What is the most common complication after parotid (parotid gland) surgery or parotidectomy (surgical removal of the parotid gland)?

Most Common Complication After Parotid Surgery

Frey's syndrome is the most common complication after parotid surgery or parotidectomy, occurring in up to 23.5% of patients following the procedure 1.

Understanding Frey's Syndrome

Frey's syndrome, also known as auriculotemporal syndrome or gustatory sweating, develops due to aberrant regeneration of damaged parasympathetic nerve fibers that inappropriately reinnervate sweat glands in the overlying skin, causing:

• Gustatory sweating
• Flushing
• Warming over the preauricular and temporal areas 2

This occurs when patients eat or are otherwise stimulated to salivate, as the parasympathetic signals meant for salivary production are misdirected to sweat glands.

Incidence and Presentation

• Occurs in approximately 23.5% of patients after parotidectomy 1
• Typically develops after an average of 12 months post-surgery (range: 12.3±9.9 months) 1
• While nearly all patients who undergo parotidectomy will develop some degree of Frey syndrome, only about 44% of those with the condition are symptomatic 1, 3

Risk Factors for Developing Frey's Syndrome

Several factors influence the likelihood of developing symptomatic Frey's syndrome:

• Tumor size: Larger tumors significantly increase risk (43.5±38.4 mm in Frey group vs. 33.1±27.5 mm in non-Frey group) 4

  • Tumors ≥4 cm nearly double the risk (33%) compared to tumors <4 cm (18%) 4

• Extent of surgery: More extensive resections increase risk 2, 5

  • Risk ratios compared to tail lumpectomy:
    • Pre-auricular lumpectomy: 4.378
    • Superficial parotidectomy: 8.040
    • Total parotidectomy: 8.174 6

• Repeat parotidectomy: Increases risk by 3.2 times 6

Comparison with Other Complications

While Frey's syndrome is the most common complication, other significant complications include:

1. Temporary facial weakness: Occurs in approximately 4.49-17.67% of cases depending on surgical approach 5
2. Permanent facial weakness: Occurs in approximately 2.25-6.56% of cases 5
3. Salivary fistulas: Occurs in approximately 6.18-8.58% of cases 5
4. Sialoceles: Occurs in approximately 3.53-4.77% of cases 5
5. Surgical wound dehiscence: Occurs in approximately 10.6-12.64% of cases 5

Prevention and Management

• Surgical techniques to minimize risk:

  • Maintaining thick skin flaps when oncologically appropriate 2
  • Partial superficial parotidectomy when indicated 2, 3

• Treatment options:

  • Intracutaneous injection of botulinum toxin A is the most effective treatment 2, 3
  • Treatment is long-lasting but can be repeated if symptoms recur 3

Important Clinical Considerations

• Not all patients with Frey's syndrome require treatment - only those with significant symptoms 3
• The syndrome may develop years after surgery, requiring patient education and long-term follow-up 2
• While preventive measures like sternocleidomastoideus flaps have been tried, some studies show no significant benefit 1

Frey's syndrome represents a significant quality of life issue for many patients after parotid surgery, though facial nerve issues may have more functional impact when they occur.