Alternative clinical uses of the botulinum toxin in plastic and reconstructive surgery: Frey's syndrome [impieghi clinici alternativi della tossina botulinica in chirurgia plastica e ricostruttiva: La sindrome di Frey]

Aim. Frey's syndrome is common after parotidectomy or operations on the temporo-mandibular joint. It is characterized by hyperhidrosis and facial erythema during eating. Methods. A total of 28 patients affected by Frey's syndrome have been studied. The gustatory stimulation was obtained by making the patients sipping lemon juice. The temperature and color of the skin, the quantity of swear and the interested area have been evaluated on each hemiface, comparing them to the healthy side. The affected area has been marked by painting 1 cm2 squares and the botulinum toxin was injected in the derma. Patients from group 1 (light symptoms), had 20 U (0,4 ml) of toxin; patients form the group 2 (with important symptoms) had 75 U (1,5 ml). Results. All the patients treated showed a disappearance or an improvement of the symptoms. Controls were at the 4th and 7th day, at the 1st and 3rd month and every 3 months for 2 years. No secondary side effects were reported. The duration of symptomatic remission appeared directly dependent on the administered dose. The symptomatic remission was, for the 1st group 9±2 months, while for the patients that received the toxin at high concentration 16±4 months. When the effect disappears, the botulism toxin may be administered again, with a longer lasting effect achieved with the same initial dose. Conclusion. The treatment of Frey's syndrome symptoms with butulinum toxin is simple, effective, fast and free from major secondary side effects.