DT
PT
Subscribe To Print Edition About The Tribune Code Of Ethics Download App Advertise with us Classifieds
search-icon-img
search-icon-img
Advertisement

Info Nugget: Facial sweating during meals? It could be Frey’s Syndrome

The science behind the syndrome: Causes, symptoms & treatment
  • fb
  • twitter
  • whatsapp
  • whatsapp
featured-img featured-img
A gustatory problem: Frey’s Syndrome and its impact on quality of life
Advertisement

What is Frey’s Syndrome?

  • A rare neurological disorder also called auriculotemporal syndrome or gustatory sweating.
  • Triggered by the abnormal regeneration of nerve fibres post injury near the parotid gland, causing facial sweating and flushing during eating or even thinking about food.
  • Named after neurologist Lucja Frey, who described it in 1923.

Why in the news?

  • It’s back in attention due to advances in parotidectomy techniques and minimally invasive surgeries reducing its incidence.
  • Botulinum toxin treatments are evolving, with studies exploring newer long-acting formulations.
  • Also debated in UPSC medical science and ethics papers, given its implications in surgical consent and postoperative quality of life.

Symptoms

  • Gustatory sweating: facial sweating, especially on cheek, temple and behind ear, during meals or food thoughts
  • Flushing, warmth and sometimes burning sensation or itching
  • Typically unilateral, occurs 6-18 months post-injury
  • Severity varies; Rs 15 % describe it as “severe”

Causes/risk factors

  1. Parotidectomy: most common (Rs 30-50 % incidence)
  2. Other surgeries or trauma near the auriculotemporal nerve: submandibular surgery, neck dissection, TMJ repair
  3. Rare: inflammation, infections (e.g., mumps), forceps delivery trauma
  4. Pathophysiology: Aberrant regeneration of parasympathetic fibres misdirected to sweat glands, instead of salivary glands

Diagnosis

  • Clinical history: association with eating, past parotid/neck surgery.
  • Minor’s starch-iodine (starch-iodine) test: affected skin turns blue-black during sweating.
  • Occasionally use QSART, infrared thermography or salivary gland imaging to exclude other pathologies.

Treatment & management

Conservative/medical

Advertisement

  • Lifestyle and dietary adjustment: avoiding spicy, sour meals.
  • Topical anticholinergics (e.g., glycopyrrolate), antiperspirants.
  • Anticholinergic ointments like scopolamine.

Interventional

  • Botulinum toxin A injections: highly effective, lasting 6-12 months, often >90 % symptom relief.
  • Surgical options (for severe/persistent cases):
  • Neurectomy: cutting aberrant nerve fibres.
  • Barrier grafts (fat, fascia, muscle flaps during parotidectomy) – preventive

Prognosis

Advertisement

  • Generally benign; may resolve spontaneously in mild cases.
  • With treatment, quality of life improves notably.
  • Severe cases may need repeat botox or surgical correction.

UPSC civil services perspective

AspectAnswer focus
DefinitionBrief definition with clinical significance.
EpidemiologyIncidence post-parotid surgery (30–50 %), equal gender distribution.
EtiologyRole of auriculotemporal nerve injury, aberrant reinnervation.
SymptomsGustatory sweating, flushing, social/psych impact.
PathophysiologyParasympathetic–sympathetic misdirection – key mechanism.
DiagnosisMinor’s starch-iodine test; history-based differential.
TreatmentMedical, botulinum, surgical; stage-appropriate.
PreventionSurgical best practices.
PrognosisGenerally good; recurrent treatment if needed.
Health ethicsInformed consent, patient counselling, quality-of-life focus.

Practice questions

Short-answer (50-100 words)

  1. Define Frey’s Syndrome and outline key clinical features.
  2. What is the role of the starch-iodine test in diagnosing Frey’s Syndrome?

Long-answer (300-400 words)

Advertisement

  1. Discuss the etiopathogenesis, diagnostic methods and management of Frey’s Syndrome in the context of parotid surgeries.
  2. Critically examine the role of botulinum toxin A injections in managing Frey’s Syndrome, including alternatives and patient counselling.

Analytical/essay (800+ words)

  1. “Frey’s Syndrome exemplifies the importance of surgical ethics and postoperative patient-centred care in otolaryngology.” Critically analyse with reference to its prevention, management and impact on quality of life.
Advertisement
Advertisement
Advertisement
tlbr_img1 Classifieds tlbr_img2 Videos tlbr_img3 Premium tlbr_img4 E-Paper tlbr_img5 Shorts