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Auriculotemporal syndrome

What is the auriculotemporal? syndrome?

Auriculotemporal syndrome is characterized by sweating, redness, and warmth over the preauricular area (the front part of the ear) and temporary areas (the region of the face behind the eyes) in response to a gustatory stimulus [1].

Lucja Frey, a Polish physician and neurologist, first described auriculotemporal syndrome in 1923, giving rise to the alternative name, Frey syndrome. [2]. Also known as gustatory hyperhidrosis, Baillarger syndrome and Dupuy syndrome.

Who gets auriculotemporal syndrome?

The precise incidence of auriculotemporal syndrome is unknown [3]. Patients often underreport the incidence due to subclinical symptoms. [4].

Auriculotemporal syndrome occurs most frequently as a complication of surgical removal of the parotid gland (parotidectomy) with estimated rates of 4 to 96% [5,6,7]. Men and women are equally affected.

Infrequently, auriculotemporal syndrome is seen in infants and children after forceps delivery. [8]. a rare family, bilateral auriculotemporal syndrome without trauma It has been reported [9].

What causes auriculotemporal syndrome?

The cause of the syndrome involves aberrant regeneration of the auriculotemporal branch of the mandibular nerve after injury. infectionor surgery in the vicinity of the parotid gland (the salivary gland in front of the ears) [3].

The auriculotemporal nerve normally provides sympathetic innervation to sweat glands and parasympathetic innervation to the salivary gland.

With trauma, parasympathetic fibers can be diverted and regenerated along the sympathetic nerve pathway, establishing a connection with the sweat glands and blood vessels of the skin [10]. Therefore, instead of producing saliva, sweating and redness occur with a taste stimulus. [eleven].

Damage to ganglia within the cervical sympathetic chain can also cause auriculotemporal syndrome [12].

What are the clinical characteristics of auriculotemporal syndrome?

Symptoms are often apparent within the first year after parotidectomy. However, late recognition is not unusual. [13]. Once symptoms begin, there is often a gradual increase in severity over several months, and then they remain relatively constant thereafter.

Symptoms are triggered by chewing (gustatory sweating) or by seeing, smelling or thinking about food. They include:

  • Redness, heat and excessive sweating (located hyperhidrosis) ipsilateral facial skin [11]

  • A burning, itching, or painful sensation in the distribution of the auriculotemporal nerve [1].

The severity of the symptoms is variable, from barely noticeable to quite problematic; 15% patients rate their symptoms as severe and are especially concerned about excessive sweating.

What are the complications of auriculotemporal syndrome?

Auriculotemporal syndrome is associated with a significant psychosocial morbidity [1, 14]. See Psychosocial factors in dermatology.

How is auriculotemporal syndrome diagnosed?

The diagnosis of auriculotemporal syndrome is based on the recognition of characteristic symptoms. [1].

The minor starch-iodine test can be used to confirm hyperhidrosis [15]. Iodine solution It is applied to the affected area, allowed to dry and then starch is applied. The patient is then given a stimulus to promote salivation, often an acidic food. Marked discoloration in the affected region indicates disproportionate sweating.

Which is the differential diagnosis for auriculotemporal syndrome?

Other conditions that may be considered in a patient with symptoms suggestive of auriculotemporal syndrome include:

  • Primary generalized hyperhidrosis
  • Primary focal hyperhidrosis
  • facial shingles
  • Diabetic neuropathy (see diabetic skin disease)
  • Iatrogenic sympathectomy [12]
  • pancoast tumor (a type of lung Cancer) [16]

  • Food allergy (in a baby) [9,17].

What is the treatment for auriculotemporal syndrome?

Treatment of auriculotemporal syndrome is aimed at symptom control [1]. Patients with mild symptoms do not require treatment.

A Cochrane review could not establish the effectiveness and safety of various treatments for auriculotemporal syndrome, due to the absence of randomized control trials [18].

Pharmacologic options to treat problematic auriculotemporal syndrome include:

  • Botulinum toxin A [19–22]

  • Aluminum Chloride Antiperspirant
  • Oral or current glycopyrrolate [23–25].

Surgical treatment is reserved for severe and refractory auriculotemporal syndrome and may include:

  • Intracranial glossopharyngeal nerve section
  • Tympanic neurectomy
  • Musculofascial flap interposition [1,26].

What is the result of auriculotemporal syndrome?

Auriculotemporal syndrome tends to be benign in infants with spontaneous resolution in the majority [27].

Spontaneous resolution occurs at 5% in adults with auriculotemporal syndrome. The drug treatments described above generally control symptoms in the short term. Repeated injections of botulinum toxin A are required every 4–6 months or sooner if symptoms recur [22,28]. Rarely, refractory cases require surgical treatment. [26].