Treatment of Frey Syndrome with Botulinum Toxin-A: A Practical Approach from Minor's Test to Injection.

Introduction: Frey's syndrome, described by Lucy Frey in 1923, is a unique condition characterized by sweating, flushing, and reddening as a direct response to mastication. This phenomenon results from the aberrant regeneration of postganglionic parasympathetic neurons originating from the auriculotemporal nerve and the subsequent acetylcholine secretion induced by masticatory stimuli. Although rare, this syndrome can have multiple underlying causes and is frequently observed, occurring in up to 65% of cases following lateral parotid resections. Additionally, it can less commonly manifest after neck dissection, facelift procedures, or be associated with diabetes mellitus. Method: This article outlines a comprehensive diagnostic algorithm for Frey's syndrome, which includes the utilization of the Minor-Starch-Iodine Test. This test is a key component in diagnosing the syndrome and is discussed in detail, providing insights into its procedure and interpretation. Additionally, the gold standard of treatment for established Frey's syndrome, botulinum toxin A, is thoroughly described, including its mechanism of action, administration, and potential side effects. Discussion: Finally, the article underscores the need for further research to enhance our understanding of Frey's syndrome, leading to better diagnostic methods and more tailored treatment options for patients.

An Extremely Delayed Onset of Frey Syndrome: A Case Report and Literature Review.

We report the case of an 80-year-old man with Frey syndrome that developed 30 years postoperatively, which is an exceptionally long period before its occurrence. Sweating and flushing occurred on only the side of his face where the surgery was performed, and he had no other causative abnormalities. Following treatment with botulinum toxin, the patient's symptoms resolved. Extremely early- and late-onset cases do not fit the conventional paradigm of this pathology. Various surgical methods to prevent this syndrome have been explored, but complete prevention has not yet been achieved. These findings suggest that the underlying pathophysiology of Frey's syndrome may be more complex than previously recognized.

Late Prevalence of Typical and Atypical Symptoms of Frey's Syndrome after Parotidectomy for Benign Tumor.

BACKGROUND: The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of surgical procedure, the most common complication is Frey's syndrome (FS). Traditionally, FS includes unilateral gustatory sweating and flushing of the facial skin lining the parotid compartment. Recent research describes atypical discomfort associated with FS. The aim of this study was to assess the late prevalence and severity of both usual and atypical symptoms after parotidectomy for benign tumors. METHODS: We conducted a cross-sectional study involving 86 subjects who underwent superficial parotidectomy at least one year before the study. The questionnaire included the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale supplemented by specific questions about symptoms. RESULTS: Sixty-seven out of eighty-six (77.9%) cases reported almost one symptom. The most frequent symptom was itch (36/67-53.7%), followed by pain (35/67-52.2%), while 28/67 (41.8%) subjects complained of atypical symptoms without flushing or sweating. A desire to treat the discomfort was reported by 50/67 (74.6%) subjects. CONCLUSIONS: Late postparotidectomy local discomfort is not infrequent and includes both usual and "unusual" symptoms almost equally. Our results suggest the importance of informing patients about the occurrence of the syndrome and the available treatment options during pre- and postoperative counseling.

The incidence of Frey syndrome and treatment with botulinum toxin in the Central Denmark Region.

Objectives: Frey syndrome (FS) is a common complication to large salivary glands surgery. This study primarily aims to describe the incidence of FS among parotid surgery patients in the Central Denmark Region. The secondary aim is to describe predisposing characteristics to syndrome development and the effect of treatment with botulinum toxin (Botox) injection. Methods: This is a retrospective qualitative study spanning the years 2015-2020. Data on patients diagnosed with FS after parotid surgery with symptoms severe enough to require Botox was extracted from electronic patient records. Incidence of FS development was calculated using data from all parotid gland surgeries in the same period and region. Results: The incidence of treatment-requiring FS was 2.6% (20/775), with an annual incidence ranging from 0.8% (1/125) in 2017 to 4.5% (5/112) in 2016. Difference in FS development for men and women was not statistically significant (p = .07), although it was significantly more common after total parotidectomy compared to superficial resection (p = .003), and after malignant compared to benign diagnosis (p = .01). Complications in the postoperative period arose for 30% of FS patients. Repeated treatment with Botox was necessary after 6-12 months and at a median interval of 11 months. Forty-five percent of patients received only one injection. The average dose per injection was 48.3 IU. Conclusion: This study revealed a rather low incidence of FS in the Central Denmark Region compared to current international literature. Total parotidectomy and malignant diagnosis predisposed to syndrome development. Botox injection had a wide-ranging effective duration but typically lasted for around 1 year. Level of evidence: Level IV.

Auriculotemporal Frey syndrome not associated with surgery or diabetes: systematic review.

Patients who undergo salivary gland, neck, or facelift surgery or suffer from diabetes mellitus often develop Frey syndrome (also known as auriculotemporal syndrome or gustatory sweating). Frey syndrome has been occasionally reported to occur in subjects without history of surgery or diabetes but this variant of Frey syndrome has not been systematically investigated. We searched for original articles of Frey syndrome unrelated to surgery or diabetes without date and language restriction. Article selection and data extraction were performed in duplicate. Our systematic review included 76 reports describing 121 individual cases (67 males and 54 females) of Frey syndrome not associated with surgery or diabetes. The age at onset of symptoms was ≤ 18 years in 113 (93%) cases. The time to diagnosis was 12 months or more in 55 (45%) cases. On the other hand, an allergy evaluation was performed in half of the cases. A possible cause for Frey syndrome was detected in 85 (70%) cases, most frequently history of forceps birth (N = 63; 52%). The majority of the remaining 22 cases occurred after a blunt face trauma, following an auriculotemporal nerve neuritis or in association with a neurocutaneous syndrome. The cause underlying Frey syndrome was unknown in 36 cases.   Conclusion: Frey syndrome not associated with surgery or diabetes almost exclusively affects subjects in pediatric age and is uncommon and underrecognized. Most cases occur after forceps birth. There is a need to expand awareness of this pseudo-allergic reaction among pediatricians and allergists. What is Known: • Pre-auricular reddening, sweating, and warmth in response to mastication or a salivary stimulus characterize Frey syndrome. • It usually occurs after salivary gland surgery and in diabetes. What is New: • In children, Frey syndrome is rare, and most cases occur after a forceps-assisted birth. • In childhood, this condition is often erroneously attributed to food allergy.

Infrahyoid myofascial flap transfer for the prevention of concave deformity and gustatory sweating after parotidectomy.

OBJECTIVE: Concave deformities and gustatory sweating are the most common complications that cause substantial patient dissatisfaction after parotidectomy. Various surgical methods to prevent these complications have been described. However, effective techniques have not been established, especially in patients with medium- to large-sized parotidectomy defects. We evaluated the utility of infrahyoid myofascial flap reconstruction of parotidectomy defects for the prevention of these complications. METHODS: We conducted a retrospective case series study in patients with a benign or malignant parotid tumor measuring over 4 cm who underwent immediate pedicle infrahyoid myofascial flap reconstruction after total or subtotal parotidectomy or total resection of either the superficial or deep parotid gland at our hospital. Subjective analyses of facial symmetry, postoperative concave deformities of the anterior neck, gustatory sweating, voice disorders, odynophagia, neck scarring in the parotid and anterior neck areas, sensory disorders, pain, and neck stiffness were performed using patient interview data. Objective evaluations of facial symmetry were made by the first or second author. Both analyses were performed after a follow-up of more than six months. Additionally, patient demographic data, clinicopathological factors, parotidectomy and skin incision types, flap survival, and postoperative complications were evaluated. RESULTS: We included eight patients (male, n=5; mean age, 69.3 years [range, 37-93 years]). Procedures included total or subtotal parotidectomy (n=4), superficial lobe parotidectomy (n=2), and deep lobe parotidectomy with partial superficial lobe parotidectomy (n=2). Infrahyoid myofascial flaps reached the cranial tip of the parotid defect without tension, and their volume sufficiently filled the parotidectomy defect in all patients. There were no local signs of insufficient blood flow within the transferred flaps. Objective and subjective assessments were made after a mean duration of 1.2 years (range, 0.6-1.8). Postoperatively, no patient subjectively reported facial asymmetry. Objectively, facial symmetry was "good" in four patients and "fair" in four patients. No distinctly visible concave deformity in the parotid or anterior neck area occurred in any patient. Gustatory sweating occurred in one patient; this individual had the largest parotidectomy defect. Only one patient experienced donor site morbidity (mild anterior neck stiffness) related to infrahyoid myofascial flap elevation. CONCLUSION: Although complete prevention of gustatory sweating was unsuccessful, infrahyoid myofascial flap reconstruction of medium- to large-sized parotidectomy defects led to postoperative facial symmetry with minimal donor site morbidity.

Frey's Syndrome: A Review of Aetiology and Treatment.

First described by Polish Neurologist Lucja Frey in 1923, Frey's syndrome (FS), or auriculotemporal syndrome, is a rare condition characterised by gustatory sweating, typically encountered as sequelae following invasive head and neck surgery. The pathophysiology of FS can be described by aberrant reinnervation of postganglionic parasympathetic neurons to the surrounding denervated sweat glands and cutaneous blood vessels. Multiple invasive procedures have been associated with FS ranging from salivary gland surgery to burn reconstruction and thoracoscopic sympathectomies. Rarely, FS can be secondary to trauma or non-surgical aetiologies, including diabetes and infection. Physical symptoms vary based on the severity and surface area affected by FS and range from mild symptoms to severe psychosocial morbidity for patients. Surgeons operating in the head and neck, including otolaryngologists, maxillofacial surgeons, and plastic surgeons, should be aware of this potential complication and be up to date with diagnosis and treatment strategies for FS. This review article summarises the literature relating to FS focusing on its aetiologies, symptomatology, prevention, and available treatments, aiming to provide an up-to-date review of this condition for surgeons operating in the head and neck region. Although various treatment options have been suggested, these are often limited to topical agents that require life-long administration for symptom control. Further research is recommended to identify the optimal treatment for this condition and the role of surgery as a treatment for severe or refractory cases.

Gustatory sweating in people with type 1 and type 2 diabetes mellitus: Prevalence and risk factors.

OBJECTIVE: Gustatory sweating (GS) is characterized by profuse sweating during or immediately after ingestion of food and is known as a complication of diabetes mellitus (DM). This study aimed to determine the prevalence of GS and to characterize the sweating in a cohort of patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM) as compared with a control group. METHODS: In a cross-sectional study, 665 outpatients with T1DM and 505 outpatients with T2DM filled in an 8-point questionnaire about GS. Answers were paired with medical data from the electronic patient records to explore associations with DM complications. The control group consisted of 1158 persons without DM answering the same questionnaire in an online version. RESULTS: In people with T1DM and T2DM, the prevalence of GS was 10% (95% CI 7%-12%) and 13% (95% CI 10%-16%), respectively. In the control group, the prevalence of GS was 5% (95% CI 3%-6%). Most commonly, people sweat on the face and/or head and upper body with a duration of 10-30 min albeit in the control group <10 min. In patients with T1DM, increased HbA1c was associated with GS (OR 1.3 [95% CI 1.05-1.6], p = .016), and in T2DM, younger age (OR 0.95 [95% CI 0.92-0.99), p = .006), presence of severe peripheral neuropathy (OR 2.33 [95% CI 1.04-5.2], p = .039) and absence of proliferative retinopathy were associated with GS (OR 0.22 [95% CI 0.07-0.71], p = .011). CONCLUSION: We found the prevalence of gustatory sweating of 11% in a hospital-based cohort of patients with T1DM and T2DM. This was twice as high as in non-diabetic control persons. Associations between GS and known diabetes complications could only be demonstrated in T2DM. Compared with a control group without DM, odds for GS are higher in people with DM and age >45.

Prevention of Frey's Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 "Formal" Parotidectomies for Benign Pathologies.

BACKGROUND: Frey's syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. METHODS: We conducted a 20-year retrospective study including the patients who had undergone "formal" (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. RESULTS: We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey's syndrome was found after the use of dermal collagen interpositional barrier (P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor's test was positive at an incidence of 59.09% in Group A and 21.87% in Group B (P = .004, 95% CI). Severe Frey's syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B (P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey's syndrome in the compared groups. CONCLUSION: Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey's syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

What is the best method for prevention of postparotidectomy Frey syndrome? Network meta-analysis.

BACKGROUND: Prevention of Frey syndrome (FS) after parotidectomy using an interposition barrier has long been gaining a wide popularity; however, there is no clear evidence regarding which preventive technique is more effective. The aim of this network meta-analysis (NMA) is to answer the question: What is the best method for prevention of FS after parotidectomy? METHODS: A comprehensive search of the PubMed, Embase, SCOPUS, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of subjective Frey syndrome (SFS) and objective Frey syndrome (OFS). The Bayesian NMA accompanied with a random effects model and 95% credible intervals (CrIs) were calculated using GeMTC R package. RESULTS: Thirty-four studies (n = 2987 patients) with five interventions, namely Alloderm (ADM), temporoparietal fascia (TPF), sternocleidomastoid muscle (SCM), superficial musculoaponeurotic system (SMAS), and free fat graft (FFG), were compared together and with no interposition barrier (NB). The results of NMA showed a statistically significant reduction in both SFS and OFS when ADM, TPF, SMAS, FFG, and SCM were compared with NB. No statistical differences were observed when comparing ADM, SCM, SMAS, FFG, and TPF. TPF ranked the best of all treatments (59.4%) and was associated with the least incidence of SFS; whereas ADM ranked the best of all treatments (61.1%) and was associated with the least incidence of OFS. CONCLUSIONS: All interventions (TPF flap, ADM, FFG, SMAS, and SCM) were associated with a significant reduction in the incidence of FS when compared with NB. TPF and ADM showed the best outcome with the least incidence of SFS and OFS, respectively.

Over a decade of single-center experience with thoracoscopic sympathicolysis for primary palmar hyperhidrosis: a case series.

BACKGROUND: Primary palmar hyperhidrosis is a severely debilitating condition that can affect patients of any age. We report our experience with thoracoscopic sympathicolysis in a large cohort of children less than 14 years of age. METHODS: All children who underwent thoracoscopic sympathicolysis from April 2005 through January 2017 were evaluated retrospectively. The procedure entailed bilateral bipolar fulguration of the second and third thoracic ganglia with transverse disruption of collateral nerve fibers along the third and fourth rib. Demographic information, as well as postoperative outcome, complications, and satisfaction were analyzed. RESULTS: Over the 12 year study interval, a total of 102 children underwent thoracoscopic sympathicolysis for palmar hyperhidrosis. Complete follow-up was available for 98 patients (median age 12 [range 5-14] years; 38 boys [39%]). Median follow-up was 4 [range 2-12] years. Complete palmar dryness was achieved in 93 (95%) cases. One patient suffered postoperative unilateral ptosis, 6 reported gustatory sweating, and 65 experienced compensatory sweating. Average postoperative rating on a 1 (lowest) to 10 (highest) rating scale was 9, with 97 (99%) patients saying that they would undergo the procedure again. CONCLUSION: Our technique of thoracoscopic sympathicolysis in children was associated with very high postoperative satisfaction, despite a high rate of compensatory sweating and occasional autonomic gustatory sweating. Other more severe complications in this age group were rare.

Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: A systematic review.

BACKGROUND: Botulinum neurotoxin type A has been used for the treatment of hyperhidrosis. OBJECTIVE: To perform a systematic review of the literature to identify evidence on the treatment approaches and outcomes associated with abobotulinumtoxinA (aboBoNT-A) treatment of hyperhidrosis. METHODS: EMBASE, MEDLINE, and the Cochrane Library were searched for relevant observational studies, randomized controlled trials, and nonrandomized controlled trials. There were no date or country restrictions. Bibliographies of review articles and recent congress proceedings (2017-2019) were also searched. Articles were screened using predefined eligibility criteria and relevant data were extracted. RESULTS: Of 191 unique articles identified, 23 were considered relevant (3 observational studies, 10 nonrandomized controlled trials, and 10 randomized controlled trials). These articles provided data on axillary (13), palmar (7), and forehead (1) hyperhidrosis, compensatory hyperhidrosis of the back (1), Frey syndrome (1), and diabetic gustatory sweating (1). All studies reported that aboBoNT-A reduced sweating and no serious adverse events were observed. Patient satisfaction was high and improvements to quality of life were observed after aboBoNT-A treatment. LIMITATIONS: Variability in the injection technique when data were compared across studies. CONCLUSION: This study describes a range of treatment approaches and demonstrates positive outcomes of aboBoNT-A treatment for multiple types of hyperhidrosis.

Not only gustatory sweating and flushing: Signs and symptoms associated to the Frey syndrome and the role of botulinum toxin A therapy.

BACKGROUND: The classic symptoms of Frey syndrome are gustatory sweating and flushing. Aims of the study were to describe prevalenceand severity of typical and atypical presentations of the disorder and to assess the effects of botulinum neurotoxin A (BoNT-A) therapy in patients with Frey syndrome after parotidectomy. METHODS: In this prospective, observational study on 18 patients, we assessed symptom severity before therapy, after 15 days, 1, 3 and 6 months' follow-up with the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale specifically designed by the authors themselves for this study. RESULTS: Before BoNT-A injection, all patients (100%) complained gustatory sweating, 80% paresthesia, 77% gustatory flushing, 60% pain and 60% gustatory itch. The SFIPP-Frey overall score and the symptom-specific ones decreased significantly at each post-therapy control. CONCLUSIONS: The prevalence of "unusual" manifestations is not negligible. BoNT-A improves symptoms severity. The SFIPP-Frey scale may be useful to assess symptoms and to monitor post-therapy outcomes.

Modified facelift incision and superficial musculoaponeurotic system flap in parotid malignancy: a retrospective study and review of the literature.

BACKGROUND: Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. METHODS: We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015-2019) in the 1st ENT University Department, University of Athens, Greece. RESULTS: We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey's syndrome. CONCLUSIONS: The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.

Analysis of Abdominal Dermal-Fat Grafting to Repair Parotidectomy Defects: An 18-Year Cohort Study.

OBJECTIVES: To assess the outcomes of abdominal dermal-fat grafting following superficial and total parotidectomy. METHODS: A retrospective chart review of parotidectomy patients was performed. Patients were divided into four groups based on surgical extent and grafting status: superficial parotidectomy (SP), superficial parotidectomy with grafting (SPg), total parotidectomy (TP), and total parotidectomy with grafting (TPg). Complication rates and operative times were then compared between surgically matched groups (SP vs. SPg, TP vs. TPg). Complications included graft necrosis, gustatory sweating, first-bite syndrome, infection, hematoma, sialocele, and seroma. Data was analyzed via chi-square and two-sample t testing, logistic regression, and one-way analysis of variance. RESULTS: The cohort consisted of 330 patients: 106 SP (32.12%), 61 SPg (18.48%), 82 TP (24.85%), and 81 TPg (24.55%). No donor site complications occurred. TPg resulted in seven graft necroses (8.64%), and 22 reported gustatory sweating (27.20% vs. 10 TP patients (12.2%), P = 0.016); SPg resulted in two necroses (3.28%). There were no other statistically significant differences in complication rates. Graft recipients receiving adjuvant radiation were more likely to develop necrosis (odds ratio [OR] 4.60, 95% confidence interval [CI], 1.16-18.27, P = .0194). Patients who developed gustatory sweating were 8.38 years younger (95% CI 2.66-14.10, P = 0.002, follow-up time > 48 days). Grafting did not increase operative times (TP/TPg: mean = 275.91/263.65 minutes, standard error of the mean = 41.96/33.75, P = 0.822). CONCLUSION: An abdominal dermal-fat graft is an excellent reconstructive choice for a parotidectomy defect and is not associated with increased complication rates or prolonged operative time. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2144-2147, 2020.

Auriculotemporal nerve syndrome (Frey's syndrome): A literature review and case report.

Frey's syndrome in children is rare and often erroneously attributed to food allergy. A description of a case of Frey's syndrome in a child and a review of the literature is provided. Awareness of this condition is important for the pediatric dentist to avoid unnecessary medical procedures and provide reassurance to the dental team in the setting of this benign condition.

The superficial musculoaponeurotic system flap in the prevention of Frey syndrome: A meta-analysis.

OBJECTIVES/HYPOTHESIS: Evaluate the difference of the incidence in clinical Frey syndrome in studies comparing classical parotidectomy and parotidectomy with superficial musculoaponeurotic system (SMAS) flap elevation and suturing through meta-analysis methodology. STUDY DESIGN: Meta-analysis of controlled studies with and without SMAS flap. METHODS: Database search with the following key word combination: "Frey syndrome" and "SMAS." INCLUSION CRITERIA: parotidectomy, SMAS flap and control groups, minimal follow-up of 1 year. The outcome was the presence of clinical Frey syndrome. RESULTS: Eleven studies, mostly retrospective and not randomized. According to the fixed-effect model, SMAS technique is associated with a decrease of clinical Frey syndrome with an odds ratio (OR) of 0.42 (confidence interval [CI] 0.32-0.56). With the random-effect model, the difference remains significant (P = 0.006) with an OR of 0.25 (CI 0.09-0.66). The heterogeneity index I(2) is very high (85%). CONCLUSION: The use of SMAS flap and suturing is associated with a decreased incidence of Frey syndrome. Laryngoscope, 126:1581-1584, 2016.

Auriculotemporal Syndrome (Frey Syndrome).

Frey syndrome is a common sequela of parotidectomy, and although it is not frequently manifested clinically, it can cause significant morbidity for those affected. Frey syndrome results from synkinetic autonomic reinnervation by transected postganglionic parasympathetic nerve fiber within the parotid gland to the overlying sweat glands of the skin. Many surgical techniques have been proposed to prevent the development of Frey syndrome. For those who develop clinical symptoms of Frey syndrome, objective testing can be performed with a Minor starch-iodine test. Some of the current methods to prevent and treat symptomatic Frey syndrome are reviewed.