Frey Syndrome

What is Frey Syndrome?

Frey Syndrome is a disorder that happens when a nerve, called the auriculotemporal nerve, is damaged. The auriculotemporal nerve runs along both sides of your head. It provides feeling to the side of your head, near your ear, and temples (the lower sides of your forehead.)

What causes Frey Syndrome?

The most common cause of Frey Syndrome is surgery near your parotid gland. Your parotid gland is one kind of salivary gland. There is a parotid gland on each side of your head that sits in front of your ears and helps make saliva. The auriculotemporal nerve runs near the parotid glands. The damaged nerve causes the symptoms of Frey Syndrome.

Frey syndrome can also be caused by neck dissection surgery, facelift surgery, trauma, and radiation therapy to the head and neck area. In some cases, it is not exactly known why Frey syndrome happens. Talk with your provider if you have any questions or concerns.

What are the symptoms of Frey Syndrome?

The symptoms of Frey Syndrome happen when you eat, and even when you see, dream about, or think about food. Symptoms may be worse when eating very flavorful or spicy foods. Along your temples, cheeks, and upper neck, you may have:

• Redness and flushing.
• Sweating (called gustatory sweating).
• Warmth.
• Pain.

These symptoms often start a few weeks to months after surgery. Symptoms tend to start seconds after eating/thinking about food and can last a few minutes. When the auriculotemporal nerve is damaged during surgery, Frey Syndrome often does not go away on its own.

How is Frey Syndrome diagnosed?

Let your provider know right away if you start having any of the symptoms of Frey Syndrome. Your provider will go over your history and symptoms. Frey syndrome can be diagnosed using a minor starch iodine test:

• Iodine is coated on your skin where your symptoms are. Once dry, starch is applied to the same area. The provider will then stimulate (rev up) your salivary glands. This is often done by having you suck on a lemon. The starch will turn a blue/brown color if you sweat, and it mixes with the iodine.

How is Frey Syndrome treated?

If you are having surgery near your parotid gland, your surgeon may try to prevent the auriculotemporal nerve from being damaged. This is done by placing a barrier so that the nerve and salivary glands cannot touch each other. The barrier is a flap (piece of tissue), taken from another part of your body (autologous) or from a donor (allogenic). This barrier method can also be used to treat Frey Syndrome if it happens after your surgery.

Medications may help with symptoms. These may be:

• Anticholinergic (scopolamine, glycopyrolate): Blocks a neurotransmitter in your body. Often used as an ointment that is put right on your skin, this medication can help you not to sweat.
• Anti-perspirant (deodorant): Blocks your sweat glands so that you sweat less after meals.
• α (Alpha) agonist (clonidine): Lowers your heart rate and relaxes blood vessels so there is less flushing and sweating.
• Botulinum toxin (Botox) injections: This medication is placed under your skin using a needle. It acts as an anticholinergic and causes denervation (the nerves no longer work) and paralysis (unable to move). This is the most common nonsurgical treatment, as they often have helpful results and few side effects. The length of time the injections last varies, so you may need more injections over time.

If you need surgery to treat your head and neck cancer, ask your provider about what to expect and if damage to the auriculotemporal nerve is possible. If you have Frey Syndrome, talk with your provider about which treatment options may work best for you.