Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors.

Importance: Limited literature exists on surgical outcomes after selective deep lobe parotidectomy (SDLP) with preservation of superficial lobe for patients with benign deep lobe tumors. Objective: To compare the following factors for SDLP vs total parotidectomy for patients with benign tumors in the deep lobe: postoperative complications, including facial nerve paresis or paralysis, Frey syndrome, first bite syndrome, cosmetic defect, sialocele formation, and wound infection; and tumor control and recurrence. Design, Setting, and Participants: This case series included 273 adults who underwent SDLP (n = 177) or total parotidectomy (n = 96) at a single tertiary care institution for benign parotid tumors located in the deep lobe or deep lobe and parapharynx from January 1, 2000, to December 31, 2020. Exposure: Selective deep lobe parotidectomy vs total parotidectomy. Main Outcomes and Measures: Incidence of postoperative complications and tumor recurrence. Results: Among 273 patients (SDLP, 177 [65%]; 122 women [69%]; median age at surgery, 58 years [IQR, 46-67 years]; total parotidectomy, 96 [35%]; 57 women [59%]; median age at surgery, 59 years [IQR, 40-68 years]), the most common tumor was pleomorphic adenoma (SDLP, 128 of 177 [72%]; total parotidectomy, 62 of 96 [65%]). An abdominal dermal fat graft was less commonly performed for patients who underwent SDLP than those who underwent total parotidectomy (2 of 177 [1%] vs 20 of 96 [21%]; difference, -20% [95% CI, -28% to -11%]). The rate of great auricular nerve preservation was higher in the SDLP group than in the total parotidectomy group (84 of 102 [82%] vs 20 of 34 [59%]; difference, 24% [95% CI, 5%-42%]). No meaningful difference in length of hospital stay was found. The percentage of patients with House-Brackmann grade I immediately after surgery was 48% (85 of 177) in the SDLP group and 21% (20 of 96) in the total parotidectomy group (difference, 28% [95% CI, 16%-40%]). There were no clinically meaningful differences in rates of hematoma, sialocele, seroma, ear numbness, wound infection, or unplanned return to emergency department or operating room. The SDLP group reported a lower rate of Frey syndrome than the total parotidectomy group (1 of 137 [1%] vs 12 of 78 [15%]; difference, -15% [95% CI, -23% to -7%]), as well as a lower rate of facial contour defect (28 of 162 [17%] vs 25 of 84 [30%]; difference, -13% [95% CI, -24% to -1%]) and a higher rate of first bite syndrome (34 of 148 [23%] vs 7 of 78 [9%]; difference, 14% [95% CI, 5%-23%]). The percentage of patients with House-Brackmann grade I at their first follow-up visit was 67% (118 of 177) in the SDLP group compared with 49% (47 of 96) in the total parotidectomy group (difference, 17% [95% CI, 4%-30%]). There was no clinically meaningful difference in House-Brackmann grade after 1 year. Conclusions and Relevance: Findings of this case series study suggest that SDLP can be considered an effective and even superior technique for management of benign tumors in the deep parotid lobe. Advantages associated with SDLP include reduction in need for reconstruction for facial contour defect and reduction in complications, such as immediate facial nerve weakness and Frey syndrome. The incidence of first bite syndrome was higher in the SDLP group. Tumor control was not compromised by SLDP.

Frey syndrome after conservative parotidectomy: Importance of closing the remnant parotid parenchyma.

BACKGROUND: Frey syndrome (FS) is a typical late complication following parotidectomy. Parotid surgery without proper coverage or reconstruction of exposed parotid parenchyma may contribute to the development of FS. Therefore, this study compared the closure versus the non-closure of exposed parotid parenchyma in the occurrence of FS. METHODS: This study included 195 patients with parotid lesions who underwent partial or superficial parotidectomy plus closure or non-closure of exposed parotid parenchyma, both with the application of fibrin glue. Two surgical methods of closure and non-closure were allocated to patients without randomization and blinding processes. The primary outcome was FS, and the second outcome was other complication rates. RESULTS: The closure and non-closure of exposed parotid parenchyma were performed in 102 and 93 patients, respectively. Early postoperative complications occurred with temporary events: transient facial weakness, 32 (16.4%); hematoma, 13 (6.7%); and wound infection, 2 (1.0%), without statistical difference between the two groups (P > 0.1). However, sialocele occurred in the non-closure group (n = 19) more than in the closure group (n = 7) (P = 0.005). In the first postoperative year, decreased sensation and local pain were found in 16 patients (8.2%) and 9 patients (4.6%), respectively, with no statistical difference between the two groups (P > 0.1). FS was found more in the non-closure group (n = 19, 20.4%) than in the closure group (n = 4, 3.9%) (P < 0.001). CONCLUSION: The closure of exposed parotid parenchyma and covering fascia is preferred over the non-closure to prevent FS.

[Complications in the surgery of the parotid salivary glands. Causes, mechanisms of development, methods of prevention]. / Oslozhneniya v khirurgii okoloushnykh slyunnykh zhelez. Prichiny, mekhanizmy razvitiya, sposoby profilaktiki.

Operations for neoplasms of the parotid salivary gland require from the surgeon a deep knowledge of the anatomical and topographic features of this area and technical skill, which puts it in a number of «jewelry¼ operations that require patience and concentration. The review is devoted to the topic of specific postoperative complications after parotidectomy or subtotal resection of the gland. These include relapses of tumors, paralysis or paresis of facial muscles, Frey syndrome, salivary fistulas or sialocele, violation of skin sensitivity, soft tissue deformity. The review presents the frequency and causes of complications, mechanisms of their development, methods of prevention and elimination.

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.

Tratamiento de la hiperhidrosis secundaria a síndrome de Frey con toxina botulínica. A propósito de un caso / Treatment of hyperhydrosis secondary to Frey syndrome with botulinum toxin. Apropos of a case

El síndrome aurículo-temporal o síndrome de Frey, es una entidad caracterizada por sudoración y enrojecimiento de la piel del territorio inervado por el nervio aurículo-temporal en relación con la masticación. Se presenta el caso de un paciente diagnosticado de hiperhidrosis hemifacial secundaria a síndrome de Frey, remitido desde otorrinolaringología a consulta de rehabilitación para valoración de tratamiento. Se decide tratamiento con toxina botulínica tipo A, con buena respuesta. Se hace una breve revisión del tratamiento con toxina botulínica en el síndrome de Frey, resaltando su efectividad y facilidad de aplicación

Auriculotemporal syndrome, or Frey syndrome, is characterised by sweating and redness of the skin in the area innervated by the auriculotemporal nerve during chewing. We report the case of a patient diagnosed with hemifacial hyperhidrosis secondary to Frey syndrome who was referred by the otorhinolaryngology service to the rehabilitation service for treatment assessment. The patient was treated with botulinum toxin with good response. We provide a brief review of botulinum toxin treatment in Frey syndrome, highlighting its effectiveness and ease of application

Frey syndrome following herpes zoster in an otherwise healthy girl.

A 12-year-old girl presented with red spots appearing on the left side of her face. The girl was usually healthy and fully vaccinated, including varicella vaccination.Six years prior to her presentation, she had suffered an episode of blister rash on the left side of her face, including lesions in the ear canal and buccal mucous membrane. A diagnosis of herpes zoster was made, and she was treated with acyclovir with complete skin recovery. A hearing examination demonstrated mild-to-moderate left neurosensory hearing loss.Since then, she is having short episodes of redness on her face without pain or sweating at the exact distribution of the zoster blisters 6 years ago. The appearance of spots is related to sour foods, such as sour flavoured candies, yoghourt and green apples. The diagnosis of postherpetic Frey syndrome was made, and observational approach was adopted due to the benign character of symptoms.

Sialocutaneous fistula to the external auditory canal repaired with superficial parotidectomy and temporoparietal flap: A case report.

RATIONALE: Gustatory otorrhea can lead to cutaneous changes, recurrent infection, and social disruption. We present a case of a late, evolving sialocutaneous fistula to the external auditory canal, managed surgically after failing conservative therapies. This case is unique by late evolution, whereby the symptoms presented with significance 27 years after her operation and 19 years after mild symptoms initially arose. PATIENT CONCERNS: Gustatory, left-sided clear otorrhea with acutely increased volume over 8 months causing social disruption. DIAGNOSES: Sialocutaneous fistula to the external auditory canal. INTERVENTIONS: Superficial parotidectomy and temporoparietal flap for closure of fistula. OUTCOMES: No postoperative complications and resolution of gustatory otorrhea at one-year follow-up. LESSONS: This rare, but important, postoperative complication can present late with evolving symptoms, causing significant social disruption. It can be treated with conservative medical management and several surgical approaches.

Frey Syndrome.

OBJECTIVE: To describe the features of Frey syndrome (auriculotemporal nerve dysfunction with gustatory flushing) in childhood. STUDY DESIGN: A multicenter, retrospective, descriptive observational national case series study was conducted with the help of French academic societies. Diagnostic criteria were based on clinical history, and sometimes also on photographs or provocation tests. RESULTS: Forty-eight cases were identified, with 2 subtypes: 35 unilateral and 13 bilateral. Associated sweating was reported in only 10% of cases. Diagnosis was made in only 20% of children at the first consultation and inappropriate dietary restriction was prescribed for 21%. Instrumented vaginal delivery was significantly associated with unilateral forms (OR [unilateral vs bilateral] = 29; 95% CI 3.99-311.58; P < .001). The outcome was favorable overall with 57% regression, 20% recovery, and only 23% persistence of initial symptoms. Regression was more frequent in unilateral forms (OR = 6.60; 95% CI 1.23-44.04; P = .016), observed in 69% of unilateral forms at a median age of 27 (24-48) months. Recovery predominated in bilateral forms (OR = 0.05; 95% CI 0-0.38; P = .001), observed in 58% of bilateral cases at a median age of 8 (7-9) months. CONCLUSIONS: Frey syndrome in childhood is a rare but benign condition with mild symptoms and a favorable outcome in most cases. Unilateral forms are mostly associated with instrumented delivery. Pediatricians should be familiar with this disorder in order to avoid misdiagnosis, mainly as food allergy, and unnecessary referrals and tests.

Aplicación terapéutica de toxina botulímica en pacientes con síndrome de Frey / Botulinum toxin therapy for management of Frey´s syndrome patients

Objetivo: determinar la terapéutica más efectiva para el tratamiento del síndrome de Frey. Caso clínico: un paciente de sexo femenino, de 68 años de edad, se presentó a la consulta en el Servicio de Cirugía Bucomaxilofacial de la Unidad Asistencial Por + Salud Dr. César Milstein, por sudoración cervical molesta del lado izquierdo. Fue tratada con infiltración subcutánea de toxina botulínica por desarrollar síndrome de Frey posparotidectomía. Conclusión: actualmente, la infiltración subcutánea de toxina botulínica de tipo A constituye la primera opción de tratamiento, pues brinda resultados efectivos y seguros.

Infantile Frey's syndrome.

Frey's syndrome in children is rare and often erroneously attributed to food allergy. Here we describe a case of Frey's syndrome in an infant and provide a review of the literature. Awareness of this condition is important for the Otolaryngologist in order to avoid unnecessary medical costs and procedures and provide reassurance to both parents and primary care providers in the setting of this benign condition.

Congenital Frey's syndrome associated with nontraumatic bilateral trifid mandibular condyle.

Congenital Frey's syndrome and bilateral trifid mandibular condyle are two different entities. The occurrence of both together is rare and has not been reported in the literature. This article describes the case of a 17-year-old male patient who complained of bilateral warmness, flushing and sweating in the preauricular area after eating spicy and sour foods since childhood. He had no complaint related to the functions of the temporomandibular joint and had no history of facial trauma. The patient was treated with injections of botulinum toxin A and the signs and symptoms of Frey's syndrome improved significantly.

Frey's syndrome: case report.

Frey's syndrome is characterized by facial sweating and flushing in the parotid area when saliva is stimulated. It usually results from damage to the auriculotemporal nerve during parotidectomy.

Auriculotemporal nerve syndrome in association with congenital haemangiopericytoma: a case report.

BACKGROUND: Auriculotemporal nerve syndrome is characterised by recurrent episodes of facial gustatory flushing and/or sweating along the cutaneous distribution of the auriculotemporal nerve. The condition is rare in children and is normally a sequel of perinatal birth trauma. We report a case of a sixteen-month-old boy referred by paediatric oncology with recurrent, unilateral facial flushing of the left cheek which had been present for 2 months. The flushing only occurred during mastication. The patient had also received treatment for a rare vascular tumour, congenital haemangiopericytoma, of the left cheek and parotid region. The possible association between auriculotemporal nerve syndrome and congenital haemangiopericytoma is discussed. Knowledge of the presentation, aetiology and management of Auriculotemporal Nerve Syndrome can provide much needed reassurance to those suffering with this condition.

'Minor' morbidity after parotid surgery via the modified Blair incision.

OBJECTIVE: To assess the 'minor' morbidities subjectively experienced by the patient after parotid surgery; these include scar cosmesis and pain, 'contour' deformity following removal of parotid bulk, numbness of the pinna and gustatory sweating. DESIGN: Retrospective study SETTING: Tertiary Referral Centre. PATIENTS: 28 patients were included in the study. RESULTS: Contour deformity, scarring and paraesthesia of the pinna secondary to great auricular nerve sacrifice are the most noticeable sequelae following parotidectomy. DISCUSSION: Although facial nerve injury is the most serious morbidity following parotidectomy, it is relatively uncommon. Other 'minor' morbidities are more likely to cause post-operative problems. Despite there being a number of different approaches to the parotidectomy, with or without reconstruction, these have not been satisfactorily compared.

Síndrome auriculotemporal (síndrome de Frey) en dos lactantes con presentación bilateral / Auriculotemporal nerve syndrome (Frey syndrome) in two infants with bilateral presentation

El síndrome auriculotemporal (síndrome de Frey) se caracteriza por episodios de enrojecimiento facial, sudoración o ambos, localizados en el territorio de distribución del nervio auriculotemporal, y que ocurren como respuesta a estímulos gustativos. Cuando se manifiesta en la infancia y coincide con la introducción de nuevos alimentos en lactantes, se puede llegar al diagnóstico erróneo de alergia alimentaria. Presentamos dos lactantes (de 5 y 6 meses) con enrojecimiento facial bilateral en el área temporal, extendiéndose hasta el borde oral; ambos manifestaron los síntomas inmediatamente a la toma de fruta (y posteriormente tras un tipo de golosina en uno de los niños) con desaparición de cuadro instantes después del cese de la toma. Los dos niños eran fruto de un parto eutócico. En uno de ellos, los síntomas desaparecieron antes del año, mientras que el segundo aún tiene 7 meses y presenta episodios de intensidad variable. Es conveniente reconocer este síndrome para evitar exploraciones innecesarias y restricciones dietéticas improcedentes (AU)

Patients with auriculotemporal nerve syndrome (Frey syndrome) have facial flushing, sweating, or both located along the distribution of the auriculotemporal nerve, and that occurs in response to gustatory stimuli. As the condition usually manifests during infancy with the introduction of solid food, it can lead to the misdiagnosis of food allergy by physicians unfamiliar with this syndrome. Two boys (5 and 6 months old) presented with a history of bilateral facial flushing extending from the corner of the mouth to the temporal area. Symptoms began at the moment of fruit introduction (orange, pear, apple and banana) and also with some type of candy in the first. Symptoms appeared immediate to fruit mastication and cutaneous erythema spontaneously disappeared in a few minutes after finishing fruit. Both cases had been born without instrumental delivery. In one case the symptoms disappeared before the end of the first year of age, and the second (he?s now 7 months old) has symptoms discontinuously. The recognition of this entity might avoid unnecessary referral and laboratory evaluation (AU)

Síndrome de Frey en la infancia / Frey´s sydrome in childhood

El síndrome de Frey o auriculotemporal se caracteriza por la aparición de episodios recurrentes de eritema facial y/o hiperhidrosis, localizados en el territorio del nervio auriculotemporal, que ocurre en respuesta a los estímulos gustatorios. Este cuadro es poco frecuente en la infancia. Presentamos el caso clínico de una niña de 4 años de edad que presentaba eritema sin hiperhidrosis en la mejilla izquierda tras la masticación

Frey's syndrome, also known as auriculotemporal syndrome is characterized by recurrent episodes of facial flushing and/or sweating along the distribution of the auriculotemporal nerve, that occurs in response to gustatory stimuli. The disorder is rare in children. We report a 4-year-old girl with flushing without hyperhidrosis in the left cheek on eating