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 inappropriately regenerate and innervate sweat glands in the skin overlying the parotid area. As a result, patients experience sweating and flushing of the skin over the parotid region when eating or thinking about food. The incidence varies widely in literature, ranging from 10-60% of patients undergoing parotidectomy, though many cases may be subclinical. While facial nerve palsy is a significant concern during parotidectomy, it is less common than Frey's syndrome when considering all degrees of severity.
Key Points to Consider
- Frey's syndrome can significantly impact quality of life despite being non-life-threatening.
- Treatment options for Frey's syndrome include topical antiperspirants containing aluminum chloride, botulinum toxin injections for temporary relief, and in severe cases, surgical interventions such as interpositional grafts.
- Patients should be informed about this potential complication before undergoing parotidectomy.
- The management of salivary gland malignancy, as outlined in the ASCO guideline 1, emphasizes the importance of achieving negative surgical margins and preserving the facial nerve when possible, to minimize morbidity and improve quality of life.
- The surgical approach for advanced or high-grade parotid cancers should balance the removal of the primary tumor with the risk to the facial nerve, as more aggressive surgery may not necessarily yield improved survival or locoregional control when adjuvant therapy is used 1.
Clinical Implications
The clinical implications of Frey's syndrome and other potential complications of parotidectomy should be carefully considered in the management of patients undergoing this procedure. By prioritizing the preservation of the facial nerve and minimizing the risk of complications, clinicians can improve outcomes and quality of life for patients with salivary gland malignancies. As noted in the study by Guntinas-Lichius et al, cited in 1, the decision to resect facial nerve branches should be made cautiously, taking into account the potential benefits and risks of this approach.
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 there is limited evidence to suggest that they are as common as Frey's syndrome.
- Frey's syndrome has been shown to have a significant impact on quality of life, and treatment options such as botulinum toxin A injections and surgical interventions have been developed to manage the condition 2, 3, 4.