Skin Flap Elevation Technique May Affect Extent of Gustatory Sweating in Frey Syndrome: Study

A new study published in the journal of BMC Surgery found that the incidence of Frey syndrome was similar across surgical techniques. However, monopolar cautery showed a trend toward a greater extent of gustatory sweating. Among patients with a positive starch–iodine test, variations in the extent of gustatory sweating were noted depending on the skin flap elevation technique.

These observations should be interpreted descriptively, as they do not establish causality or indicate differences in clinical severity. Thus, the findings suggest that skin flap elevation techniques may influence the extent of subclinical gustatory sweating rather than the clinical incidence or severity of Frey syndrome.

Frey syndrome is a well-recognized long-term complication following superficial parotidectomy. The condition is characterized by sweating and flushing of the cheek during eating, caused by misdirected nerve regeneration after surgery. Despite its reported prevalence which varies widely depending on diagnostic methods and follow-up duration, this research largely focused on whether the syndrome occurs, rather than how surgical techniques might affect its severity.

This study followed 30 adult patients who underwent superficial parotidectomy for benign parotid gland lesions from March 2021 to March 2023. Participants had a median age of 59 years, and 70% were male. This research assessed patients approximately 12 months after surgery using the starch–iodine test to visually identify areas of gustatory sweating.

The results showed that 43.3% of patients tested positive for Frey syndrome using the starch–iodine test. However, only 6.7% reported obvious clinical symptoms, which confirms previous findings that many cases remain subclinical and undetected without formal testing.

Patients were divided into two groups based on the technique used to elevate the surgical skin flap: cold scalpel or monopolar cautery. The rate of positive test results was not significantly different between the two groups, with 35.7% positivity in the cold scalpel group and 50% in the monopolar cautery group. Those treated with monopolar cautery showed a larger median area of sweating which was around 5.85 square centimeters when compared to 8.00 square centimeters in the cold scalpel group.

Despite the difference not reaching statistical significance due to the small sample size, the analysis indicated a moderate effect size which suggests a potentially meaningful trend. Overall, the results point toward a possible influence of surgical approach on the extent of subclinical gustatory sweating rather than on the clinical incidence of Frey syndrome.

Source:

Karataş, M., Durgut, O., Solmaz, F., Dikici, O., Gençay, S., İnan, H. C., & Cangül, B. (2026). Impact of skin flap elevation technique on the extent of gustatory sweating after superficial parotidectomy: a comparative study. BMC Surgery. https://doi.org/10.1186/s12893-026-03614-8