An Extremely Delayed Onset of Frey Syndrome: A Case Report and Literature Review

Abstract

We report the case of an 80-year-old man with Frey syndrome that developed 30 years postoperatively, which is an exceptionally long period before its occurrence. Sweating and flushing occurred on only the side of his face where the surgery was performed, and he had no other causative abnormalities. Following treatment with botulinum toxin, the patient's symptoms resolved. Extremely early- and late-onset cases do not fit the conventional paradigm of this pathology. Various surgical methods to prevent this syndrome have been explored, but complete prevention has not yet been achieved. These findings suggest that the underlying pathophysiology of Frey syndrome may be more complex than previously recognized.

Keywords: Frey syndrome; delayed onset; gustatory sweating; parotid gland surgery; postoperative complications.

Figure.

A: Magnetic resonance imaging showed no parotid gland on the left side. No other notable lesions were detected. B: One minute after the patient began licking the hard candy, Minor iodine-starch testing was positive, with color changing to a bluish-purple in response to sweating only on the left side. C: Botox was injected (1.25 U) at each of the points marked with a black dot. D: One month later, Minor iodine-starch testing was negative.