A Case Series of Five Parotidectomy Patients with Paraumbilical Fat Grafts

Abstract

Gustatory sweating, commonly known as Frey syndrome or auriculotemporal nerve syndrome, is detected clinically with presentations of preauricular sweating, burning and abnormal flushing due to regeneration of the secretomotor parasympathetic fibers which are cut during surgery. These fibers normally innervate the sweat glands and subcutaneous vessels, and therefore when dissected during a parotidectomy will cause pathology of these regions during regeneration. Management options for Frey Syndrome include preventative (including a breadth of various flaps), medical (including injection of alcohol into the otic ganglion and botulinum toxin administration) and surgical techniques (which are reserved for cases where conservative and medical management options are unsuccessful). Free fat grafts have been identified in the literature as having the benefits of remedying the contour defect from parotidectomy surgery and also preventing Frey Syndrome. Autologous fat grafts, including paraumbilical free-fat grafts, are thought to have the additional advantage of decreased donor site morbidity when compared with other techniques, such as lateral arm, sternocleidomastoid, rectus abdominis myocutaneous and temporoparietal fascial flaps. The consequences of Frey Syndrome to patients may include significant social embarrassment due to sweating and flushing whilst eating, with 80% of patients complaining of sweating only. We present a series of cases in which Paraumbilical free-fat grafts were used in parotidectomy patients to demonstrate the success of the graft in the management and prevention of Frey Syndrome. Postoperative complications were documented and explored at patient reviews following surgery.