Frey Syndrome and the Temporomandibular Joint
While Frey syndrome is a frequent outcome following a parotidectomy , the risk of developing it with the preauricular approach to the temporomandibular joint is far less. In 1982, Dolwick and Kretzschmar studied the prevalence of various postoperative complications following the surgical treatment of internal derangement of the temporomandibular joint through the preauricular and perimeatal approaches . Fifty-six patients were included in the study with all patients developing paresthesia over the distribution of the auriculotemporal nerve, but no cases of gustatory sweating were reported. A similar study by Kryshtalsky and Weinberg several years later determined that three out of 16 patients demonstrated a positive Minor’s starch iodine test after having undergone a similar preauricular approach . Interestingly none of the affected patients admitted to symptomatic gustatory sweating, erythema, or pain in the region.
The previously mentioned studies utilized a preauricular incision that extended inferiorly to the level of the tragus and superiorly in an oblique fashion into the hairline. This larger incision allowed for extensive anterior reflection of the parotid tissues. In 1991, Swanson and Laskin performed a retrospective investigation of 47 temporomandibular joint surgeries using a conservative, straight preauricular incision without the oblique extension and aggressive reflection of the anterior parotid tissues. Twenty-eight patients (47 TMJs) were evaluated with none reporting any subjective gustatory sweating or having a positive Minor’s starch iodine test . It remains unclear whether a conservative incision when accessing the temporomandibular joint reduces the likelihood of Frey syndrome.