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

Efficacy and safety of botulinum toxin type A for treatment of Frey's syndrome: evidence from 22 published articles

Frey’s syndrome (FS) is an unavoidable sequela following the surgery of the parotid gland. Although several treatment methods are available, their efficacy is short term or accompanied by unacceptable complications. In the past two decades, botulinum toxin type A (BTXA) has been widely used to treat FS. Although several systematic reviews have been reported recently, they were conflicting and with obvious deficiencies. Thus, we performed an objectively systematic review to determine whether BTXA is an effective and safe treatment for FS. A literature retrieval covering PubMed, Web of Science, Ovid, Embase and Cochrane library was performed on 16 January, 2015. Proportion meta-analysis and corresponding 95% confidence interval (CI) were performed to evaluate the efficacy and safety of BXTA in treatment of FS. A total of 499 records were retrieved and 22 articles with 23 studies were included after scrutiny by two independent authors. Statistical analyses regarding the effective rate, incidence of complications were used to estimate the efficacy and safety of BTXA. Our results suggested that the effective rate of BTXA for treatment of FS is 98.5% (95% CI = 0.971–0.994) and the incidence of complication is 3.6% (95% CI = 0.017–0.061). In conclusion, our study supports that BTXA produces meaningful benefits on the treatment of patients with FS. However, owing to lack of strong evidence, future studies with well-designed inclusion criteria and multicenter randomized controlled trials are needed to give more credible evidence, if possible.

Frey's Syndrome Consequent to an Unusual Pattern of Temporomandibular Joint Dislocation: Case Report with Review of Its Incidence and Etiology

Frey's syndrome was first described in the 18(th) century. Recognizing it as a nonspecific condition, the symptom of gustatory sweating in patients with parotid gland inflammation was described by Duphenix and Baillarger. However, as a specific diagnostic entity, gustatory sweating, following trauma to parotid glands, was first described by Polish neurologist Lucie Frey, in 1923, and hence he proposed the term auriculotemporal syndrome. The condition is characterized by sweating, flushing, a sense of warmth, and occasional pain in the preauricular and temporal areas, following the production of a strong salivary stimulus. Several etiologies of Frey's syndrome have been mentioned in the literature; however, none attribute dislocation of the "intact" mandibular condyle as a cause of the syndrome. Reviewing its pathophysiology, etiology, and incidence in detail, we describe a case of Frey's syndrome subsequent to superolateral dislocation of the intact mandibular condyle following fracture of the anterior mandible. Its management and prevention are also discussed in brief.

A split-face study using botulinum toxin type B to decrease facial erythema index

INTRODUCTION

A reddish tone in facial skin is a common concern of patients who suffer from facial flushing. No studies have been conducted to date for evaluation of the effect of botulinum toxin type B (BTX-B) on facial flushing.

MATERIALS AND METHOD

We evaluated the efficacy of BTX-B for improvement of facial flushing. Fifteen Korean subjects who complained of facial flushing were enrolled in this study. Patients were randomized to receive BTX-B injections on one side of the face, with the other side receiving saline control injections. Changes in skin tone were evaluated using an overall self-assessment and an objective mexameter.

RESULT

After treatment, this mexameter demonstrated significant improvement of erythema at 8 weeks after injections on both sides. However, according to the change in erythema index measures between the two groups, the BTX-B injection side did not show a significant decrease in objective erythema, compared with the control side. Subjective satisfaction did not differ between the treated side and the control side.

CONCLUSION

Although findings from this study suggest that BTX-B was ineffective in treatment of facial flushing, it is significant that, to the best of our knowledge, this is the first report on an investigator-initiated, randomized, split-face trial for evaluation of efficacy of BTX-B treatment for facial flushing.

AlloDerm implants for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis

Although Frey syndrome is not life-threatening, it is identified as the most serious and widely recognized sequela of parotidectomy and has significant potential negative social and psychological implications. Several studies have investigated whether AlloDerm® implants prevent Frey syndrome effectively and safely, however, the conclusions are inconsistent. We aimed to evaluate the precise effectiveness of AlloDerm implants for preventing Frey syndrome after parotidectomy, using a systematic review and meta-analysis. We searched randomized and quis-randomized controlled trials in which AlloDerm implants were compared to blank controls for preventing Frey syndrome after parotidectomy, from the PubMed, Embase, the Cochrane Library and the ISI Web of Knowledge databases, without any language restriction. Two reviewers independently searched, identified, extracted data and assessed methodological quality. Relative risks with 95% confidence intervals were calculated and pooled. Five articles involving 409 patients met the inclusion criteria. Meta-analyses showed a significant 85% relative risk reduction in objective incidence (RR=0.15, 95% CI 0.08-0.30; P<0.00001) and 68% in subjective incidence (RR=0.32, 95% CI 0.19-0.57; P<0.00001) of Frey syndrome with AlloDerm implants; there was a significant 91% relative risk reduction in salivary fistula (RR=0.09, 95% CI 0.01-0.66; P=0.02); there was no statistical significance for the incidence of facial nerve paralysis (RR=0.96, 95% CI 0.84-1.09; P=0.51); there was no statistical significance for the incidence of seroma/sialocele (RR=1.36, 95% CI 0.66-2.80; P=0.40); there was a trend for a small effect in improving facial contour. Adverse events related to AlloDerm implants were not found. There is evidence that AlloDerm reduces the incidence of Frey syndrome effectively and safely, and also has the potential to improve facial contour and decrease salivary fistula. However, it is unclear whether AlloDerm implants improve facial contour and decrease other complications. Thus, further controlled evaluative studies incorporating more precise measures are required.

Botulinum toxin for Frey's syndrome: a closer look at different treatment responses

OBJECTIVE

Botulinum toxin is a widely accepted, effective treatment for Frey's syndrome. While some patients need only one injection, others require repeated treatments. We aimed to describe the clinical features of patients with a more challenging treatment course.

DESIGN

Literature review and retrospective analysis of eight consecutive patients treated at a university hospital.

SUBJECTS

These patients' treatment responses were categorised (using our own system) and compared with those of 25 published cases.

RESULTS

Combined analysis identified no significant correlation between treatment response and age, gender or the extent of primary salivary gland surgery. There was no significant correlation between botulinum toxin dosage and time between treatments.

CONCLUSION

Frey's syndrome should be viewed as a dynamic process in which the stimulus for aberrant reinnervation of parasympathetic nerve fibres can be reduced, in some patients, with higher botulinum toxin dose injections to the treated areas. However, responses are unpredictable, and relapses may occur at different time points and in different areas.

Botulinum toxin for treatment of glandular hypersecretory disorders

SUMMARY

The use of botulinum toxin to treat disorders of the salivary glands is increasing in popularity in recent years. Recent reports of the use of botulinum toxin in glandular hypersecretion suggest overall favourable results with minimal side-effects. However, few randomised clinical trials means that data are limited with respect to candidate suitability, treatment dosages, frequency and duration of treatment. We report a selection of such cases from our own department managed with botulinum toxin and review the current data on use of the toxin to treat salivary gland disorders such as Frey's syndrome, excessive salivation (sialorrhoea), focal and general hyperhidrosis, excessive lacrimation and chronic rhinitis.