DermNet provides Google Translate, a free machine translation service. Note that this may not provide an exact translation in all languages

Auriculotemporal syndrome

Authors: Matthew James Verheyden, Medical Student University of Notre Dame Australia, Sydney, NSW, Australia; Claudia Hadlow, Medical Student University of Notre Dame Australia, Sydney, NSW, Australia; Dr Tevi Wain, Consultant Dermatologist, The Skin Hospital, Westmead, NSW, Australia. DermNet NZ Editor in Chief: Adjunct A/Prof. Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. November 2019.

What is the auriculotemporal syndrome?

The auriculotemporal syndrome is characterised by sweating, flushing, and warming over the preauricular area (the front of the ear) and temporal areas (the region of the face behind the eyes) in response to a gustatory stimulus [1].  

Lucja Frey, a Polish physician and neurologist, first described the auriculotemporal syndrome in 1923, leading to the alternative name, Frey syndrome [2]. It is also known as gustatory hyperhidrosis, Baillarger syndrome, and Dupuy syndrome.

Who gets auriculotemporal syndrome?

The precise incidence of the auriculotemporal syndrome is unknown [3]. Patients often underreport the incidence due to subclinical symptoms [4].

The auriculotemporal syndrome most frequently occurs as a complication of surgical removal of the parotid gland (parotidectomy) with estimated rates of 4–96% [5,6,7]. Males and females are affected equally.

Infrequently, the auriculotemporal syndrome is observed in infants and children following forceps-assisted delivery [8]. A rare familial, bilateral auriculotemporal syndrome without trauma has been reported [9].

What causes the auriculotemporal syndrome?

The cause of the syndrome involves aberrant regeneration of the auriculotemporal branch of the mandibular nerve following injury, infection, or surgery in the vicinity of the parotid gland (the salivary gland in front of the ears) [3]. 

The auriculotemporal nerve ordinarily provides sympathetic innervation to the sweat glands and parasympathetic innervation to the salivary gland. 

With trauma, the parasympathetic fibres may become misdirected and regenerate along the pathway of the sympathetic nerve establishing a connection with the sweat glands and blood vessels of the skin [10]. Thus, instead of saliva production, sweating and flushing occur with a gustatory stimulus [11]. 

Damage to the ganglions within the cervical sympathetic chain may also cause auriculotemporal syndrome [12]. 

What are the clinical features of the auriculotemporal syndrome? 

Symptoms are often apparent within the first year after parotidectomy. However, delayed recognition is not unusual [13]. Once symptoms commence, there is often a gradual increase in severity for several months, and they then remain relatively constant thereafter.

Symptoms are triggered by chewing (gustatory sweating) or the sight, smell, or thought of food. They include:

  • Flushing, warmth, and excessive sweating (localised hyperhidrosis) of ipsilateral facial skin [11]
  • A burning sensation, itching, or pain in the distribution of the auriculotemporal nerve [1].

Symptoms are variable in severity ranging from barely perceivable to rather troublesome; 15% of patients rate their symptoms as severe and are especially concerned by excessive sweating.

What are the complications of the auriculotemporal syndrome?

The auriculotemporal syndrome is associated with significant psychosocial morbidity [1, 14]. See Psychosocial factors in dermatology.

How is the auriculotemporal syndrome diagnosed?

The diagnosis of the auriculotemporal syndrome is based on the recognition of characteristic symptoms [1]. 

The Minor starch-iodine test can be used to confirm hyperhidrosis [15]. Iodine solution is applied to the affected area, allowed to dry, and is followed by the application of starch. Subsequently, the patient is given a stimulus to promote salivation, often an acidic food. Marked discolouration in the affected region indicates disproportionate sweating.

What is the differential diagnosis for auriculotemporal syndrome?

Other conditions that may be considered in a patient with symptoms suggesting auriculotemporal syndrome include:

What is the treatment for the auriculotemporal syndrome?

Treatment of auriculotemporal syndrome is targeted at symptom control [1]. Patients with mild symptoms do not require treatment.

A Cochrane review was unable to establish the efficacy and safety of various treatments for the auriculotemporal syndrome, due to an absence of randomised control trials [18].

Pharmacological options to treat troublesome auriculotemporal syndrome include:

Surgical management is reserved for severe and refractory auriculotemporal syndrome and may involve:

  • Intracranial glossopharyngeal nerve section
  • Tympanic neurectomy
  • Musculofascial flap interposition [1,26].

What is the outcome for the auriculotemporal syndrome?

The auriculotemporal syndrome tends to be benign in infants with spontaneous resolution occurring in the majority [27]. 

Spontaneous resolution occurs in 5% of adults with the auriculotemporal syndrome. The pharmacological treatments described above generally control symptoms short term. Repeated injections of botulinum toxin A are required every 4–6 months, or earlier if symptoms recur [22,28]. Rarely, refractory cases require surgical management [26].

See smartphone apps to check your skin.
[Sponsored content]


Related information



  1. Motz KM, Kim YJ. Auriculotemporal Syndrome (Frey Syndrome). Otolaryngol Clin North Am 2016; 49: 501–9. PubMed Central
  2. Frey L. Le syndrome du nerf auriculo-temporal. Rev Neurol 1923; 2: 97–104. Available at:
  3. O’Neill JP, Condron C, Curran A, Walsh M. Lucja Frey — historical relevance and syndrome review. Surgeon 2008; 6: 178–81. PubMed
  4. Neumann A, Rosenberger D, Vorsprach O, Dazert S. [The incidence of Frey syndrome following parotidectomy: results of a survey and follow-up]. HNO 2011; 59: 173–8. PubMed
  5. Lee CC, Chan RC, Chan JY. Predictors for Frey Syndrome Development After Parotidectomy. Ann Plast Surg 2017; 79: 39–41. PubMed
  6. Linder TE, Huber A, Schmid S. Frey's syndrome after parotidectomy: a retrospective and prospective analysis. Laryngoscope 1997; 107: 1497–501. PubMed
  7. Guntinas-Lichius O, Gabriel B, Klussmann JP. Risk of facial palsy and severe Frey's syndrome after conservative parotidectomy for benign disease: analysis of 610 operations. Acta Oto-Laryngologica 2006; 126: 1104–9. PubMed
  8. Tillman BN, Lesperance MM, Brinkmeier JV. Infantile Frey's syndrome. Int J Pediatr Otorhinolaryngol 2015; 79: 929–31. PubMed
  9. Sethuraman G, Mancini AJ. Familial auriculotemporal nerve (Frey) syndrome. Pediatr Dermatol 2009; 26: 302–5. PubMed
  10. Singh N, Kohli M, Kohli H. Innovative Technique to Reduce Incidence of Frey's Syndrome after Parotid Surgery. American Surg 2011; 77: 351–4. PubMed
  11. de Bree R, van der Waal I, Leemans CR. Management of frey syndrome. Head & Neck 2007; 29: 773–8. PubMed
  12. Laskawi R, Ellies M Fau - Rodel R, Rodel R Fau - Schoenebeck C, Schoenebeck C. Gustatory sweating: clinical implications and etiologic aspects. J Oral Maxillofac Surg 1999; 57: 642–8. PubMed
  13. Bakke M, Max Thorsen N, Bardow A, Dalager T, Eckhart Thomsen C, Regeur L. Treatment of gustatory sweating with low-dose botulinum toxin A: a case report. Acta Odontologica Scandinavica 2006; 64: 129–33. PubMed
  14. Hartl DM, Julieron M, LeRidant AM, Janot F, Marandas P, Travagli JP. Botulinum toxin A for quality of life improvement in post-parotidectomy gustatory sweating (Frey's syndrome). J Laryngol Otol 2008; 122: 1100–4. PubMed
  15. Arad A, Blitzer A. Botulinum toxin in the treatment of autonomic nervous system disorders. Operative Techniques in Otolaryngology-Head and Neck Surgery 2004; 15: 118–21. Journal
  16. Friedman JH. Hemifacial gustatory sweating due to Pancoast's tumor. The Am J Med 1987; 82: 1269–71. PubMed
  17. Giovannini-Chami L, Blanc S, Albertini M, Bourrier T. Frey's syndrome: differential diagnosis of food allergy. Archives of Disease in Childhood 2014; 99: 457. Journal
  18. Li C, Wu F, Zhang Q, Gao Q, Shi Z, Li L. Interventions for the treatment of Frey's syndrome. Cochrane Database Syst Rev 2015; 3: CD009959. PubMed
  19. Bjerkhoel A, Trobbe O. Frey's syndrome: treatment with botulinum toxin. J Laryngol Otol 1997; 111: 839–44. PubMed
  20. Steffen A, Rotter N, König IR, Wollenberg B. Botulinum toxin for Frey's syndrome: a closer look at different treatment responses. J Laryngol Otol 2012; 126: 185–9. PubMed
  21. Jansen S, Jerowski M, Ludwig L, Fischer-Krall E, Beutner D, Grosheva M. Botulinum toxin therapy in Frey's syndrome: a retrospective study of 440 treatments in 100 patients. Clinical Otolaryngology 2017; 42: 295–300. PubMed
  22. Beerens AJ, Snow GB. Botulinum toxin A in the treatment of patients with Frey syndrome. Br J Surg 2002; 89: 116–9. PubMed
  23. Urman JD, Bobrove AM. Diabetic gustatory sweating successfully treated with topical glycopyrrolate: report of a case and review of the literature. JAMA Internal Medicine 1999; 159: 877–8. PubMed
  24. Shaw JE, Abbott CA, Tindle K, Hollis S, Boulton AJM. A randomised controlled trial of topical glycopyrrolate, the first specific treatment for diabetic gustatory sweating. Diabetologia 1997; 40: 299–301. PubMed
  25. Hays LL. The Frey syndrome: A review and double blind evaluation of the topical use of a new anticholinergic agent. The Laryngoscope 1978; 88: 1796–824. PubMed
  26. Li C, Yang X, Pan J, Shi Z, Li L. Graft for Prevention of Frey Syndrome After Parotidectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Oral Maxillofac Surg 2013; 71: 419–27. PubMed
  27. Dizon MVC, Fischer G, Jopp-McKay A, Treadwell PW, Paller AS. Localized facial flushing in infancy: auriculotemporal nerve (Frey) syndrome. Arch Dermatol 1997; 133: 1143–5. PubMed
  28. de Bree R, Duyndam JE, Kuik DJ, Leemans CR. Repeated botulinum toxin type A injections to treat patients with Frey syndrome. Arch Otolaryngol Head Neck Surg 2009; 135: 287–90. PubMed

On DermNet NZ

Other websites

Books about skin diseases