Botulinum toxin treatment for symptomatic Frey's syndrome

Gustatory sweating, or Frey's syndrome, usually occurs after surgery or tra uma to the parotid gland as a result of inappropriate parasympathetic choli nergic innervation of cutaneous sympathetic receptors. Numerous medical and surgical treatments have been proposed to prevent or treat this condition. The results, overall, have been unsatisfactory. Botulinum toxin is a relat ively new treatment modality for Frey's syndrome. We review the literature and present our experience with 7 patients successfully treated with intrad ermal injections of botulinum toxin (Botox), Our technique and dosing are d escribed. In all treated patients gustatory sweating ceased in the area inj ected with botulinum toxin, In 6 patients, symptoms reappeared, and additio nal injections were needed up to 4 times, at 6- to 8-month intervals. All p atients now have been free of symptoms for a long period of time (mean 12.1 months). We strongly recommend intradermal injections of botulinum toxin a s a safe, efficacious treatment for gustatory sweating.