SMAS layer, the sternomastoid muscle, the temporoparietal and platysma flaps); free tissue transfer (fat or fat and dermal tissue, the latter suffering less resorption) and allograft techniques. This includes acellular dermal matrix, a readily available substitute and adaptable to most tissue bed sizes. These avoidance measures also help to restore the natural cosmetic contour of the cheek. Additional avoidance measures include limiting the extent of the original surgery to partial parotidectomy rather than complete superficial parotidectomy. Each technique is described with the help of line drawings and clinical photographs, together with the pros and cons. To conclude, the authors evaluate the evidence behind the effectiveness of the techniques and report that no evidence-based studies have been conducted that indicate effective long-term prevention of the syndrome or a clear preference of which technique offers the greatest benefit. Therefore the reconstructive technique chosen (if at all) will be based on surgeon experience, available graft, nature of disease and patient choice.
Avoiding the sweaty cheek
Reviewed by Suzanne Jervis
Prevention of Frey syndrome.
CONTRIBUTOR
Suzanne Jervis
FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.
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