From the Guidelines
The most common complication after parotidectomy is Frey's syndrome. This condition, also known as gustatory sweating, occurs when damaged parasympathetic nerve fibers that normally stimulate salivary secretion mistakenly regenerate and innervate sweat glands in the skin overlying the parotid area. As a result, patients experience facial flushing, sweating, and warmth over the cheek area when eating or thinking about food. Frey's syndrome typically develops several months after surgery and affects approximately 10-40% of patients who undergo parotidectomy, though not all cases are symptomatic enough to require treatment. While facial nerve palsy is a significant concern during parotid surgery, it occurs less frequently than Frey's syndrome when proper surgical technique is employed, as noted in studies discussing the importance of preserving the facial nerve during parotidectomy 1. The risk of Frey's syndrome can be reduced by creating thicker skin flaps during surgery or by placing barriers such as temporoparietal fascia or acellular dermal matrix between the skin and the remaining parotid tissue.
Key points to consider in the management and prevention of complications after parotidectomy include:
- The importance of preserving the facial nerve to minimize the risk of facial nerve palsy, as discussed in guidelines for the management of salivary gland malignancy 1.
- The use of appropriate surgical techniques to reduce the risk of Frey's syndrome, such as creating thicker skin flaps or using barriers to prevent aberrant nerve regeneration.
- The consideration of adjuvant therapy, such as radiation, in the treatment of advanced or high-grade parotid cancers, which may impact the extent of parotidectomy required 1.
- The need for careful patient selection and individualized treatment planning to balance the risks and benefits of different surgical approaches, taking into account factors such as tumor stage, grade, and location, as well as patient preferences and quality of life considerations.
In terms of specific studies, a review of the literature highlights the importance of achieving negative surgical margins and preserving the facial nerve when possible, to optimize outcomes and minimize morbidity in patients undergoing parotidectomy for salivary gland malignancies 1. However, the most recent and highest quality study on this topic, which prioritizes morbidity, mortality, and quality of life as outcomes, supports the notion that Frey's syndrome is the most common complication after parotidectomy, and provides guidance on strategies to reduce its incidence and impact on patients.
From the Research
Complications after Parotidectomy
- The most common complication after parotidectomy is Frey's syndrome, which is characterized by gustatory sweating and flushing [(2,3,4,5,6)].
- Frey's syndrome is a common complication of parotid surgery, with a reported incidence of 62% in patients who underwent superficial parotidectomy [(2,3)].
- The syndrome can have a significant impact on the quality of life of patients, with 19 patients in one study reporting a decrease in their quality of life due to the symptoms 3.
- Other complications after parotidectomy include facial nerve palsy, recurrent infection, and bleeding, but Frey's syndrome is the most common 5.
- The risk of developing Frey's syndrome is lower in patients with malignant tumors than in those with benign tumors, and repeat parotidectomy increases the risk of developing the syndrome 6.
Treatment Options for Frey's Syndrome
- Treatment options for Frey's syndrome include botulinum toxin A injections, which have been shown to be safe and effective in reducing symptoms [(2,3)].
- Surgical treatment options, such as tympanic neurectomy and local flaps, have also been developed, but the results are not always as effective as desired 4.
- The use of a superficial muscular aponeurotic system (SMAS) flap does not appear to affect the risk of developing Frey's syndrome 6.