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PubMedDate not supplied

Characteristics and associated features of persistent post-sympathectomy pain.

OBJECTIVES: The aim of this study is to describe the incidence and characteristics of pain, sensory abnormalities, abnormal body sweating, and pathologic gustatory sweating in pain patients with persistent post-sympathectomy pain. METHODS: A retrospective chart review of a series of consecutive pain patients with persistent post-sympathectomy pain was performed. Inclusion criteria were: (1) sympathectomy performed for the indication of neuropathic pain, and (2) persistent pain after the procedure. Demographic data, patterns of pain before and after sympathectomy, patients' pain drawings, and incidence of pain had been collected concurrently at the time of referral. Additional data regarding sensory findings, surgical details of the sympathectomy, sweat patterns, and incidence of abnormal body sweating and pathologic gustatory sweating were extracted from the patients' charts or obtained in follow-up appointments. RESULTS: Seventeen adults (13 females and 4 males) with a mean age of 37 years (range 25-52) at the time of sympathectomy met the inclusion criteria. Five of the 17 patients experienced temporary pain relief for an average of 4 months (range 2-12 months), 3/17 retained the same pain as before the surgery, 1 patient was cured of her original pain but experienced a new debilitating pain, and 8/17 patients continued to have the same or worse pain in addition to a new or expanded pain. Pathologic gustatory sweating was present in 7/11 patients asked, and abnormal sweating (known as compensatory hyperhidrosis) in 11/13 patients asked. DISCUSSION: The present study does not allow for conclusions about the effectiveness of surgical sympathectomy for neuropathic pain. However, our findings indicate that if the pain persists after the procedure, the complications may be quite serious and at times worse than the problem for which the surgery was originally performed.

Adult↗
PubMed2005

Effect of endoscopic thoracic sympathetic block on plantar hyperhidrosis.

HYPOTHESIS: Endoscopic thoracic sympathetic block at T4 (ESB4) provides excellent results in patients with primary hyperhidrosis (HH) of the upper limb. Most patients have combined palmo-plantar or palmo-axillary-plantar HH. This study evaluates the clinical outcome of patients with upper limb HH with special emphasis on plantar sweating and patients' quality of life. DESIGN: Review of a prospectively gathered database. SETTING: Tertiary care university teaching hospital. PATIENTS: The cohort included 73 patients (50 women and 23 men; mean age, 30.2 years). Twenty-six patients had palmar; 3, isolated axillary; and 44, combined HH. Sixty-six patients (90.4%) had concomitant plantar HH. INTERVENTIONS: One hundred forty-five operations were performed by applying one 5-mm clip above and below the fourth sympathetic ganglion. RESULTS: Of palms, 71.9% were completely and 28.1% were nearly dry. Corresponding percentages were 45.1% and 50.5% for armpits and 4.5% and 37.9% for the soles, respectively. Of soles, 42.4% remained unchanged and 15.2% became slightly worse. Compensatory sweating occurred in 19.4% of patients, with 2.8% having severe compensatory sweating. Feet were rarely affected by compensatory sweating (5.6%). Gustatory sweating was reported by 31.9% of patients but did not bother them. Quality of life improved significantly after ESB4. Most patients (87.5%) were completely satisfied with the outcome; 9.7% were partly satisfied. CONCLUSIONS: In the treatment of upper limb HH, ESB4 yields excellent success rates. Plantar sweating can be relieved in nearly half of patients, although exact neurophysiologic mechanisms remain unclear. Incidence of compensatory and gustatory sweating is low, contributing to a high patient satisfaction and improvement in quality of life.

Adult↗
PubMed1995

Gustatory facial sweating subsequent to upper thoracic sympathectomy.

Gustatory facial sweating has been described as a consequence of upper thoracic sympathectomy. Patients may also develop compensatory hyperhidrosis, sensory deficits, nipple hypersensitivity, and Horner's syndrome. In this article, we have reviewed three patients with reflex sympathetic dystrophy who developed gustatory facial sweating subsequent to endoscopic T2 and T3 ganglionectomy. This article also discusses the possible mechanisms of gustatory facial sweating.

Adult↗
PubMed2001

The use of acellular dermis in the prevention of Frey's syndrome.

EDUCATIONAL OBJECTIVE: At the conclusion of this presentation, the participant should be able to discuss the indications and advantages of using acellular dermis in the prevention of post-parotidectomy gustatory sweating (Frey's Syndrome). INTRODUCTION: Gustatory sweating is a common postoperative problem and a challenge to treat. The purpose of this study was to evaluate the role of acellular dermis in preventing post-parotidectomy gustatory sweating. METHODS: Sixty-four patients were randomly assigned to two groups. Group I consisted of 32 patients who underwent a superficial lobe parotidectomy. Group II consisted of 32 patients who underwent a superficial lobe parotidectomy and underwent intraoperative placement of acellular dermis within the parotid bed, between the skin flap and the remaining parotid tissue. The implanted volume of acellular dermis was determined by the amount required to aesthetically restore lateral facial contour. All 64 patients were evaluated for gustatory sweating by identical phone and mail questionnaires. Thirty randomly chosen patients (group I = 15, group II = 15) were evaluated using a modified Minor's Starch-Iodine Test (MSIT). In all 30 patients, the MSIT was administered to both sides of the face. RESULTS: The responses to questionnaires (N = 64) demonstrated the subjective presence of gustatory sweating in 3 of 32 patients (9.3%) in group I, whereas group II demonstrated a subjective incidence in 1 of 32 patients (3.1%). The objective incidence determined by those who underwent the MSIT (n = 30) revealed a 40% (6) and 0% incidence of Frey's Syndrome in groups I and II, respectively. The complication rate in group I was 9% (3 seromas) and in group II it was 25% (7 seromas and 1 wound infection). CONCLUSIONS: Acellular dermis appears to be an effective method for preventing post-parotidectomy gustatory sweating, despite its higher complication rate.

Biocompatible Materials↗
PubMed1977

Gustatory phenomena after upper dorsal sympathectomy.

In a series of 100 bilateral upper dorsal sympathectomies performed for palmar hyperhidrosis, gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%), followed up for an average of 1 1/2 years. These gustatory phenomena were quite different from physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in varied locations. There was a negative correlation between the incidence of these phenomena and the occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical and experimental work of others, leads to the conclusion that gustatory phenomena after upper dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting with aberrant synapses in the superior cervical ganglion.

Adult↗
PubMed1994

Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations.

OBJECTIVE: This evaluated the long-term outcome after endoscopic thoracic sympathectomy (ETS) from below D1 to D4, using a single-site access technique for primary hyperhidrosis of the upper limbs. SUMMARY BACKGROUND DATA: Primary hyperhidrosis of the upper limbs is a distressing and often socially disabling condition. Endoscopic thoracic sympathectomy is considered the treatment of choice, causing minimal morbidity and high initial success rates. However, data regarding long-term results are scarce. METHODS: Two hundred seventy of 323 patients (83.7%), in whom 480 sympathectomies were performed, answered a questionnaire after a mean of 14.6 years postoperatively regarding the early postoperative result, side effects, and complications caused by the operation and long-term results with particular emphasis on patient satisfaction. RESULTS: There was no postoperative mortality and no major complications requiring surgical reintervention. A majority of the patients (98.1%) were relieved, and 95.5% were satisfied initially. Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's trias in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and a 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively).

Adolescent↗
PubMed1996

Clonidine in the management of asymmetrical gustatory facial sweating: an N-of-1 trial.

OBJECTIVE: To determine the efficacy of clonidine in the management of gustatory facial sweating (GFS) ipsilateral to an upper thoracic sympathectomy. DESIGN: Placebo-controlled N-of-1 trial. SETTING: Tertiary care referral center. INTERVENTION: Clonidine patch that delivers 0.2mg/d. OUTCOME MEASURE: Daily episodes of GFS are recorded. The severity of GFS is graded as mild, moderate, or severe, and a daily GFS score is calculated. RESULTS: Clonidine was shown to significantly decrease (p < .05) the incidence and frequency of gustatory facial sweating.

Administration, Cutaneous↗
PubMed1977

A reevaluation of the Frey syndrome following parotid surgery.

The Frey syndrome, or gustatory sweating, is an accepted complication of parotid gland surgery that may occur with varying degrees of secerity. Since misdirection of auriculotemporal secretomotor nerve fibers has been found to play an important role in the development of the syndrome, a study was initiated to attempt mechanical interference with the regenerating fibers of the nerve. A superiorly based muscle flap from the sternocleidomastoid muscle was developed to cover the operative wound after either partial or complete parotidectomy. Results in 35 patients with such a muscle flap were compared with those in 35 control patients for the presence of absence of the Frey syndrome; the muscle flap was shown to be ineffective in preventing occurrence of gustatory sweating. Moreover, gustatory sweating to varying degrees was present in 34 patients with the muscle flap and in 33 control patients. Also, only 23 of the 70 patients had subjective complaints related to the syndrome, none of whom was incapacitated ore required additional measures for care.

Humans↗
PubMed1997

Application of medical thermography to the diagnosis of Frey's syndrome.

BACKGROUND: In Frey's syndrome, the secretory parasympathetic fibers of the parotid gland are thought to communicate with the sympathetic nerve fibers of sweat glands and blood vessels of the skin following parotidectomy. Miscommunication results in subjective gustatory sweating and facial flushing, which appear early with postoperative mastication. In this study, we compared the efficacy of medical thermography to the Minor's starch-iodine test to determine the presence of gustatory sweating in Frey's syndrome. METHODS: Patients were considered to have Frey's syndrome if signs of gustatory sweating and localized skin flushing of the parotid region were present. In four patients who had undergone unilateral parotidectomy, gustatory sweating and facial flushing were present after gustatory stimulation, and the presence of Frey's syndrome was confirmed with Minor's starch test in all patients. Infrared thermography was then performed, and the same area measured. The contralateral side served as an internal control for each patient. RESULTS: Before gustatory stimulation, the isothermal pattern of the diseased side and the nonoperative side was similar. Stress thermography using a sialogogue (lemon, 3 mL) showed a cold spot at the operative site in all four patients with Frey's syndrome. The contralateral nonoperative side showed normal skin temperature distribution in all patients. Minor's test was positive in all patients. CONCLUSIONS: Thermography is a noninvasive, facile test that provides a qualitative visual analysis of the cutaneous capillary response in Frey's syndrome following parotid surgery.

Adenocarcinoma↗
PubMed2005

Preliminary experience with botulinum toxin type A intracutaneous injection for Frey's syndrome.

BACKGROUND: Gustatory sweating, the main symptom of Frey's syndrome, usually occurs after parotid gland surgery. Numerous medical and surgical treatments have been proposed to treat this condition, but there are various drawbacks. Botulinum toxin type A intracutaneous injection is a relatively new treatment modality; its use has never been reported in Taiwan. Here, we present our preliminary experience with this technique and review the literature. METHODS: Between March 2002 and June 2005, 10 consecutive patients with severe gustatory sweating were managed with intracutaneous injection of botulinum toxin type A for a total of 16 times. The affected skin was visualized by Minor's starch-iodine test and then recorded. The interinjection distance was 1 cm and a mean dose of 46.4 U (at a concentration of 2.5 U/0.1 mL) was used. RESULTS: In all 10 cases, gustatory sweating improved within 2 days after injection, with no side effects. Patients in whom the first 13 injections were performed experienced recurrence of gustatory sweating. Mean duration of effectiveness was 9.3 months; the shortest duration of effectiveness was 2 months and the longest was 28 months. One patient also had gustatory flushing, but this symptom did not improve even after 3 treatments. CONCLUSION: Intracutaneous injection of botulinum toxin type A is a highly reliable, effective, safe, and minimally invasive treatment for gustatory sweating. Some patients had long-lasting therapeutic results. We recommend it as a valuable treatment option for severe cases of gustatory sweating. However, in our experience, it had no effect on facial skin flushing. Therefore, in addition to acetylcholine, there might be other neurotransmitters that are responsible for skin vasodilatation.

Adult↗
PubMed1999

Frey syndrome: treatment with temporoparietal fascia flap interposition.

There is a 10% to 48% reported incidence of clinically significant gustatory sweating after parotid surgery or injury. Various medical and surgical treatments have been used in the attempt to treat this socially embarrassing condition. These treatments are not always effective and often have unwanted risks and adverse effects. They also do not address the post-parotidectomy defect. Prevention of Frey syndrome and correction of the postoperative contour deformity after parotidectomy have recently been achieved by interposition of temporoparietal fascia flap between the parotid gland and the cheek skin flap at the time of parotidectomy. This article presents the first report (to our knowledge) of an established case of Frey syndrome being treated with temporoparietal fascia flap interposition.

Follow-Up Studies↗
PubMed2006

Improved quality of life after sympathetic block for upper limb hyperhidrosis.

BACKGROUND: The aim of the study was to assess two disease-specific quality of life (QoL) instruments after limited endoscopic thoracic sympathetic block (TS) at T4 for upper limb hyperhidrosis. METHODS: : Between 2001 and 2005, 112 patients underwent 223 TS procedures in a prospective study. Some 103 patients (92.0 per cent) had palmar, 87 (77.7 per cent) had axillary and 75 (67.0 per cent) had combined hyperhidrosis. QoL questionnaires devised by Keller et al. and Milanez de Campos et al. were employed before and after treatment. Mean(s.d.) follow-up was 21.9(10.1) months. RESULTS: A total of 106 patients (94.6 per cent) were evaluated. All patients with palmar hyperhidrosis were completely or almost dry after surgery. Side-effects of compensatory sweating and gustatory sweating were observed in 17.0 and 28.3 per cent of patients respectively. QoL improved after TS in 100 per cent (Keller) and 97.3 per cent (Milanez de Campos) of patients illustrated by ameliorated scores of 78.7 and 67.8 per cent, respectively (both P < 0.001). Both questionnaires showed that compensatory sweating resulted in reduced postoperative QoL (P = 0.011, Keller; P = 0.032, Milanez de Campos). CONCLUSION: Endoscopic sympathetic block at T4 leads to improved QoL. Both current questionnaires fulfilled validation criteria for disease-specific QoL instruments in upper limb hyperhidrosis.

Adult↗
PubMed2003

[First use of botulinum toxin type B in ENT patients with secondary therapy failure of botulinum toxin type A].

The first botulinum toxin type B (BT-B) formulation, NeuroBloc, has been licensed in Germany for the treatment of cervical dystonia since March 2001. This allows the treatment of patients with secondary failure of botulinum type A (BT-A) injections for the first time. Three patients with such a secondary failure were successfully treated with BT-B. A total of 1,000 mouse units (MU) NeuroBloc per eye were injected in a patient with blepharospasm. The treatment was effective for 4 months. In a patient with spasmodic dysphonia, 250 MU were injected into each vocal cord. This was effective for 3.5 months. The third patient suffered from bilateral Frey's syndrome. A total of 7,500 MU were used on the right side and 6,000 MU on the left side to stop the gustatory sweating for 9 months. Overall, BT-B showed similar intervals of effectiveness as BT-A. Side effects were not seen using the above dosage regimes.

Aged↗
PubMed2004

[Frey's syndrome of the external auditory canal].

Frey's syndrome of the external auditory canal is extremely rare. A 55-year old woman presented with a 6 month history of unilateral gustatory otorrhea. She never complained of hearing impairment, tinnitus, vertigo or otalgia. No trauma or surgical signs were evident near the ear or parotid gland. Examination of the ear showed an intact tympanic membrane without disease. A diagnosis of gustatory sweating syndrome was suggested by the observation of sweat production after chewing and by Minor's starch-iodine test. Symptoms were relieved after tympanic neurectomy. The pathogenesis, differential diagnosis and treatment options are discussed.

Chorda Tympani Nerve↗
PubMed2001

[Frey syndrome].

AIMS: The incidence of Frey's syndrome after parotidectomy as cited in the literature varies distinctively. Strategies for successful treatment are also assessed differently. PATIENTS: Between 1980 and 1994 a total of 372 parotidectomies were performed in 364 patients at the Bochum University Hospital. RESULTS: After an average of 18 months following parotidectomy, 86 patients (23.5%) developed Frey's syndrome. Thirty-five patients were treated with scopolamine ointment. The symptoms improved in nine cases after an average of 25 months of therapy. Of the patients receiving no treatment (n = 20), seven improved after an average follow-up of 20 months. Therapy with scopolamine ointment did not elicit significantly better results compared to no treatment at all. CONCLUSION: Gustatory sweating after parotidectomy still has to be regarded as an unpleasant complication which is difficult to cure.

Adolescent↗
PubMed2003

Sequelae of endoscopic sympathetic block.

Endoscopic sympathetic block as a treatment for primary hyperhidrosis is associated with certain sequelae. The reported occurrence of side effects still varies in the literature. As the majority of patients describe sequelae after sympathetic surgery, the frequency and importance of these persisting changes are still underestimated. Patient's informed consent should include and define side effects like gustatory sweating, olfactory sweating and bradycardia as likely, and compensatory sweating as obligatory.

Adaptation, Physiological↗
PubMed1976

Frey's syndrome after parotid surgery.

The operative records of seventy-one patients who had parotid surgery carried out in the ten year period from 1964 to 1973 were reviewed. Forty-one (67%) of the operations were suprafacial parotidectomies. Of the fifty patients who agreed to reassessment in a special clinic, seventeen had a noticeable degree of Frey's syndrome, and of these fourteen were submitted to further investigations. Minor's test in these fourteen patients showed the greater auricular nerve to be involved in six patients, the ariculotemporal nerve in four, and both nerves in two. The results in two patients were inconclusive. Because the starch test reveals only the distribution of the gustatory sweating, a useful adjunct is described for investigating Frey's syndrome. By blocking of the contralateral greater auricular nerve in the neck and mapping out of the anesthetized area, its sensory distribution is demonstrated. We conclude that it is manifestly unwise to avulse the auriculotemporal nerve if the sweating occurs in the distribution of the greater auricular nerve.

Adolescent↗