How Can Frey's Syndrome Be Prevented or Treated Following Parotid Surgery?

Frey's syndrome (FS) following parotid surgery resulted from reinnervation of sweat glands and subcutaneous vessels, causing gustatory sweating and facial flushing. FS did not resolve spontaneously and became more disturbing over time, affecting 50.9% of patients at 5 years post-surgery. The incidence of FS was higher with more extensive parotidectomy procedures. Various prevention techniques, such as interposition of muscle or fascial flaps, and grafts, were suggested but none completely prevented FS. Botulinum toxin type A injections significantly improved quality of life and were the preferred treatment, though they might need repeating after 1.5 years. Interposition grafts offered some long-term prevention but had a failure rate and lacked durability reports beyond 3 years. The literature reviewed provided levels of evidence ranging from 2a to 4.