The auriculotemporal nerve is a branch of the mandibular nerve that carries postganglionic parasympathetic fibres from the otic ganglion to the parotid gland for secretomotor function, as well as providing sensory innervation to the temple, auricle, and TMJ. Frey syndrome from parotidectomy involves misdirected regrowth of the parasympathetic auriculotemporal nerve fibres into the skin sweat glands, producing gustatory sweating (sweating over the parotid region during eating).
| Origin | Posterior division of the mandibular nerve (V3) |
|---|---|
| Course | Encircles the middle meningeal artery (arises as two roots that bracket the artery then merge), passes behind the TMJ to ascend over the zygomatic arch into the temple |
| Motor |
|
| Sensory |
|
Frey syndrome (gustatory sweating or auriculotemporal nerve syndrome) affects up to 30 percent of patients after superficial parotidectomy from regenerating auriculotemporal parasympathetic fibres inappropriately innervating the overlying skin sweat glands. Botulinum toxin injection into the affected skin is the most effective treatment. The starch-iodine Minor test confirms and maps the distribution of gustatory sweating.
Post-parotidectomy misdirected auriculotemporal nerve regrowth into sweat glands producing gustatory sweating over the cheek region, managed with botulinum toxin injection.
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