Frey Syndrome — MFDS Part 1 MCQ

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ModerateOral MedicineFrey SyndromeMFDS Part 1

Six months after head-and-neck surgery, a patient develops unilateral flushing and sweating of the preauricular skin whenever they eat, particularly sour foods. Which previous procedure is most likely to have caused this complication?

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Correct answer: E — Parotid gland surgery

The correct answer is E, parotid gland surgery. The meal-related flushing and sweating over the preauricular skin are characteristic of Frey syndrome, a recognised delayed complication of parotidectomy. Following surgery, regenerating postganglionic parasympathetic secretomotor fibres associated with the auriculotemporal nerve may aberrantly innervate sweat glands and cutaneous blood vessels. Gustatory stimulation then causes sweating and flushing rather than salivation. Gustatory sweating has occasionally been reported after submandibular gland surgery, but this is rare and does not represent the classical auriculotemporal distribution described here. Sublingual surgery, tonsillectomy and wisdom tooth extraction do not characteristically disrupt the parasympathetic fibres within the parotid bed and are therefore substantially less likely causes.

Reference: Royal Devon University Healthcare NHS Foundation Trust. Parotidectomy, section “Frey’s Syndrome”, version May 2023. https://www.royaldevon.nhs.uk/media/5ojm4vko/patient-information-leaflet-parotidectomy-rde-18-091-001.pdf