Bakke Merete, Max Thorsen Niels, Bardow Allan, Dalager Torben, Eckhart Thomsen Carsten, Regeur Lisbeth
Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Odontol Scand. 2006 Jun;64(3):129-33. doi: 10.1080/00016350600555743.
Frey's syndrome, gustatory sweating in the preauricular area, is an unpleasant phenomenon occurring during meals after surgery on the parotid gland. Recently, botulinum toxin A (BTX) has been shown to reduce the symptoms, but the variation in the reported doses is large.
To quantify the effect of treatment with low-dose BTX in a case of Frey's syndrome over a period of 6 months.
A 56-year-old woman was treated with 10 U Botox given as 20 single, intracutaneous injections of 0.5 U, one for each cm(2), 3 years after resection of the parotid gland. Before treatment and repeatedly during the 6-month period, the sweating was rated subjectively on a 100-mm visual analog scale (VAS) and by a severity index, and objectively by assessment of the extent of the involved skin area using Minor's iodine-starch test, staining the area of sweating dark.
The treatment decreased the involved area from 20 to 5 cm(2) and the VAS ratings from 98 to 8 mm. The index showed that treatment affected the sweating intensity, not the frequency. After the 6-month period the patient was still satisfied, but the involved skin area had increased; however, not entirely to pretreatment values.
The effect of BTX injections for gustatory sweating obtained in this case was comparable to results reported using higher doses. Low doses of BTX can therefore be used in the treatment of Frey's syndrome, but studies to clarify the dose-response relationship, in terms of both time-course and obtained effect, are needed.
弗雷综合征，即耳前区味觉性出汗，是腮腺手术后进食时出现的一种令人不适的现象。最近，已证明A型肉毒毒素（BTX）可减轻症状，但报道的剂量差异很大。
量化低剂量BTX治疗弗雷综合征6个月的效果。
一名56岁女性在腮腺切除术后3年，接受了10单位保妥适治疗，以0.5单位进行20次皮内单点注射，每平方厘米注射1次。在治疗前及6个月期间多次进行评估，主观上通过100毫米视觉模拟量表（VAS）和严重程度指数对出汗情况进行评分，客观上通过使用米诺氏碘淀粉试验评估受累皮肤面积，将出汗区域染成深色。
治疗后受累面积从20平方厘米减少至5平方厘米，VAS评分从98降至8毫米。指数显示治疗影响出汗强度，而非频率。6个月后患者仍感满意，但受累皮肤面积有所增加；不过，并未完全恢复至治疗前水平。
该病例中BTX注射治疗味觉性出汗的效果与使用更高剂量报道的结果相当。因此，低剂量BTX可用于治疗弗雷综合征，但需要开展研究以阐明在时间进程和获得的效果方面的剂量反应关系。
