ABSTRACT
OBJECTIVE: The aim of this retrospective article is to evaluate postoperative outcomes after extracapsular dissection for small benign superficial parotid neoplasms (<3â¯cm) in patients who received Superficial Musculoaponeurotic System (SMAS) flap and in patients who did not receive it. METHODS: Two groups were created and statistically compared regarding Frey's syndrome and aesthetic satisfaction by data collected through the POI-8 validated questionnaire and through an aesthetic satisfaction scale ranging from 1 to 10. The difference between these two groups was the utilization of SMAS flap. SMAS flap was harvested in one of these two group, meanwhile was not used in the other. RESULTS: The p-value analysis between group 1 and group 2 on these complications, resulted statistically not significant. Also, the aesthetic satisfaction resulted not statistically significant between group 1 and group 2. Gender, localization, and facial palsy resulted statistically correlated with the aesthetic satisfaction (p-value < 0.05). CONCLUSION: In conclusion, there is no statistical difference in the use of SMAS flap for benign parotid neoformations of the superficial lobe, with a diameter of less than 3â¯cm for which extracapsular dissection is adopted as a surgical technique.
Subject(s)
Parotid Neoplasms , Patient Satisfaction , Surgical Flaps , Humans , Parotid Neoplasms/surgery , Parotid Neoplasms/pathology , Female , Male , Retrospective Studies , Middle Aged , Adult , Aged , Treatment Outcome , Superficial Musculoaponeurotic System/surgery , Dissection/methods , Sweating, Gustatory/etiology , Young Adult , EstheticsABSTRACT
BACKGROUND: Frey's syndrome is a group of symptoms that include unilateral sweating with malar region and external ear reddening after eating or drinking some food. It is a lesion of the auriculotemporal nerve that is secondary to surgery, parotid gland infection or facial trauma. CLINICAL CASES: Three children between 4 and two and a half years of age: two girls and one boy. They had self-limiting unilateral erythematous facial macules that reached the external ear, without rash, itching, angioedema and gastrointestinal or respiratory symptoms; its onset was associated with the consumption of acid and some sweet foods. Symptom reproduction of was observed in the path of the auriculotemporal nerve. Their histories included cesarean section delivery owing to cephalopelvic disproportion (case 1), birth by operative vaginal delivery with forceps (case 2) and cesarean delivery owing to preeclampsia (case 3). CONCLUSIONS: Frey's syndrome is often mistaken with food allergy, leading to unnecessary dietary restrictions. Sweating is often absent in children owing to possible eccrine glands immaturity.
Antecedentes: El síndrome Frey es un conjunto de síntomas que incluyen la sudoración unilateral con enrojecimiento de la región malar y pabellón auricular después de comer o beber algún alimento. Se trata de una lesión del nervio auriculotemporal secundaria a cirugía o infección de las glándulas parotídeas o traumatismo facial. Casos clínicos: Tres niños entre cuatro y dos y medio años de edad: dos niñas y un niño. Presentaban máculas eritematosas unilaterales en la cara que llegaban el pabellón auricular de resolución espontánea, sin erupciones, prurito, angioedema, síntomas gastrointestinales ni respiratorios; su aparición estaba asociada con el consumo de alimentos ácidos y algunos dulces. Se observó la reproducción de los síntomas en el recorrido del nervio aurículo-temporal. Entre sus antecedentes se encontraban nacimiento por cesárea debido a desproporción cefalopélvica (caso 1), nacimiento por parto instrumentado con fórceps (caso 2) y nacimiento por cesárea debido a preeclampsia (caso 3). Conclusiones: A menudo el síndrome de Frey suele ser confundido con alergia alimentaria, ocasionando restricciones innecesarias de la dieta. En los niños suele estar ausente la sudoración debido a la posible inmadurez de las glándulas ecrinas.
Subject(s)
Sweating, Gustatory/diagnosis , Allergy and Immunology , Child, Preschool , Female , Humans , Male , PhenotypeABSTRACT
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.
Subject(s)
Sweating, Gustatory/diagnosis , Child , Child, Preschool , Diagnosis, Differential , Female , Food Hypersensitivity/diagnosis , Humans , Infant , Infant, Newborn , Male , Outcome Assessment, Health Care , Referral and Consultation , Retrospective Studies , Sweating, Gustatory/complications , Sweating, Gustatory/therapyABSTRACT
Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with amean of 1.55 _ 0.93; the scores fromthe blinded evaluators ranged from1 to 3 with a mean 1.64 _ 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Facial Paralysis/etiology , Parathyroid Glands , Sweating, Gustatory , Plastic Surgery Procedures , Surgical FlapsABSTRACT
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.
Subject(s)
Humans , Female , Aged , Parotid Gland/pathology , Sweating, Gustatory/complications , Botulinum Toxins, Type A/therapeutic use , Argentina , Dental Care for Chronically Ill/methods , Dental Service, HospitalABSTRACT
BACKGROUND AND OBJECTIVES: Painful phenomenon is one of the most important and complex experiences. Phentolamine is a non-selective alpha-adrenergic antagonist. The objective of this study was to compare the effect of increasing doses of phentolamine into subarachnoid space in rats in the modulation of painful phenomenon. METHODS: 84 male Wistar rats were divided into formalin and plantar incision groups, subdivided into six subgroups (n = 7). Control group received only saline (10 µL); active subgroups received phentolamine 10 µmg (GF10), 20 mg (GF20), 30 mg (GF30), 40 mg (GF40), and 50 g (GF50). In formalin group, pain was induced by injection of 50 µL of 2% formalin in dorsal region of right posterior paw. In plantar incision group, pain was induced by plantar incision and evaluated using von Frey filaments. Induction and maintenance of anesthesia were performed with 3% halothane for catheter placement into subarachnoid space and plantar incision. Statistical analysis was performed using the JMP program from SAS with 5% significance level. RESULTS: Phentolamine at doses of 20 and 30 g increased the algesic response in the intermediate phase of the formalin test. In plantar incision test, it had hyperalgic effect on first, third, fifth, and seventh days at a dose of 10 g and on first, third, and fifth days at a dose of 20 g and on fifth day at a dose of 30 g. CONCLUSION: Subarachnoid administration of phentolamine showed hyperalgesic effect, possibly due to the involvement of different subclasses of alpha-adrenergic receptors in modulating pain pathways. .
JUSTIFICATIVA E OBJETIVOS: O fenômeno doloroso é uma das mais importantes e complexas experiências. A fentolamina é antagonista alfa-adrenérgico não seletivo. O objetivo foi comparar os efeitos de doses crescentes da fentolamina, por via subaracnóidea, em ratos na modulação do fenômeno doloroso. MÉTODO: Foram usados 84 ratos Wistar machos, divididos nos grupos formalina e incisão plantar, subdivididos em seis subgrupos (n = 7). No subgrupo controle (GC) apenas salina (10 µL), nos subgrupos ativos, 10 µg de fentolamina (GF10), 20 µg (GF20), 30 µg (GF30), 40 µg (GF40) e 50 µg (GF50). No grupo formalina, a dor foi induzida com injeção de 50 µL de formalina a 2%, na região dorsal da pata posterior direita. No grupo incisão plantar, a dor foi induzida por incisão plantar e avaliação pelos filamentos de Von Frey. Indução e manutenção anestésica com halotano a 3% para introdução de cateter no espaço subaracnóideo e feitura da incisão plantar. Análise estatística dos resultados pelo programa JMP do SAS com nível de significância 5%. RESULTADOS: A fentolamina nas doses de 20 e 30 µg produziu aumento da resposta álgica na fase intermediária do teste da formalina. No teste da incisão plantar, promoveu efeito hiperálgico no primeiro, terceiro, quinto e sétimo dias na dose de 10 µg, no primeiro, terceiro e quinto dias na dose de 20 µg e no quinto dia na dose de 30 µg. CONCLUSÃO: A fentolamina por via subaracnóidea promoveu efeito hiperálgico, possivelmente pela participação de diferentes subclasses de receptores alfa-adrenérgicos nas vias modulatórias da dor. .
JUSTIFICACIÓN Y OBJETIVOS: El fenómeno doloroso es una de las más importantes y complejas experiencias. La fentolamina es un antagonista alfaadrenérgico no selectivo. El objetivo fue comparar los efectos de dosis crecientes de fentolamina por vía subaracnoidea en la modulación del fenómeno doloroso en ratones. MÉTODO: Fueron usados 84 ratones Wistar machos, divididos en los grupos formalina e incisión plantar, subdivididos en 6 subgrupos (n = 7). En el subgrupo control (GC) solamente se administró solución salina (10 µL); en los subgrupos activos, 10 µg de fentolamina (GF10), 20 µg (GF20), 30 µg (GF30), 40 µg (GF40) y 50 µg (GF50). En el grupo formalina, el dolor fue inducido con una inyección de 50 µL de formalina al 2% en la región dorsal de la pata posterior derecha. En el grupo incisión plantar, el dolor se indujo por incisión plantar y evaluación por los filamentos de Von Frey. La inducción y el mantenimiento anestésico se llevó a cabo con halotano al 3% para la introducción de catéter en el espacio subaracnoideo y la realización de la incisión plantar. El análisis estadístico de los resultados se hizo mediante el programa JMP(r) del SAS con un nivel de significación del 5%. RESULTADOS: La fentolamina en las dosis de 20 y 30 µg produjo un aumento de la respuesta de dolor en la fase intermedia del test de la formalina. En el test de la incisión plantar, generó un efecto hiperalgésico en el primero, tercero, quinto y séptimo días con dosis de 10 µg; en el primero, tercero y quinto días con dosis de 20 µg; y en el quinto día con dosis de 30 µg. CONCLUSIÓN: La fentolamina por vía subaracnoidea generó un efecto hiperalgésico posiblemente por la participación de diferentes subclases de receptores alfaadrenérgicos en las vías moduladoras del dolor. .
Subject(s)
Animals , Rats , Phentolamine/pharmacology , Pain Measurement/methods , Sweating, GustatoryABSTRACT
Frey's syndrome, is characterized by warmth, flushing and sweating of the face, most of time in the preauricular region, initiated by any gustatory stimulus. It is frequently related to parotid surgery. A case of Frey's syndrome in a 81-year-old female whose long-delayed clinical onset post-parotidectomy is presented.
Subject(s)
Sweating, Gustatory/diagnosis , Aged, 80 and over , Female , Humans , Parotid Gland/surgeryABSTRACT
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.
Subject(s)
Mandibular Condyle/abnormalities , Sweating, Gustatory/congenital , Adolescent , Arthralgia/drug therapy , Botulinum Toxins, Type A/administration & dosage , Humans , Injections, Intra-Articular , Male , Mandibular Condyle/diagnostic imaging , Neuromuscular Agents/administration & dosage , Radiography, Panoramic , Sweating, Gustatory/complications , Sweating, Gustatory/diagnosis , Tomography, X-Ray ComputedABSTRACT
La hiperhidrosis es la sudoración excesiva que puede ser generalizada o afectar sólo las axilas, las palmas, las plantas o el rostro. La mayoría de las veces es primaria. Si bien existen múltiples alternativas terapéuticas con resultados dispares, en los últimos años se ha comunicado una buena respuesta a la oxibutinina. Se presentan tres niñas con hiperhidrosis primaria que fueron tratadas con este anticolinérgico y tuvieron una excelente respuesta con efectos adversos mínimos o nulos.
Hyperhidrosis is the excessive sweating that may be generalized or limited to armpits, palms, soles or face. Most of the cases are primary. Although there are several therapeutics options available, good results with the use of oxybutynin have been described in the last years. We present three girls affected by primary hyperhidrosis who were treated with this anticholinergic drug and obtained an excellent response with minimal or no adverse effects.
Subject(s)
Humans , Female , Child , Adolescent , Mandelic Acids/therapeutic use , Muscarinic Antagonists/therapeutic use , Hyperhidrosis/drug therapy , Sweating, Gustatory/therapyABSTRACT
Fryns syndrome is a rare multiple congenital anomaly syndrome. The syndrome is characterized by congenital diaphragmatic hernia, unusual facial features and distal limb abnormalities. Here we report a case of monozygotic twins with Fryns syndrome of consanguine parents with normal first child. The mother with 20 weeks of gestation having hyperemesis was referred from a primary health centre to the department of obstetrics and gynaecology at our hospital with polyhydramnios detected in ultrasonogram. Detailed ultrasound was done and after finding that both babies having multiple congenital anomalies, emergency caeserian section was done. The malformations in the twins suggestive of Fryns syndrome.
El síndrome de Fryns, es un raro síndrome de múltiples anomalías congénitas. El síndrome se caracteriza por la hernia diafragmática congénita, rasgos faciales inusuales y alteraciones distales del miembro. Se presenta un caso de gemelos monocigóticos con síndrome de Fryns de padres consanguíneos con un primer hijo normal. La madre con 20 semanas de gestación e hiperemesis fue remitida desde un centro de salud primario al departamento de obstetricia y ginecología de nuestro hospital con polihidramnios detectado en ecografía. En una ecografía detallada se evidenció que los dos bebés tenían múltiples anomalías congénitas, por lo que se realizó una cesárea de emergencia. Las malformaciones en los gemelos sugieren un síndrome de Fryns.
Subject(s)
Pregnancy , Congenital Abnormalities , Sweating, Gustatory/diagnosis , Sweating, Gustatory , Pregnancy Complications/diagnosis , Pregnancy Complications , Polyhydramnios , Pregnancy Trimester, ThirdABSTRACT
BACKGROUND: Parotidectomy is a common procedure and Frey's syndrome (gustatory sweating) is a common side effect. The current literature was assessed concerning the effectiveness of the sternocleidomastoid muscle (SCM) flap to prevent Frey's syndrome after parotidectomy. METHODS: A bibliography search was conducted for studies published between 1966 and 2010 and included randomized controlled trials (RCTs) or cohort studies with patients undergoing parotidectomy with facial nerve preservation. The outcome measures of particular interest were the incidence of Frey's syndrome and cosmetic impairment. RESULTS: In all, 12 studies were selected (1 meta-analysis of all interventions to prevent Frey's syndrome, 2 RCTs, and 9 cohort studies). The trials were too heterogeneous to perform a meta-analysis on the effect of the SCM flap. The results reported by the authors of each study suggest an objective decrease in Frey's syndrome when the SCM flap was used, but there was no difference in the patients' subjective reporting of symptoms. However, this conclusion is prone to the biases inherent in these studies, and thus overall it is impossible to make any recommendation. CONCLUSION: Current reported evidence is inconclusive as to the use of SCM muscle flap as an intervention to prevent Frey's syndrome following parotid surgery.
Subject(s)
Muscle, Skeletal/transplantation , Parotid Gland/surgery , Surgical Flaps/blood supply , Surgical Procedures, Operative/adverse effects , Sweating, Gustatory/prevention & control , Controlled Clinical Trials as Topic , Female , Follow-Up Studies , Humans , Male , Muscle, Skeletal/surgery , Parotid Gland/physiopathology , Postoperative Complications/prevention & control , Primary Prevention/methods , Randomized Controlled Trials as Topic , Risk Assessment , Surgical Procedures, Operative/methods , Sweating, Gustatory/etiology , Treatment OutcomeABSTRACT
Evaluar la posibilidad de resección de las lesiones de la glándula parótida por incisiones periauriculares (grupo I) y valorar las complicacionesin mediatas derivadas de esta técnica, resultados cosméticos y dolor posoperatorio, comparándolas con el abordaje preauricular-transcervical (grupo II). Los 61 pacientes, de ambos sexos, entre julio de 2006 a julio de 2009, fueron sometidos a este estudio prospectivo, aleatorizado doble ciego, evaluando dos grupos, categorizados grupo I yII, haciendo comparaciones en cuanto a dolor posoperatorio según la escala analógica de niveles de dolor, complicaciones relacionadas al nervio facial, posibilidad de resección indistintamente del tipo histológico, del lóbulo afectado, y por último, la satisfacción cosmética. Los 59 pacientes completaron este estudio, no obteniendo diferencias estadísticamente significativas en cuanto al dolor posoperatorio, ni en cuanto a las complicaciones, pero si en lo referido a la visualización de la cicatriz operatoria; 96% de los pacientes (grupo I), refirió satisfacción con el resultado cosmético en comparación con 65% del grupo II; siendo estadísticamente significante. No hubo diferencias en cuanto a la presentación de dolor ni complicaciones posoperatorias en cuanto al abordaje periauricular en comparación a los que se les realizó el abordaje preauricular-transcervical. Fue mayor la manifestación de satisfacción cosmética en el abordaje periauricular, la cual recomendamos, porque no produce dificultades técnicas, indistintamente del sexo, edad, tipo histológico o ubicación de la lesión dentro de la glándula parótida.
To evaluate the possibility of resection of the lesions of the parotid gland by the incisions around the ear (Group I) and assess immediate complications arising fromthis technique, the cosmetics results and the post operative pain, comparing them with the ahead ear - transcervical approach (Group II). In 61 patients of both sex, from July 2006 to July 2009, were subjected to this prospective study, and randomized double blind, evaluating the two groups, categorized group I and II, making comparisons on post operative by the analog levels of the pain, complications related to the facial nerve, possibility of resection regardless of the histological type, the affected lobe, and finally, the cosmetic satisfaction. The 59 patients that completed this study, no statistically significant differences we found in the post operative pain getting. There were no differences also on complications, but if in connection with the post operative scar, the 96%patients (Group I), spoke to us, their satisfaction with the cosmetic outcome compared with 65% of Group II; that being statistically significant. There was no differences as regards the presentation of the painor the post operating complications in the around ear compared to the ahead ear - transcervical approach. The manifestation of cosmetic satisfaction in around ear were approach, we recommend it because it does not produce technical difficulties, without any distinction of sex, age, histological type, or location into the parotid gland.
Subject(s)
Humans , Male , Adult , Female , Parathyroid Glands/anatomy & histology , Parathyroid Glands/surgery , Parathyroid Glands/pathology , Thyroid Gland/injuries , Rhytidoplasty/methods , Sweating, Gustatory/pathologyABSTRACT
Botulinum toxin is a neuromodulator produced by Clostridium botulinum, a gram-negative, anaerobic bacterium responsible for botulism. The clinical utility of botulinum toxin initially became evident in the treatment of strabismus. Subsequently, botulinum toxin has been used for a variety of other medical conditions such as muscular hyperactivity, including blepharospasm, hemifacial spasm, and cervical dystonia. In addition to its well-known applications, within the properties of botulinum toxin are those that make possible the treatment of various diseases affecting salivary glands and oral cavity. Recently there has been an important development in research and finding new applications in otolaryngology. Recent studies have demonstrated the advantages of botulinum toxin injected into the salivary glands of patients who present drooling, reducing the salivary flow and improving their quality of life. In the same way it has proven to be effective as a treatment of sialocele in patients with parotid gland surgery. In parotid and pharyngocutaneous fistula it has proven effective in reducing the salivary flow, facilitating the closure of the defect. Moreover, in patients with Freys syndrome it has been effective reducing symptoms and improving quality of life. It has also been histologically demonstrated its protective effect on the glandular damage in patients undergoing radiotherapy.
Subject(s)
Humans , Salivary Glands/physiopathology , Botulinum Toxins/supply & distribution , Botulinum Toxins/therapeutic use , Sialorrhea/therapy , Sweating, Gustatory/therapyABSTRACT
El síndrome de Frey descrito inicialmente en 1923, es también conocido como Síndrome de la sudoración gustativa o Síndrome del Nervio aurículotemporal (N.auriculotemporalis), ya que las lesiones cutáneas asociadas a éste aparecen en la zona inervada por esta rama del nervio maxilar inferior (N. Mandibulares). Se caracteriza por sudoración gustativa y eritema en la región cervico-facial como respuesta a estímulos gustativos y excepcionalmente táctiles, pudiendo surgir como una complicación tras cirugía de la glándula parótida (parotidectomía), traumatismos o infección supurativa de esta glándula, como consecuencia de un daño ocasionado en las fibras parasimpáticas del nervio aurículotempora (N.auriculotemporalis). Los síntomas de sudoración y enrojecimiento de la piel suelen desarrollarse lentamente y resultan muy molestos. El tratamiento consiste en la colocación de anticolinérgicos locales o sistémicos, interposición de diversos materiales como colgajos regionales, tal como el músculo esternocleidomastoideo o la fascia temporoparietal
Frey's syndrome described initially in 1923, is also known as gustatory sweating syndrome or Auriculotemporal nerve Syndrome, since the cutaneous injuries associated with this one appear in the area supplied by this branch of the mandibularis nerve. It is characterized by gustatory perspiration and erythema in the cervico-facial region as response to gustatory and exceptionally tactile stimulation, being able to arise as a complication after surgery of the parotid gland (parotidectomy), traumatism or supurative infection of this gland, as consequence of a damage caused in the parasympathetic fibers from the auriculotemporal nerve. The symptoms of perspiration and reddening of the skin use to develop slowly and turn out to be very troublesome. The treatment consists of the placement of local or systemic anticolinergics, interposition of diverse materials as regional muscle flaps, such as the esternocleidomastoid muscle or the fascia temporoparietal