• Korean Journal of Head & Neck Oncology
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• v.32 no.1
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• pp.1-5
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• 2016

Objectives: Frey's syndrome is an infrequent complication after parotidectomy and its incidence varies from 23.5% to 50.8% in the literature. The objective of this study was to evaluate the actual incidence and clinical characteristics of Frey's syndrome. Methods: We analyzed 31 patients who underwent parotidectomy and serial Minor's starch-iodine test. The mean follow-up period was $66{\pm}26.1$ months (range, 24-118 months). The Frey's syndrome was analyzed using a questionnaire for the assessment of the subjective symptom and Minor's starch-iodine test for the objective measurement at 1, 3, 6, and 12 months after the surgery and then every 6 or 12 months. Minor's starch-iodine test was graded from 0 to 3 according to the area of discolorization. Results: Frey's syndrome occurred in 11 patients (35.5%) on the Minor's starch-iodine test. The mean onset of Frey's syndrome on the starch-iodine test was $13.6{\pm}10.4$ months after parotidectomy. Sixteen patients (51.6%) complained about gustatory sweating and flushing. The onset of the subjective symptom was $11.27{\pm}6.96$ months after the surgery. There was a significant correlation between the grade of the starch-iodine test and the severity of subjective symptoms (P <0.001). Various factors including size and location of tumor, incision method, and extent of parotidectomy did not correlate with the Frey's syndrome. Conclusion: The incidence of Frey's syndrome was 35.5% on the Starch-Iodine test, and the onset was about postoperative 13.6 months.

• Archives of Plastic Surgery
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• v.39 no.2
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• pp.143-149
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• 2012

Background : Axillary osmidrosis is characterized by an unpleasant odor, profuse sweating, and in some instances, staining of clothes that may socially and psychologically impair affected individuals. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. This study was undertaken to evaluate the effectiveness of subcutaneous pulsed neodymium: yttrium-aluminum-garnet (Nd-YAG) laser treatment for the treatment of axillary osmidrosis. Methods : Twenty-nine patients with axillary osmidrosis were included in this study. Patients were categorized according to the results of an axillary malodor grading system, and a subcutaneous pulsed Nd-YAG laser was applied to all patients. The treatment area for the appropriate distribution of laser energy was determined using the iodine starch test (Minor's test) against a grid pattern composed of $2{\times}2cm$ squares. The endpoint of exposure was 300 to 500 J for each grid, depending on the preoperative evaluation results. The results were evaluated by measurement of axillary malodor both pre- and postoperatively using the grading system and iodine starch test. Results : The average follow-up period was 12.8 months. Nineteen patients had a fair-to-good result and ten patients had poor results. The postoperative Minor's test demonstrated that there were remarkable improvements for patients with mild to moderate symptoms. Complications including superficial second degree burns (n=3) were treated in a conservative manner. A deep second degree burn (n=1) was treated by a surgical procedure. Conclusions : Subcutaneous pulsed Nd-YAG laser has many advantages and is an effective noninvasive treatment for mild to moderate axillary osmidrosis.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.114-119
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• 2009

Purpose: Several therapeutic approaches have been introduced and tried to treat Frey syndrome following parotidectomy. However they were not proved as an effective treatment. A new therapeutic modality using botulinum toxin injections was presented previously by several study groups. But, the duration of the demonstrated positive effect was essentially unknown so far. The purpose of this clinical investigation is to demonstrate the effectiveness of Botulinum toxin type A(BTXA) in patients with Frey syndrome. Methods: For this study, 12 patients were treated, They were assessed with the Minor's iodine-starch test and interviewed before and after treatment. Botulinum toxin is injected with $1.0cm^2$ apart into the skin where symptoms of Frey's syndrome has manifestated. The patients were classified according to the concentration of botulinum toxin and dosage of botulinum toxin. Results: The outcome measures were the time of reappearance of gustatory sweating(subjective study), and the results of an Minor's iodine-starch test(objective study) of 3 weeks, 3 months, 6 months, 9 months, 12 months after treatment. This treatment was effective in all groups of patients. The concentrations and the amount of dosages did not affect the treatment. But high concentration produced faster effectiveness in subjective. Conclusion: Botulinum toxin type A(BTXA) for Frey syndrome is easy, convenient and effective withouts severe complication. And the patients has no difficulty and limitation in their life.

• The Korean Journal of Pain
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• v.22 no.3
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• pp.253-256
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• 2009

Conventional thoracoscopic sympathectomy is an effective method in treating palmar-axillary hyperhidrosis. However, this may result in a postoperatively compensatory hyperhidrosis. Conservative treatments of compensatory hyperhidrosis consist of aluminum chloride, anticholinergics, iontrophoresis, and botulinum toxin A injections. Surgical treatments in compensatory hyperhidrosis include excision of axillary tissue, liposuction, and thoracoscopic sympathectomy. Intradermal injection of botulinum toxin A has used to treat focal axillary or palmar hyperhidrosis. Botulinum toxin A bestows significant benefits with few side-effects and is well-tolerated, with beneficial results lasting from 4-16 months. We report a case illustrating the beneficial use of botulinum toxin A in a 25-year-old healthy male patient with compensatory sweating of the flank after thoracoscopic sympathectomy. Modified Minor's starch iodine test was used to allow accurate assess the impact of hyperhidrosis on the patient. In conclusion, Botulinum toxin type A is a valuable therapy for compensatory sweating after endoscopic thoracic sympathectomy.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.283-288
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• 2009

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.

• Korean Journal of Head & Neck Oncology
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• v.23 no.2
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• pp.142-146
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• 2007

Objectives and Backgrounds : After parotidectomy, some of patients complain gustatory sweating, facial flushing and discomfort in the same area. A series of these symptoms are supposed to be caused by the aberrant regeneration of the secretory parasympathetic fibers to sweat glands and blood vessels of the skin following parotidectomy. In this study, we want to compare the efficacy of thermography to the Minor's starch-iodine test for determining the presence of Frey's syndrome. Materials and Methods : 48 patients who underwent total or superficial parotidectomy from March 2002 to December 2004 were selected for this study. A subjective clinical questionnaire and the objective Minor's starchiodine test were performed to evaluate the incidence of this syndrome. Total 21 patients were confirmed as positive Frey's syndrome and infrared thermography was performed for them. Result : Frey's syndrome occurred in 21 patients(43.8%). The average temperature of parotidectomy site and normal opposite area were $27.65^{\circ}C\;and\;26.41^{\circ}C$ respectively. Thermography showed temperature difference in 20 patient(95.2%) and the difference of temperature was statistically significant above $1.0^{\circ}C$(p<0.001). The severity of symptoms were related with the difference of temperature(p<0.05). Conclusion : Thermography is useful, non-invasive, simple and quantifying method to diagnose Frey's syndrome. Additionally, this geographic diagnosis is available to show the accurate area for botulinum toxin injection.