Post Herpetic Frey's Syndrome

Abstract

Frey's syndrome is characterized by unilateral sweating and flushing of the skin in the area of the parotid gland, occurring during meal, or on salivary stimulation. It is a common complication following surgery/injury in the parotid gland region/temporomandibular joint surgery; however, very few cases have been reported of its occurrence following herpetic infection. It is important for the clinician to recognize its unusual symptoms as early as possible to prevent its potential negative social and psychological effect on the patient. It is diagnosed on clinical presentation and confirmed by objective testing methods. The treatment ranges from topical application of glycopyrrolate to local injections of botulinum toxin and lastly to surgical intervention. An interesting case of Frey's syndrome is presented in a young patient having the previous history of herpes zoster infection, which was diagnosed clinically and confirmed by starch-iodine test and was successfully treated with topical application of glycopyrrolate.

Keywords: Frey's syndrome; glycopyrrolate; herpes infection; minor-starch iodine test.

Figure 1

Lateral profile of the patient showing the presence of scar marks over the preauricular region and temporal region (arrows)

Figure 2

Orthopantomograph of the patient with periapical radiolucency in relation to lower central incisors and impacted lower third molars

Figure 3

Sagittal (a) and coronal (b) magnetic resonance imaging section of the patient with no intracranial abnormality

Figure 4

Application of 1% iodine over the affected area (a), application of starch powder over the skin (b), bluish-black discoloration over the right side of face suggestive of positive starch iodine test (c)