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Frey’s syndrome in infancy

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    Here is a diagnosis that will amaze your peers and make you the (temporary) star of the clinical meeting. Have you ever come across Frey’s syndrome (auriculotemporal nerve syndrome) in infancy?

    It is a syndrome with a history; first described by Duphenix in 1757 but rediscovered by Frey in 1923. Mostly seen in adults with problems in or around the parotid gland, it occurs rarely in children and then usually soon after the introduction of solid foods. American and Australian clinicians have recently described eight children who developed symptoms in infancy (Maria Victoria Dizon and colleagues;Archives of Dermatology1997;133:1443-5). That is, they developed the symptom localised facial erythema almost immediately after tasting solid foods and lasting for 30 to 60 minutes. Unlike adults, the children did not exhibit sweating over the affected area of skin. Photographs of two of the children show two areas of erythema, one in the cutaneous distribution of the auriculotemporal nerve in front of the upper part of the pinna, and one in the centre of the cheek, in the area of the maxillary branch of the trigeminal nerve (should it be auriculotemporotrigeminal syndrome?). It is said that the flushing often diminishes with time; it did so before the age of 5 years in three of six children followed up in this series. Two of the eight children had bilateral flushing. The condition in infants is usually attributed to forceps injury, and six of the eight had forceps delivery. Treatment is unnecessary.

    I’m not fond of telephone diagnosis but perhaps you could add this to your list of conditions that could be diagnosed that way.