Prevention of Frey syndrome

Frey syndrome (gustatory sweating) is a common and often times significant consequence of parotid gland surgery. The classic signs and symptoms include facial sweating, flushing, rubor, and sensation of heat over the preauricular region during oral stimulation. These clinical findings may provoke quality of life changes, and thus, are considered significant. Both surgical and nonsurgical treatment modalities have been advanced in the treatment of this disorder. Surgical treatment is aimed at prevention of the development of Frey syndrome and consists of a constellation of techniques which are designed to interpose tissue in the parotid surgical bed to act as a barrier to prevent aberrant parasympathetic fiber ingrowth and innervation to facial skin eccrine sweat glands. These techniques include: limiting the extent of parotid surgery when possible, use of local tissue as advancement or rotational flaps, autologous transfer of tissue, and use of allograft material.