Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지

Treatment of Frey's Syndrome Patients with Botulimum Toxin A

보툴리눔 독소를 이용한 Frey 증후군 환자의 치료

  • Park, Byung-Chan (Department of Plastic & Reconstructive surgery, College of Medicine Yeungnam University) ;
  • Ryu, Min-Hee (Department of Plastic & Reconstructive surgery, College of Medicine Yeungnam University) ;
  • Kim, Tae-Gon (Department of Plastic & Reconstructive surgery, College of Medicine Yeungnam University) ;
  • Kim, Yong-Ha (Department of Plastic & Reconstructive surgery, College of Medicine Yeungnam University)
  • 박병찬 (영남대학교 의과대학 성형외과학교실) ;
  • 류민희 (영남대학교 의과대학 성형외과학교실) ;
  • 김태곤 (영남대학교 의과대학 성형외과학교실) ;
  • 김용하 (영남대학교 의과대학 성형외과학교실)
  • Published : 2009.05.15
⟨ Previous Next ⟩

Abstract

Purpose: Frey's syndrome is a common complication after parotid surgery and characterized by gustatory sweating and flushing in the periauricular area during meals. Although a variety of methods have been proposed to prevent this postoperative problem but they have been unsatisfactory. In this article, therefore, botulinum toxin A was used to treat nine patients with Frey's syndrome and its duration effect after injection was investigated. Methods: Nine patients became the object of study about the effect of botulinum toxins as treatment of Frey's syndrome. Age of patients ranged from 25 to 78 years (mean, 43.7 years). Six of nine patients had both symptoms of gustatory sweating and flushing. And the others had only gustatory sweating symptom. Using Minor starch iodine test, the affected skin area was detected, and it was marked by $1cm^2$ sized grid appearance. After application of EMLA cream on the gustatory sweating area, botulinum toxin A was injected intracutaneously into the affected skin area ($2.5U/cm^2$). Patients were followed up from six to fifteen months (mean, about 12 months) and asked about improvement of their symptoms. Results: The treatement with botulinum toxin A took effective within two days after injection. Six months after injection, gustatory sweating disappeared completely in all patients, and five of six patients who had gustatory flushing improved in their symptom. Last follow-up, no patients complained of recurrent gustatory sweating and flushing except one. One patient, seven months after initial injection, was retreated with botulinum toxin A because of recurrence, and the result was successful. The duration of the effect after botulinum toxin A treatment was ranged from seven to thirteen months. One patient in our series experienced the upper eyelid weakness as adverse effect, but it improved spontaneously. Conclusion: Local injection of botulinum toxin A is an effective, safe and long - lasting method for treatment of Frey's syndrome. Hereafter, however, additional study will be required to evaluate the duration effect of botulinum toxin A according to frequency in use and dosage.

Keywords

References

  1. Bjerkhoel A, Trobbe O: Frey's syndrome: treatment with botulinum toxin. J Laryngol Otol 111: 839, 1997
  2. Guntinas-Lichius O: Management of Frey's syndrome and hypersialorrhea with botulinum toxin. Facial Plast Surg Clin North Am 11: 503, 2003 https://doi.org/10.1016/S1064-7406(03)00075-0
  3. Drobik C, Laskawi R: Frey's syndrome: treatment with botulinum toxin. Acta Otolaryngol 115: 459, 1995 https://doi.org/10.3109/00016489509139348
  4. Laccourreye O, Muscatelo L, Naude C, Bonan B, Brasnu D: Botulinum toxin type A for Frey's syndrome: a preliminary prospective study. Ann Otol Rhinol Laryngol 107: 52, 1998 https://doi.org/10.1177/000348949810700110
  5. Eckardt A, Kuettner C: Treatment of gustatory sweating (Frey's syndrome) with botulinum toxin A. Head Neck 25: 624, 2003 https://doi.org/10.1002/hed.10262
  6. Ford FR, Woodhall B: Phenomena due to misdirection of regenerating fibers of cranial, spinal and autonomic nerves. Arch Surg 38: 480, 1938 https://doi.org/10.1001/archsurg.1938.01190210109006
  7. Tugnoli V, Marchese Ragona R, Eleopra R, Quatrale R, Capone JG, Pastore A, Montecucco C, De Grandis D: The role of gustatory flushing in Frey's syndrome and its treatment with botulinum toxin type A. Clin Auton Res 12: 174, 2002 https://doi.org/10.1007/s10286-002-0026-x
  8. Drummond PD: Mechanism of gustatory flushing in Frey's syndrome. Clin Auton Res 12: 144, 2002 https://doi.org/10.1007/s10286-002-0042-x
  9. Laskawi R, Drobik C, Sch$\ddot{o}$nebeck C: Up-to-date report of botulinum toxin type A treatment in patients with gustatory sweating(Frey's syndrome). Laryngoscope 108: 381, 1998 https://doi.org/10.1097/00005537-199803000-00013
  10. Beerens AJ, Snow GB: Botulinum toxin A in the treatment of patients with Frey syndrome. Br J Surg 89: 116, 2002 https://doi.org/10.1046/j.0007-1323.2001.01982.x
  11. Leverstein H, van der Wal JE, Tiwari RM, van der Waal I, Snow GB: Surgical management of 246 previously untreated pleomorphic adenomas of the parotid gland. Br J Surg 84: 399, 1997 https://doi.org/10.1002/bjs.1800840341
  12. Park ES, Kim YB, Lee YM, Yang SJ, Park CS: Prevention of Frey's syndrome by using temporoparietal fascial flap. J Korean Soc Plast Reconstr Surg 24: 580, 1997
  13. Bakke M, Max Thorsen N, Bardow A, Dalager T, Eckhart Thomsen C, Regeur L: Treatment of gustatory sweating with low-dose botulinum toxin A: a case report. Acta Odontol Scand 64: 129, 2006 https://doi.org/10.1080/00016350600555743
  14. Laccourreye O, Akl E, Gutierrez-Fonseca R, Garcia D, Brasnu D, Bonan B: Recurrent gustatory sweating(Frey syndrome) after intracutaneous injection of botulinum toxin type a: incidence, management, and outcome. Arch Otolaryngol Head Neck Surg 125: 283, 1999 https://doi.org/10.1001/archotol.125.3.283
  15. Dulguerov P, Quinodoz D, Cosendai G, Piletta P, Marchal F, Lehmann W: Prevention of Frey syndrome during parotidectomy. Arch Otolaryngol Head Neck Surg 125: 833, 1999 https://doi.org/10.1001/archotol.125.8.833