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 per cent) 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 auriculotemporal 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.