Application of botulinum toxin-A for treatment of Frey’s syndrome J. Mareque, J. Gonzalez Lagunas, C. Bassas, G. Raspall

Revista Española de Cirugía Oral y Maxilofacial 2008: 30: 327–340

The authors presented a study about the use of botulinum toxin-A for the treatment of Frey’s syndrome (auriculo-temporal syndrome).

A retrospective review on 289 surgical interventions on the parotid glands confirmed Frey’s syndrome affected 7.2% of cases (31 patients) and was the second most frequent complication behind transitory facial paralysis. Seven cases were excluded from the study due to malignant aetiology, while 10 out of 20 remaining cases agreed to be included in the study. The mean age of this group was 61.8 years, ranging from 40 to 82 years. Six patients had a diagnosis of pleomorphic adenoma, two of Warthin’s tumour, one of lymphangioma and one of haemangioma. Surgical techniques were superficial parotidectomy in eight cases, total conservative parotidectomy in one case and partial parotidectomy in one case. Tests were performed to quantify the skin surface affected. Once the affected area suffering local hyperhydrosis was defined, 0.1 ml (10 units) of botulinum toxin-A (Botox ^® ) was injected into the dermis in every square centimetre of the affected areas. Follow-up was carried out at 15th days and at 1, 3, 6, 9, 12, 15 and 18 months after the injection.

Results of the study did not show any subjective improvement in the quality of life of all patients while local nor systemic side effects were identified (potential risk of pain, oedema, ecchymosis, headache, facial palsy, nausea). Sweating disappeared in all cases. The effect started 48 h after injection, reaching the maximum effect between 10 and 14 days after injection. The mean duration of effect was 16 months, ranging from 12 to 22 months.

The authors concluded that intradermal injection of botulinum toxin-A was an effective and reproducible method for controlling the symptoms in established auriculo-temporal syndrome without local or systemic side effects.

JULIO ACERO