Treatment of Traumatic Frey Syndrome and Facial Contour Deformity Using a De-Epithelialized Free SCIP Flap: A Case Report

Frey syndrome (FS), or gustatory sweating, is typically characterized by sweating and flushing in the parotid region during eating. While FS most commonly develops after parotidectomy, it has also been reported following traumatic causes such as submandibular gland surgery, radical neck dissection, mandibular condyle fracture, or forceps delivery. The authors present the case of a 58-year-old male who developed FS and a right-sided facial contour deformity 11 months following severe blunt maxillofacial trauma. On the basis of the diagnosis, a de-epithelialized superficial circumflex iliac artery perforator (SCIP) free flap was planned and successfully utilized to simultaneously treat the gustatory sweating and restore facial volume. The patient's complaints of redness and sweating in the preauricular region resolved completely. At the 12-month postoperative follow-up, the patient achieved significant symmetry with the contralateral face. To our knowledge, a free flap has not been previously reported in the English literature for the treatment of established FS. The SCIP flap offers a versatile, reliable, autologous solution that functions as both a barrier to aberrant nerve regeneration and a volume filler for contour correction. The authors believe this case is important as it demonstrates the utility of free flaps in the management of FS.