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A 30-year-old man had a pleomorphic adenoma removed from his left parotid gland. His postoperative course was uncomplicated. Two months later, he noted that his left cheek became wet while he was eating. Believing that saliva was being discharged from the parotidectomy scar, he went to the emergency department. An examination revealed that the wound had healed well: there were no signs of a fistula (arrow, Panel A). Frey's syndrome was suspected, and the lemon test was performed. As soon as the patient ate a lemon wedge, his left auricular and parotic regions became flushed and sweaty (arrow, Panel B), thus confirming the diagnosis. He opted for no treatment. Gustatory sweating, or Frey's syndrome, can develop after a variety of insults to the autonomic nervous system, such as trauma or radiation therapy, but is most commonly encountered as a complication of parotidectomy. The most widely accepted mechanism is aberrant neuronal regeneration resulting in parasympathetic cholinergic innervation of cutaneous sympathetic receptors.
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