1/4. Cutaneous sensory stimulation leading to facial flushing and release of calcitonin gene-related peptide.A patient is described with a 17-year history of intractable left-sided facial pain. The pain occurred daily in 5 sec spasms to a maximum of one every 2-3 min and was restricted to the left upper face. It was associated with rhinorrhoea on the left and often with ipsilateral facial flushing. Conventional therapy, including carbamazepine, baclofen and three posterior fossa explorations, had not provided lasting relief. Local facial stimulation by tapping a painful trigger point led to both pain and flushing of the face ipsilaterally. During this flushing, blood was collected and assayed using sensitive radioimmunoassays for several neuropeptides (neuropeptide y, substance p, vasoactive intestinal polypeptide and calcitonin gene-related peptide). A marked (119%) increase in calcitonin gene-related peptide was noted in the external jugular vein blood ipsilaterally during the flushing with no change in the other peptides measured. To quantitate the effect of calcitonin gene-related peptide on human extracranial vessels, standard pharmacological procedures were used to examine the potency of the peptide as a vasodilator of human facial artery. The IC50 of calcitonin gene-related peptide for the prostaglandin F2 alpha-precontracted human facial artery was 10(-9) mol/l. The relevance of these observations to the clinical problem of migraine is considered.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/4. Postherpetic gustatory flushing and sweating.An 11-year-old girl who had suffered right facial herpes zoster at the age of 6 years was left with anesthetic scars in the distribution of the third division of the trigeminal nerve. Since then, certain tastes provoked flushing and sweating localized to the scarred areas, lasting for 10 to 15 minutes after a latency of a few seconds. The response was evoked most readily from the ipsilateral posterior section of the tongue and was virtually abolished by local administration of anesthesia to the tongue. It remained unaltered after blockade of the sphenopalatine and stellate ganglia but was diminished by blockade of the mandibular nerve. Thermoregulatory sweating and flushing were diminished in the scarred areas. Patchy destruction of sympathetic fibers, which are known to accompany peripheral trigeminal nerve branches, and reinnervation of the affected areas by parasympathetic fibers that normally mediate salivation may explain the phenomenon. It is thus analogous to the gustatory flushing and sweating that may follow damage to the auriculotemporal nerve in the region of the parotid gland (Frey's syndrome).- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/4. Localized facial flushing in infancy. Auriculotemporal nerve (Frey) syndrome.BACKGROUND: patients with auriculotemporal nerve syndrome (Frey syndrome) have facial flushing, sweating, or both localized to the distribution of the auriculotemporal nerve that occurs in response to gustatory stimuli. In adults, the syndrome usually results from surgical injury or trauma to the parotid gland. The condition is rare in infants, but usually manifests during infancy with the introduction of solid food, thus leading to the misdiagnosis of food allergy by physicians unfamiliar with the syndrome. OBSERVATIONS: We describe 8 children with auriculotemporal nerve syndrome who manifested with flushing only. The reaction was erroneously attributed to food allergy in most cases. Six of the 8 patients were delivered with forceps assistance. The remaining 2 patients, with disease onset during the first 3 months of life, had bilateral involvement without known trauma. CONCLUSIONS: Auriculotemporal nerve syndrome may manifest during infancy as flushing with eating food. In contrast to the syndrome in adults, gustatory sweating is rarely associated. The known use of forceps to assist in the delivery of at least 14 of the 28 previously reported pediatric cases and in 6 of our 8 patients suggests that trauma to the parotid region may be responsible for the condition in most infants, as it is in adults. Auriculotemporal nerve syndrome in infancy should be recognized as a benign condition that often resolves spontaneously. Treatment is ineffective and unnecessary.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/4. Frey's syndrome following submandibular gland excision: an unusual postoperative complication.Gustatory sweating and flushing, or Frey's syndrome, is a fairly common complication following surgery or injury to the parotid gland and is thought to be caused by aberrant nerve regeneration. A similar condition has been reported in the literature following surgery to the submandibular region. Since this was first described in 1934, only 7 subsequent cases of submandibular sweating and flushing have been reported. We present a case of a 52-year-old female who underwent excision of the left submandibular gland as a result of chronic sialadenitis. Twelve months following surgery, symptoms indicative of Frey's syndrome were experienced in the operative region. A review of the aetiology and treatment of the condition is described.- - - - - - - - - - ranking = 6keywords = gland (Clic here for more details about this article) |