The Medical Consumer's Advocate

Frey syndrome (gustatory sweating)

Q: I had my parotid gland removed. I now get red, even wet, on the side of my face since that surgery. I think they said I ended up with Frey’s syndrome. This happens more with specific foods. Can you tell me what this is all about?

A: Each of us has an autonomic nervous system, which controls such varied things as whether we are sweaty or dry, our pupils are huge or pinpoint, our mouth is drenched with saliva or parched, and so forth. "Autonomic" means "independent"; these nerves do their work without any input from the conscious mind.

The parotid gland is a salivary gland, and it is riddled with tiny autonomic nerves that control the rate of production of saliva. When the parotid gland is removed, these tiny nerves are severed. (This is an inevitable consequence of surgery and is NOT the result of any error made by your surgeon.) During the healing period, these nerves can grow back in such a way that they attach to the microscopic sweat glands of your cheek skin. When you eat certain foods (undoubtedly the ones that make you salivate a great deal, such as salty or sour foods), the nerves that used to tell your parotid to chug out more saliva are now telling your skin to flush and sweat. That’s Frey (or Frey's) syndrome.

Frey syndrome is an extremely common consequence of parotidectomy, but fortunately, most people with Frey syndrome are not bothered by their condition. In particularly nasty cases, the sweating can be profuse, to the point that one’s shirt becomes soaked with sweat dripping down from the face.

Treatment ranges from reassurance to re-operation. Thus, for many folks, simply explaining the problem suffices. Here are other treatment options, in order of increasing aggressiveness:

* Topical application of a roll-on antiperspirant.

* Topical application of stronger "drying" drugs, such as scopolamine.

* An operation on the middle ear known as "tympanic neurectomy." The culprit nerves traverse the middle ear en route to the parotid gland; in the middle ear, they are often obvious enough that they can be identified (and cut) with the aid of an operating microscope.

* An operation in which the cheek skin is again raised off the region of the parotid gland, and a layer of tissue (harvested from another part of the patient’s body) is transplanted beneath the skin. This interrupts the errant autonomic nerves, and places a barrier between them and the sweat glands of the skin.

You may wish to discuss these options further with your surgeon.

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