Nolte D, Gollmitzer I, Loeffelbein D J, Hölzle F, Wolff K-D
Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Knappschaftskrankenhaus Bochum-Langendreer Ruhr-Universität Bochum.
Mund Kiefer Gesichtschir. 2004 Nov;8(6):369-75. doi: 10.1007/s10006-004-0575-3. Epub 2004 Oct 29.
Botulinum toxin A has meanwhile become a proven method for treatment of gustatory sweating (focal hyperhidrosis, Frey's syndrome). Clear-cut recommendations regarding dosage of botulinum toxin A in Frey's syndrome are currently not available. The aim of this prospective randomized study therefore was to investigate botulinum toxin A with respect to its efficacy in Frey's syndrome, the ideal dose yielding maximal duration of the effect, and patient contentedness as well as unwanted side effects in patients of the Clinic of OMF Surgery at the Ruhr-University of Bochum.
Twenty patients suffering from severe Frey's syndrome as a result of operations of the parotid gland were examined with the starch iodine test according to Minor. The gustatory skin areas were re-examined after intracutaneous injection of botulinum toxin A for up to 1 year. The patients ( n=20) were randomly assigned to two different treatment groups (group I: 2 MU/cm(2), n=10; group II: 3 MU/cm(2), n=10).
Mean sweating skin areas in the two treatment groups ranged between 39+/-9 and 32+/-12 cm(2), respectively. A single injection of 3 MU botulinum toxin A resulted in a nearly complete blockade of gustatory sweating for the observation period of 1 year. In the group treated with 2 MU botulinum toxin A, 44% of the total gustatory skin areas were still sweating, thus necessitating a second injection of botulinum toxin A in these patients.
Intracutaneous injection of botulinum toxin A represents a highly effective and minimally invasive procedure for the treatment of Frey's syndrome. This study shows for the first time that a dosage of 3 MU/cm(2) of botulinum toxin A achieves a complete and reliable blockade of gustatory sweating lasting for at least 12 months. This dose may therefore be recommended for treatment of this syndrome.
肉毒杆菌毒素A已成为治疗味觉性出汗（局限性多汗症， Frey综合征）的一种行之有效的方法。目前尚无关于Frey综合征中肉毒杆菌毒素A剂量的确切建议。因此，这项前瞻性随机研究的目的是在波鸿鲁尔大学口腔颌面外科诊所的患者中，研究肉毒杆菌毒素A对Frey综合征的疗效、产生最长效果持续时间的理想剂量、患者满意度以及不良副作用。
对20例因腮腺手术导致严重Frey综合征的患者，根据Minor法进行淀粉碘试验检查。在皮内注射肉毒杆菌毒素A后长达1年的时间里，对味觉性皮肤区域进行重新检查。将20例患者随机分为两个不同的治疗组（I组：2 MU/cm²，n = 10；II组：3 MU/cm²，n = 10）。
两个治疗组的平均出汗皮肤面积分别在39±9和32±12 cm²之间。单次注射3 MU肉毒杆菌毒素A在1年的观察期内几乎完全阻断了味觉性出汗。在接受2 MU肉毒杆菌毒素A治疗的组中，44%的味觉性皮肤区域仍有出汗，因此这些患者需要再次注射肉毒杆菌毒素A。
皮内注射肉毒杆菌毒素A是治疗Frey综合征的一种高效且微创的方法。本研究首次表明，3 MU/cm²的肉毒杆菌毒素A剂量可实现对味觉性出汗的完全可靠阻断，持续至少12个月。因此，该剂量可推荐用于治疗此综合征。
