title: The use of botulinum toxin type A in the treatment of Frey and crocodile tears syndromes.
abstract: OBJECTIVE
  We sought to investigate the efficacy of botulinum toxin type A in the treatment of Frey and crocodile tears syndromes. Frey syndrome is a common complication after surgical intervention or injury in the region of the parotid gland. Crocodile tears syndrome is unusual and manifests after facial nerve paralysis and other causes such as head trauma.
  
  
  METHODS
  This was a prospective nonrandomized, nonblinded study. We used botulinum toxin type A for the treatment of 11 patients with gustatory sweating and 2 patients with crocodile tears syndrome.
  
  
  RESULTS
  The follow-up (6 to 23 months) of patients with gustatory sweating syndrome showed complete absence of sweating in the affected regions. One patient had recurrence after 16 months and was retreated successfully. At 1 and 24 weeks after treatment of the patients with the crocodile tears syndrome, the Schirmer test showed a reduction of stimulated lacrimation on the impaired side approaching the normal values of the unaffected side.
  
  
  CONCLUSIONS
  Our study supports the widely accepted aspect that botulinum toxin type A could be the treatment of choice for gustatory sweating syndrome. We also propose the toxin as a valuable treatment for crocodile tears syndrome.
authors.affiliation: Department of Otolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece. dkyrmiz@yahoo.com
authors.forename: Dionysios E
authors.initials: DE
authors.lastname: Kyrmizakis
authors.forename: Aris
authors.initials: A
authors.lastname: Pangalos
authors.forename: Chariton E
authors.initials: CE
authors.lastname: Papadakis
authors.forename: John
authors.initials: J
authors.lastname: Logothetis
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Maroudias
authors.forename: Emmanuel S
authors.initials: ES
authors.lastname: Helidonis
mesh_terms: D000328:Adult; D000368:Aged; D020330:Bell Palsy / Q000150:complications; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006563:Herpes Zoster Ophthalmicus / Q000150:complications; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010307:Parotid Neoplasms / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D013547:Sweating, Gustatory / Q000188:drug therapy*; D013577:Syndrome; D013666:Tears / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A