Temporoparietal frey syndrome: An uncommon variant of a common syndrome.

OBJECTIVES/HYPOTHESIS: To describe a previously unreported variant of Frey syndrome. Gustatory sweating is a common complication of parotidectomy and typically directly overlies the surgical site or parotid bed. In some instances, the sweating may occur beyond the parotid bed or involve tissue that was undisturbed during the procedure.

STUDY DESIGN

Retrospective case series.

METHODS

All cases of temporoparietal Frey syndrome in a single surgeon's experience were reviewed.

RESULTS

Seven patients were found to have temporoparietal Frey syndrome. Three patients had concomitant first bite syndrome. Three patients had some form of reconstruction at time of surgery. The mean time to onset of symptoms was 11.5 months, with a range of 7 to 21 months. Four patients did not require any treatment for their symptoms, but two patients required intradermal Botox injections for symptomatic relief.

DISCUSSION

This study describes a previously unreported variant of Frey syndrome with symptoms occurring distal to the parotid gland. This likely develops either by regeneration of severed postganglionic fibers into sympathetic targets distally along the course of the auriculotemporal nerve or by regeneration into fibers of the sympathetic plexus traveling along the superficial temporal artery.

LEVEL OF EVIDENCE

Laryngoscope, 129:2071-2075, 2019.