A 45-year-old woman is admitted to the hospital with a swelling on the side of her face of 2 months' duration. Radiographic examination reveals a parotid gland tumor. An operative procedure is performed in which the tumor is removed from the parotid gland. Three months postoperatively the patient complains that her face sweats profusely when she tastes or smells food, and a diagnosis is made of Frey syndrome (gustatory sweating). Which of the following nerves was most likely injured during the procedure?
Frey syndrome occurs following damage to parasympathetic axons in the auriculotemporal nerve. When these postganglionic cholinergic axons grow peripherally after parotid surgery, they establish synapses upon the cholinergic sweat glands, which are innervated normally only by sympathetic fibers. As the peripheral nerves make new connections, aberrant connections can be formed between the auriculotemporal nerve and other glands (not usually innervated by the auriculotemporal nerve). This results in flushing and sweating in response to the thought, smell, or taste of food, instead of the previous, normal salivary secretion by the parotid gland.
Buccal
Inferior alveolar
Auriculotemporal
Facial
Head & Neck