The prevention and management of Frey's syndrome and a step by step
guide through the nonsurgical treatment with Botulinum toxin
Abstract
Firstly described by Lucy Frey in 1923 the “Frey’s syndrome” is
characterized by sweating and flushing in direct response to
mastication. The mechanism is aberrant regeneration of postganglionic
parasympathetic neurons from the auriculotemporal nerve and
Acetylcholine secretion by a masticatory stimulus. This entity occurs in
up to 65% following lateral parotid resections and less commonly after
neck dissection or facelift procedures. This article aims to list
possible surgical and non-surgical treatment options of this iatrogenic
entity but should focus on the treatment with botulinum toxin A and
provide a step by step guide from the Lugol-Iodine-Starch test to the
botulinum toxin A (BoNTA-ONA) injection within the affected area.