Toxina Botulínica na Síndrome de Frey: Quem Tratar? Relato de Caso e Revisão da Literatura

Frey syndrome is mostly seen after parotidectomies and is an underdiagnosed surgical complication that may cause social inhibition and quality of life (QoL) deterioration. We report a case complemented with a literature review regarding the use of botulinum toxin on Frey syndrome. We consulted the patient’s file and photographed the Minor tests. We searched PubMed using the keywords: Frey syndrome; gustatory sweating; botulinum toxin. A 43-year-old woman, diagnosed with a pleomorphic adenoma of the left parotid gland treated by parotidectomy was referred to our Physical and Rehabilitation Medicine department due to symptoms suggestive of Frey syndrome: flushing and sweating on the left parotid region during meals with impact on socialization and QoL. Minor test confirmed the diagnosis. The patient underwent intradermic infiltration of 46U of onabotulinum toxin A (Botox®) across the positive area on Minor test that matched the patient’s complaints. Three weeks post-procedure, the patient denied hyperhidrosis (demonstrated on Minor test) and mentioned overall improvement on QoL. Treatment is symptomatic and should be offered to those patients whose symptoms cause a negative impact on QoL. Botulinum toxin infiltration is currently the gold standard treatment, since it is a safe, effective and reliable procedure. The Minor test is essential to optimise botulinum toxin dosage, thus reducing the possibility of occurring adverse effects.