Frey syndrome is characterized by unilateral flushing and sweating of the facial skin innervated by the auriculotemporal nerve (neck, parotid region, and. A neurologist from Poland, Dr. Lucja Frey, provided a detailed assessment of the disorder and coined the term “auriculotemporal syndrome” in Auriculotemporal nerve syndrome, also known as Frey syndrome, is an uncommon clinical entity in children. It is widely thought to be the result.
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Frey syndrome is characterized by unilateral flushing and sweating of the facial skin innervated by the auriculotemporal nerve neck, parotid region, and frontotemporal scalpwhich occurs in response to gustatory or olfactory stimuli. Bilateral involvement has been reported. It is more common in adults. In children, it is typically noted around 6 months of age at the time of introduction of solid foods fruit snacks to the diet.
The erythema and flushing begin within minutes of eating the first bite of a favorite food and last for about 20 to 60 minutes. This may occur consistently with every solid food feeding.
In contrast with adults, sweating usually does not occur in children. In children, the diagnosis is clinical. Elicitation of the characteristic linear erythema in the segmental areas innervated by the auriculotemporal nerve on solid feeding confirms the diagnosis Figure 1. In adults, a sweat test Starch iodine is performed to assess the severity of sweating. Frey syndrome has to be differentiated from food allergy, in which case the involvement is nonsegmental and bilateral.
There may be associated symptoms of itching, urticaria, angioedema, or anaphylaxis. In adults, it is common following parotid surgery. In adults, Frey syndrome occurs mostly after parotid surgery, especially after excision of the superficial lobe or drainage of a parotid abscess. The other possible etiologic factors include parotitis, mandibular condylar fracture, blunt trauma, herpes zoster, associated central nervous system disorders such as syringomyelia, epilepsy, and meningioma of the cerebellopontine angle tumor.
Frey syndrome is due to the misdirected regenerative process of the auriculotemporal nerve. This nerve is a sensory branch of the posterior division of the mandibular division of the trigeminal nerve.
Auriculotemporal Syndrome (Frey Syndrome)
The sensory fibers innervate the auricle, external auditory meatus, tympanic membrane, temporomandibular joint, and the temporal scalp. It receives the postganglionic parasympathetic secretomotor fibers from the otic ganglion, which is syyndrome for parotid glands. Frey syndrome is due to damage to these autonomic fibers.
During the process of healing the regenerating parasympathetic fibers intended for parotid may be misdirected and join the sympathetic fibers in the great auricular nerve, which supplies sweat glands and blood vessels. Because of this, any gustatory stimulus produces erythema and sweating instead of salivation. Frey syndrome may occur in association with several neurologic disorders, such as syringomyelia, central nervous system tumors, and epilepsy.
Interposition of barrier to prevent the neural anastomosis between the parasympathetic and sympathetic nerves. Frey syndrome in children has a benign and nonprogressive course. Sweating usually does not occur. Spontaneous resolution has also been reported in children.
Hence children with Frey syndrome do not require treatment. The parents need simple reassurance and counselling. Many times children are misdiagnosed as having food allergy and subjected to unnecessary skin prick tests auricullotemporal blood tests for allergy. Hence recognition of Frey syndrome in pediatric population is very important to avoid misdiagnosis as food allergy. If the response is not satisfactory, then consider Step 2 therapy. Intradermal injection of Botulinum Toxin A. The response may last for a period of 6 months and the treatment can be repeated.
If the treatment is unsuccessful, sgndrome consider surgery. Interposition of different barriers overlying the parotid to prevent aberrant reinnervation between parasympathetic and sympathetic fibers, has been found to be useful.
The barriers include 1. Temperoparietal fascia flap, 3. Sternocleidomastoid muscle flap, and 4. These surgical techniques can also be done as a prophylactic measure at the time of initial parotidectomy. The condition is benign and may persist for life. Explain the different treatment options.
The treatment is only supportive. All the treatment options have been used with variable success rates. Frey syndrome is a masquerader of food allergy, especially in children. This is because the Frey syndrome starts zuriculotemporal at the time of introduction of the solid foods around 6 months of age.
Auriculotemporal Syndrome (Frey Syndrome)
But Frey syndrome can be identified by its distinctive clinical features. In contrast to food allergy, Frey syndrome is usually unilateral, with a segmental distribution in the areas innervated by the auriculotemporal nerve. Food allergy is bilateral and presents with itching, urticaria, angioedema, or systemic symptoms or anaphylaxis. Sethuraman, G, Mancini, AJ. An unusual variant presenting as gustatory flushing mimicking food allergy”. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.
Who is at Risk for Developing this Disease? What is the Cause of the Disease? What to be alert for in the syndrom In children, it is typically noted around 6 months of age at the time of introduction of solid foods fruit snacks to the diet. Diagnosis confirmation In children, the diagnosis is clinical.
Segmental flushing after ingestion of fruit snacks. Pathophysiology Frey syndrome is due to the misdirected regenerative process of the auriculotemporal nerve. Systemic Implications and Complications Frey syndrome may occur in association with several neurologic disorders, such as syringomyelia, central nervous system tumors, and epilepsy.
These surgical techniques can also be done as a prophylactic measure at the time of initial parotidectomy Patient Management The condition is benign and may persist for life. Unusual Clinical Scenarios to Consider in Patient Management Frey syndrome is a masquerader of food allergy, especially in children. Powered By Decision Support in Medicine.
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