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 connect to sweat glands in the skin overlying the parotid region. As a result, patients experience sweating and flushing of the skin over the parotid area when eating or thinking about food. Frey's syndrome affects approximately 30-60% of patients following parotidectomy, though not all patients are symptomatic enough to require treatment 1. The condition typically develops several months after surgery as nerve regeneration occurs. While facial nerve palsy is a significant concern during parotidectomy, it occurs less frequently than Frey's syndrome when proper surgical technique is employed, as the facial nerve is preserved in most cases unless grossly infiltrated or encased by malignancy 1.
Some key points to consider:
- Frey's syndrome is a common complication after parotidectomy, affecting a significant portion of patients
- The condition results from aberrant nerve regeneration and can cause significant morbidity
- Treatment options for symptomatic Frey's syndrome include topical antiperspirants, botulinum toxin injections, or surgical interventions
- Facial nerve palsy is a significant concern during parotidectomy, but occurs less frequently than Frey's syndrome with proper surgical technique
- The management of salivary gland malignancy, including parotidectomy, should prioritize achieving negative surgical margins while preserving the facial nerve whenever possible 1.
In terms of management, it is essential to consider the potential complications of parotidectomy, including Frey's syndrome and facial nerve palsy, and to employ proper surgical technique to minimize these risks. The use of adjuvant radiation therapy may also be considered in certain cases to improve local control and overall survival 1.
From the Research
Complications after Parotidectomy
- The most common complication after parotidectomy is Frey's syndrome, also known as gustatory sweating 2, 3, 4, 5, 6.
- Frey's syndrome is characterized by abnormal sweating and flushing of the skin in response to stimuli that normally would not cause such a response, such as eating certain foods 2, 3.
- The incidence of Frey's syndrome after parotidectomy can be as high as 62% 2, 3.
- Other complications after parotidectomy include facial nerve palsy, recurrent infection, and bleeding, but Frey's syndrome is the most common complication 5.
- The risk of developing Frey's syndrome can be influenced by factors such as the type of parotid gland tumor, the type of parotidectomy procedure, and whether the patient has undergone repeat parotidectomy 6.
Comparison of Complications
- Facial nerve palsy is a potential complication after parotidectomy, but it is not as common as Frey's syndrome 5.
- Recurrent infection and bleeding are also potential complications, but they are not as frequently reported as Frey's syndrome 5.
- Frey's syndrome can have a significant impact on a patient's quality of life, and treatment options such as botulinum toxin A injections can be effective in managing the condition 2, 3, 4.