Management of Frey's with Botulinum Toxin: Case Report and Literature Review

Keywords: Frey's syndrome; auriculotemporal syndrome; parotidectomy; gustatory sweating; botulinum toxin type A; case report; minimally invasive treatment; facial hyperhidrosis. Abstract: Frey's syndrome, or auriculotemporal syndrome, is an uncommon complication resulting from aberrant nerve regeneration after parotidectomy or trauma in the parotid region. It manifests with gustatory sweating, erythema, and warmth in the preauricular or temporal skin during meals. Its incidence ranges between 12–25% in patients undergoing parotidectomy. Botulinum toxin type A has emerged as a minimally invasive, safe, and effective therapeutic alternative. We report the case of a 53-year-old female with a history of superficial right parotidectomy for papillary cystadenoma lymphomatosum. She developed erythema, warmth, and hyperhidrosis in the preauricular region when consuming citrus and spicy foods. Intradermal injections of botulinum toxin type A were applied, with a total dose of approximately 50 units distributed in the affected area. Clinical follow-up at 12 days, 1 month, 2 months, and 3 months showed complete remission of symptoms, without local or systemic adverse effects. Botulinum toxin type A provides a reproducible and safe therapeutic option in the management of Frey's syndrome. Compared with surgical or topical treatments, it offers rapid symptom resolution, minimal morbidity, and improved quality of life. This case supports its role as the treatment of choice for post-parotidectomy Frey's syndrome.