International Poster Journal of Dentistry and Oral Medicine
Login:
username:

password:

Plattform:

Forgotten password?

Registration

Int Poster J Dent Oral Med 3 (2001), No. 3     15. Sep. 2001

Int Poster J Dent Oral Med 2001, Vol 3 No 3, Poster 82

Treatment of Gustatory Sweating With Botulinumtoxin A

Language: English

Author(s): Christian Küttner MD DDS1, A. Berens MD DDS1, Mathias Tröger MD2, Gwen Swennen MD DDS 1, André Eckardt MD DDS PhD1
1Department of Oral and Maxillofacial Surgery (Prof. Dr. Dr. J.-E. Hausamen)
2Department of Neurology (Prof. Dr. R. Dengler)
 Hannover University Hospital, Germany

Date/Event/Venue: 
07/29/00 - 08/02/00
5th International Conference on Head and Neck Cancer
San Francisco/USA

Educational Objective

At the conclusion of this presentation, the participant should be able to identify the benefit of the treatment with Botulinumtoxin A in patients suffering from gustatory sweating.

Introduction

Frey'Syndrome is present in almost all patients after parotid gland surgery [2,4,8]. Affected skin area can be made visible by Minor's starch iodine test [9]. Prior studies have proven that Gustatory Sweating decreases quality of life [5]. Botulinumtoxin A has been recently described to be an effective treatment [1,3,6,7]. This prospective clinical study was disigned to evaluate the efficacy of the therapy.

Fig. 1 Fig. 2 Fig. 3
Fig. 1-3: Minors starch iodine test was performed to make the area of Gustatory Sweating visible. In Fig. 1 a iodine solution was applicated on the cheek of a patient with Frey's Syndrome. When the thinnen was evaporated starch powder was sprinkled on (Fig. 2) and after eating an apple the affected area was visible as a dark-blue coloration (Fig. 3).

Material and Methods

20 patients, 7 male and 13 female, with severe Gustatory Sweating following superficial parotidectomy due to adenoma of the parotid gland were included. Surgery was performed by avarage of 6 years before at an median age of 45 years. A median area of 41 cm2 was affected by Gustatory Sweating. Botulimnumtoxin A was injected intracutaneously once at a dosage of 1 U Botox per cm2. Minor's starch iodine test was performed one week after treatment to prove the efficacy of the therapy. To evaluate the long-term results of intracutaneous injections of Botulinumtoxin A in treatment of Frey'Syndrome the patients were examined every 2 month. Quality of life was evaluated by SF-36 before and 4 weeks after treatment.

Fig. 4 Fig. 5
Fig. 6 Fig. 7
Fig. 4-7: Expression of gustatory sweating varies much. Neither size of affected area nor intensity of sweating was correlated to surgical procedure.

Results

In 20 patients a median dosage of 40 U Botulinumtoxin A was intracutaneously injected (range from 18 to 70 U). The treatment was well tolerated and no side effects could be observed. Minor's starch iodine test showed the total absence of Gustatory Sweating within one week after treatment in all patients. Quality of life was increased significantely in FS-36 evaluation. After a median follow-up of 8 month a slight recurrance of Frey's Syndrome could be proven by Minor's starch iodine test in 9 patients. All of those had a subclinical manifestation especially in the hair-line area. All patients treated with Botulinumtoxin declared to be very satisfied with the therapy and they would like to get repeated injections in case of clinical relevant Gustatory Sweating.

Fig. 8a Fig. 8b Fig. 8c
Fig. 8 a-c: A 36 years old woman who underwent surgery 8 years ago, before treatment (8a), after marking the affected area (8b), and 1 week after treatment with Botulinumtoxin A.
Fig. 9a Fig. 9b Fig. 9c
Fig. 9a-c: A 64 years old patient, 9 years after superficial parotidectomy due to pleomorphic adenoma. One week after treatment no gustatory sweating was detectable by Minor's test.

Discussion and Conclusions

Botulinumtoxin A is highly effective and save in the treatment of gustatory sweating. Intracutaneous injections of Botulinumtoxin A are the treatment of choice in severe cases of Frey's Syndrome.

Bibliography

  1. Bjerkhoel A, Trobbe O: Frey's syndrome: treatment with botulinum toxin. J Laryngol Otol 1997,111, S.839-844
  2. Büning K, Diekmann J :Auftreten und Therapie des Frey-Syndroms nach Parotidektomien. Muench Med Wochenschr 1978, 120, S.991-992
  3. Drobik C, Laskawi R Frey's syndrome: treatment with botulinum toxin. Acta Otolaryngol Stockh 1995, 115, S.459-461
  4. Laage-Hellmann L: Gustatory sweating and flushing after konservativ parotiectomy. Acta Otolaryngol 1957, 48, S.234
  5. Kuettner C, Swennen G, Troeger M, Eckardt A: Incudence of Frey's Syndrome following parotid gland surgery. DZZ 2000, Supp, S.13
  6. Laccourreye O, Akl E, Gutierrez FR, Garcia D, Brasnu D, Bonan B: Recurrent gustatory sweating after intracutaneous injection of botulinum toxin type A: incidence, management, and outcome. Arch Otolaryngol Head Neck Surg 1999, 125, S.283-286
  7. Laskawi R, Drobik C, Schonebeck C: Up-to-date report of botulinum toxin type A treatment in patients with gustatory sweating (Frey's syndrome). Laryngoscope 1998, 108, S. 381-384
  8. Lindner TE, Huber A, Schmid S: Frey's syndrome after parotidectomy: a retrospective and prospective analysis. Laryngoscope 1997, 107, S.1496-1501
  9. Minor V: Ein neues Verfahren zu der klinischen Untersuchung der Schweißabsonderung. Dtsch Z Nervenheilkd 1927,101, S.302-303

This poster was submitted by Dr. Christian Küttner.

Correspondence address:
Dr. Christian Küttner
Medizinische Hochschule Hannover
Mund-Kiefer-Gesichtschirurgie
Carl-Neuberg-Str. 1
30625 Hannover