206 Management options for gustatory sweating (Frey syndrome) Laurent Laccourreye, MD,* Raimundo Gutierrez-Fonseca, MD, † and Ollivier Laccourreye, MD ‡ Gustatory sweating (Frey syndrome) is a universal problem after surgery of the parotid region and might be encountered in a large number of pathology cases. Numerous treatment techniques and options have been offered to manage this condition; however, none has met with universal acceptance. This article reviews the history, pathophysiology, incidence, prevention, and management options for gustatory sweating. Curr Opin Otolaryngol Head Neck Surg 2000, 8:206–210 © 2000 Lippincott Williams & Wilkins, Inc. * University Hospital, Angers 49000, France; † Fundación Jimenez-Diaz, Madrid, Spain; and ‡ Hôpital Laënnec, Assistance Publique des Hôpitaux de Paris, University Paris V, Paris, France Correspondence to Ollivier Laccourreye, MD, Department of Otorhinolaryngology—Head & Neck Surgery, Laënnec Hospital, 42 Rue de Sèvres, 75007, Paris, France; email: ollivier.laccourreye@lnc.ap-hop-paris.fr Current Opinion in Otolaryngology & Head and Neck Surgery 2000, 8:206–210 ISSN 1068–9508 © 2000 Lippincott Williams & Wilkins, Inc. Duphenix in 1853 was the first author to report the symptoms of gustatory sweating [1]. Considerable dispute existed in the medical literature during the 19th century regarding liquid production (sweat versus saliva) until Bergounhioux in 1859 demonstrated that the secretion produce was sweat and not saliva [1,2•]. In 1923, Lucie Frey, neurologist at the University of Warsaw, suggested a possible role for the auriculotem- poral nerve in the pathophysiology of local skin flushing and sweating at the level of the face during meals after an initial trauma to the parotid region [1,2•]. It was André Thomas in 1927 who suggested an aberrant innervation of the parasympathetic to the sympathic as the possible cause of gustatory sweating [3]. In 1932, Peter Bassoe reported the first case of gustatory sweat- ing after parotidectomy, and during the 20th century parotid surgery appeared to be the main etiologic factor for gustatory sweating [2•]. However, in her landmark study Lucie Frey [1] mentioned that German anatomist Henle had developed gustatory sweating after parotidi- tis induced by typhoid fewer, and since then, as depicted in Table 1, numerous other causes have been reported as etiologic factors for gustatory sweating. Pathophysiology of gustatory sweating Various theories have been advanced to explain gusta- tory sweating after parotid surgery. Currently, the most commonly accepted theory is the aberrant-regeneration theory initially suggested by French neurologist André Thomas [3]. The auriculotemporal nerve carries (1) sensory fibers to the preauricular and temporal areas, (2) postganglionic sympathetic fibers that innervate the subcutaneous arterioles and eccrine sweat glands, and (3) postganglionic parasympathetic fibers that innervate the salivary parotid gland. Trauma to the auriculotempo- ral nerve or its branches results in a retrograde degenera- tion of these fibers. The likely mechanism of gustatory sweating is considered to be a misdirection of the regen- erating postganglionic parasympathetic fibers along the postganglionic sympathetic fibers. An aberrant reflex is made possible because the postganglionic sympathetic and parasympathetic fibers share the same mediator— acetylcholine. The misdirected regeneration of postgan- glionic parasympathetic fibers towards the eccrine sweat glands causes sweating, whereas regeneration towards the subcutaneous arterioles accounts for erythema when eating and explains the delay in emergence of symptoms