Auriculotemporal syndrome R61.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Auriculotemporal syndrome; Frey-Baillarger Syndrome; Freysche's syndrome; Frey Syndrome; Hyperhidrosis gustatory; Irritable Syndrome; Syndrome of the auriculotemporal nerve

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Frey, 1923

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Form of gustatory hyperhidrosis.

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Presumably disturbed regeneration of the auriculotemporal nerve after inflammatory or surgical lesion, mostly after parotid surgery. The disease occurs in 50-80% of patients following parotid operations, as well as after abscesses and facial injuries.
Misdirected regeneration of postganglionic parasympathetic nerve fibres, which run in the auriculotemporal nerve and the auricular nerve, in axons of damaged postganglionic sympathetic nerve fibres, which supply the sweat glands and the small skin vessels.

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Beginning of symptoms 4-7 months after surgery or damage to the parotis; duration usually unlimited, less often spontaneous improvement after 3-5 years.

Clinical features
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Unilateral reddening of the skin caused by psychological stimuli or after ingestion of certain foods and increased sweat secretion in the zygomatic region. Immediate regression of hyperhidrosis after eating; additional permanent hypo- or hyperesthesia.

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External use of aluminium chloride hexahydrate gel/solution R004 R005.

Botulinum Toxin: A significant advance is the treatment with botulinum toxin. The subdivision of the hyperhidrotic areas ( Minorsch sweating test) into 2 × 2 cm boxes has proven to be effective. About 10 MU Dysport or 3 MU Botox (dilution: 500 MU Dysport or 100 MU Botox/5 ml 0.9% NaCl) are injected intradermally in a fan-shaped manner per box. The success of the therapy is monitored after 2-3 weeks. Remaining hyperhidrotic areas can be re-injected if necessary. Side effect: Painfulness of the injections.

Notice! Therapy with botulinum toxin belongs in the hands of an experienced doctor!

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  1. Burks W (2003) Skin manifestations of food allergy. Pediatrics 111: 1617-1624
  2. Eckardt A et al (2003) Treatment of gustatory sweating (Frey's syndrome) with botulinum toxin A. Head Neck 25: 624-628
  3. Frey L (1923) Le syndrome du nerf auriculo-temporal. Rev Neurol Paris 2: 97
  4. Hays LL, Novack AJ, Worsham JC (1982) The Frey syndrome: a simple, effective treatment. Otolaryngol Head Neck Surg 90: 419-425
  5. Laskawi R et al (2002) Frey's syndrome. Treatment with botulinum toxin. Curr Probl Dermatol 30: 170-177
  6. Milan JC (1967) Hereditary gustatory sweating. JAMA 201: 203-204


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Last updated on: 29.10.2020