Clin[ Otolaryn`ol[ 0887\ 23, 180Ð290 REVIEW Frey’s syndrome and parotid surgery S[ SOOD\ M[S[ QURAISHI + P[J[ BRADLEY The Department of Otolaryn`olo`y: Head and Neck Sur`ery\ Queens Medical Centre\ University Hospital\ Nottin`ham\ UK Accepted for publication 07 February 0887 The earliest known description of what is now called Frey|s syndrome "or gustatory hyperhydrosis of the cheek# dates back to 0646 when Duphenix described facial sweating fol! lowing lacerations in the region of the parotid gland[ 0 The condition was further discussed by Baillarger in 0742 1 and also by Parkes Weber in 0786 2 who described a 08!year!old patient with gustatory facial sweating and multiple scars over the jaw and parotid region as a consequence of previous suppuration of lymph nodes[ However\ it was not until 0812 that Lucia Frey\ a French neurologist\ implicated the auriculo! temporal nerve in the pathogenesis of the syndrome[ 3 In her classic report she described gustatory sweating and ~ushing in a Polish soldier following an infected bullet wound of the parotid gland\ and used the term {auriculotemporal nerve syndrome|[ Frey|s syndrome is most frequently a result of parotid gland surgery\ and has also been reported following neck dissection\ 4\5 blunt trauma to the cheek\ 6\7 and chronic infection of the parotid area[ 8 On rare occasions it follows fracture of the mandible\ 09\00 surgery or fracture of the tem! poromandibular joint\ 01\02 submandibular gland excision\ 03 thyroidectomy\ 04 or after thoracic sympathectomy[ 05 Berard\ in 0712\ 06 wrote a detailed description of parotid tumours and described a parotidectomy done by Siebold in 0686[ In the UK parotid gland surgery was popularized by Bailey in the 0839s[ 07 Its application eventually expanded to include a variety of benign and malignant conditions a}ecting the gland[ Historically\ parotid gland surgery has evolved from operations of simple enucleation to super_cial "supra! facial or lateral lobectomy# or total parotidectomy\ with or without facial nerve preservation[ The technique of paroti! dectomy is associated with a predictable group of potential sequelae including facial nerve injury\ hypoaesthesia sec! ondary to transection of the greater auricular nerve\ devel! opment of gustatory sweating or {Frey|s syndrome|\ haema! toma\ temporary _stula\ painful neuroma of the greater auricular nerve stump and keloid[ 08\19 The _rst report of Frey|s syndrome following parotidectomy was by Bassoe in 0821[ 10 The incidence of Frey|s syndrome following parotid gland Correspondence] Mr P[J[ Bradley\ The Department of Otolaryngo! logy:Head and Neck Surgery\ Queens Medical Centre\ University Hospital\ Nottingham NG6 1UH\ UK[ 180 Þ 0887 Blackwell Science Ltd surgery depends on the diligence with which it is sought and the time!interval from surgery\ with the reported incidence varying from series to series "Table 0#[ This may be due to a wide variation in the quantity and quality of the sweat\ di}er! ent techniques of surgery\ or to the di}erent methods used to evaluate gustatory sweating 27 [ The symptoms of Frey|s syndrome usually present 5 weeks to several months after parotid gland surgery\ 12\28 but can present as late as 4 years after surgery and\ therefore\ it is important to follow!up such patients for this period to obtain an accurate incidence of this syndrome 24 [ Patients will spontaneously o}er symptoms only 09) of the time\ but on questioning they will admit to symp! toms 29Ð49) of the time[ Gustatory sweating will be demon! strated on starch iodine testing in up to 89) of patients[ 17\26 Frey|s syndrome has also been reported to occur more frequently after total\ than after partial\ parotidectomy^ 22\39 and has also been reported to be less common in patients following partial super_cial parotidectomy than after full super_cial parotidectomy 25 [ Frey|s syndrome occurs more often after suprafacial parotidectomy than with extracapsular excision or enucleation[ 30\31 However\ there is a higher rate of recurrence of parotid tumours after local limited resection when compared to super_cial parotidectomy[ 16 The incidence of Frey|s syndrome has also been reported to be higher fol! lowing surgery for recurrent parotid tumours[ 18 Frey|s syndrome may occur in any age\ although it is uncommon in children[ 32 The condition tends to run a benign course with spontaneous resolution reported during a follow! up period of 4 years[ 33 Gustatory sweating has been reported in infants\ 34 and is thought to be due to facial trauma following forceps delivery\ 33 although the risk is considered to be extremely low 35 [ Food allergy in children is associated with a reaction which occurs immediately after ingestion of food and needs to be di}erentiated from Frey|s syndrome 36 [ Therefore\ it is impor! tant to recognize Frey|s syndrome in children in order to avoid unnecessary investigations and a delay in making a correct diagnosis 37 [ The symptoms of Frey|s syndrome may be precipitated by any type of food[ 38\49 Typical features occur during mas! tication and include ~ushing\ sweating\ erythema and:or gen! eral discomfort about the skin in the area anterior to the ear\