As Frey syndrome is called an abnormal sweating, which is triggered in the face and neck during consumption of food or by various stimuli such as chewing or taste.
What is Frey Syndrome?
According to PHONECATIONS, frey syndrome (gustatory sweating, auriculotemporal syndrome) is a very pronounced sweating in the neck and head area that occurs due to gustatory stimuli. It was named after the neurologist Lucja Frey-Gottesmann, who described the syndrome in more detail in 1923. Lucja Frey examined a man who, after a cut, developed sweating while eating, which mainly occurred in the area of the parotid gland.
However, there are also earlier descriptions of Baillarger, so that the disease is often also called Frey-Baillarger syndrome. Frey syndrome has been described and examined several times over the years. Larger studies come from Laage-Hellmann, for example, in which they also dealt with the period between the occurrence and the trauma suffered. Altogether two forms of gustatory sweating can be distinguished:
- Profuse sweating due to physical or physiological causes. An indication of this is usually symmetrical sweating that occurs on both cheeks, mainly after spicy food.
- Abnormal sweating due to illness-related causes. A typical feature for this is the uneven course over the entire face area.
One possible cause of the Frey symptom is the surgical removal of the parotid gland, although the syndrome usually only appears months later. The operation can affect nerve fibers, so that incorrect cross-linking occurs and stimuli are not directed to the right place. After an operation, sweating areas are found mainly in those regions that are supplied by the auricularis magnus or the auriculotemporal nerve.
Frey symptoms can also develop after inflammation of the parotid or mandibular gland or after injuries. Another cause can also be local gland trauma, which can occur as a result of a temporomandibular joint fracture. The removal of cervical lymph nodes can also trigger gustatory sweating. Central nervous disorders such as encephalitis or brain atrophy are also seen as possible triggers of Frey’s syndrome.
Symptoms, ailments & signs
Those affected suffer from profuse sweating in the facial area, which occurs within a few minutes of a gustatory stimulus. Other symptoms are redness and swelling of the skin and a burning or tingling sensation in the affected areas.
To determine the extent to which sweating occurs, the doctor performs the Minor iodine starch test. The iodine starch test uses an alcoholic solution that contains 10 percent castor oil and 1.5 percent iodine. The skin is coated with this solution over the region of the parotid gland and dusted with starch powder. Then a gustatory stimulus is triggered to determine with the help of a blue color which area is particularly affected by sweating.
Treatment & Therapy
Frey syndrome is treated with drugs as well as surgically. One treatment option is to cut the secretory nerve fibers to prevent them from sprouting into the sweat glands. Another approach is to separate the nerve fibers from the sweat glands by storing alloplastic material or muscles.
In addition, solutions for application to the skin, including, for example, scopolamine, are also prescribed. However, these only work for a short time and have to be reapplied to the affected areas again and again. We also recommend using deodorants that contain aluminum chloride. Aluminum chloride is an anti-perspiration substance that is contained in many commercially available deodorants. However, the concentration of the salt is much higher in medicinal deodorants, which makes them more effective than conventional deodorants.
Aluminum salts penetrate the sweat ducts, where they combine with the keratin and clog the gland outlets. An injection of botulinum toxin is also an effective therapy. Botulinum toxin is a protein that is produced by bacteria. The bacteria excrete the toxin and this stops the transmission of excitation from the nerve cells to the muscles. The toxin is bound to the peripheral nerve endings that use acetylcholine as a neurotransmitter.
Acetylcholine also activates the sweat glands. If botulinum toxin is injected, the signal transmission is blocked and the secretion of the sweat glands is reduced. Botulinum toxin consists of two chains that are of different lengths and are linked by disulfide bridges. The long chain is responsible for the toxin being absorbed into the nerve endings, the short chain is the actual toxin.
For the injection, the skin region is marked according to the iodine starch test and divided into areas of 2×2 cm each. The area of skin to be treated is first numbed with an ointment or frozen so that the patient does not feel any pain. Then 2.5 IU botulinum toxin in 0.1 ml solution is injected into each area. A total dose of 100 IU should not be exceeded. The injection begins to work within a few days and lasts for about a year. As a result, the symptoms appear in a greatly weakened form.
The Frey syndrome represents a restriction of the quality of life for everyone concerned. In the meantime, various techniques have been developed in surgery with which the syndrome can be avoided. For example, skin fat grafts are formed during an operation, and implants are also used to prevent Frey syndrome from occurring.