Tuesday, 20 September 2011

"My face leaks when I eat"


My patient seconds after munching a cheese
sandwich -note the glistening 'sweat'!
(patient consent given for photo)

I've mentioned patient's opening lines before, and this morning's offering was one of the more interesting ones.

Her complaint was that, within seconds of eating,  the sideburn area of the right side of her face  became wet and indeed would drip down the side of her neck.

It transpired that in 1984 she had had a benign growth removed from her right parotid gland. The small scar on her face confirmed that. The previous surgery was the clue to what was going on.

During the healing process after the surgery the nerve supply to the remnant of the parotid gland her re-grown and was now innervating her sweat glands. When I discussed the problem with a local ENT consultant he told me that the problem was previously more common. Surgeons are now aware that this can happen and are careful to insert a layer of fascia between the parotid remnant and the skin to prevent the re-growth of the auriculo-temporal branch of the trigeminal nerve from reaching the sweat glands. The nerves that had once fired off to produce saliva were now stimulating the inappropriate production of sweat!

Apparently it's called Frey's syndrome name after Lucja Frey a Polish female neurologist who sadly died during the Holocaust. It results in gustatory sweating such that even the anticipation of food can produce the 'sweaty face'.

And what to do about it? Well either a powerful deoderant (my patient wasn't keen on that) or Botox injection. Apparently just one of two may lead to long term benefit. Still I have to confirm with my PCT whether the good old NHS will fund it. I would say she deserves it. Who wants to drip sweat on their steak?

As I've said before, it's boring being a GP!


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