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Background: The auriculotemporal nerve is one of the main branches of the mandibular nerve. It provides sensory innervation to the auricle, the scalp in the temporal region, the temporomandibular joint and part of the dura mater, the parasympathetic innervation of the parotid salivary gland, as well as the external surface of the tympanic membrane, and the sympathetic innervation of the sweat glands and of the blood vessels passing through the parotid gland. Its interruption during surgical interventions or trauma can results in its most common disease - Frey's syndrome. This article is an overview and is based on 23 foreign scientific works - articles published in refereed and renowned scientific publications and anatomy atlases by world-renowned and proven specialists in their field. Review Results: The auriculotemporal nerve is a sensory nerve which includes secretory parasympathetic vasomotor sympathetic fibers coming from the otic ganglion. It is a branch of the mandibular nerve (V3). Its five terminal nerve branches are front auricular branches, branches for the external auditory canal, branches for the temporomandibular joint, branches for the parotid gland and superficial temporal branches. Frey's syndrome occurs when the auriculotemporal nerve is cut or injured proximal to the site of separation of the branches for the parotid gland or are severed themselves. The clinical picture characteristic of Frey's syndrome includes redness, sweating, warmth and itching in the area of innervation of the nerve and less often pain. Conclusion: Knowledge of the anatomy of the auriculotemporal nerve and Frey's syndrome are essential for understanding its nature and stand on the basis of its prevention.

Abstract Objectives Frey's syndrome (FS) describes the phenomenon of gustatory sweating and is a cause of significant social embarrassment for sufferers. It has been attributed to aberrant growth of parasympathetic salivatory fibers in the auriculotemporal nerve toward overlying sweat glands. However, the exact mechanism behind this growth is unknown. This review aims to expand and elucidate the theory of aberrant regeneration in FS. Methods A review of the recent literature on nerve regeneration was conducted in order develop further insights into the etiology of both adult onset and pediatric FS. Results Neurturin, a neurotrophic factor released by both salivary and sweat glands, was identified as a possible key player in the etiology of FS. Conclusion Further research into the role of neurturin could help to elucidate the pathogenic mechanisms underlying the condition and might reveal neurturin to be a potential target for pharmacological intervention. Level of Evidence NA (Basic Science Review).

Frey syndrome is a condition of gustatory sweating and hyperemia related to damage of the auriculotemporal nerve. It affects around 80% of patients after parotidectomy. Syndrome may be easily diagnosed with an iodine-starch test, even in patients without symptoms, which are about 20% depending on studies. Authors searched PubMed and Google Scholar using searchterms Frey syndrome, auriculotemporal nerve, greater auricular nerve, tympanic nerve, parotidectomy. We manually searched the references of selected articles for additional relevant articles. We selected articles relevant to a general medicine readership and prioritized systematic reviews, clinical practice guidelines and cases. The literature contains the latest reports on Frey syndrome. Symptoms of Frey syndrome are: redding of the skin due to vasodilatation, excessive sweating or tingling and burning sensation of the cheek skin. Clinicians should pay attention to frey syndrome in patients after parotid gland surgery. Treatment includes botulinum toxin type A most commonly, topical injection of alcohol, scopolamine, glycopyrrolate and less common surgical treatment including transection of auriculotemporal nerve. Frey syndrome is not such a rare disease and should be always considered by clinicians because it may worsen the quality of patients' life.

Frey's syndrome in children is rare and often erroneously attributed to food allergy. A description of a case of Frey's syndrome in a child and a review of the literature is provided. Awareness of this condition is important for the pediatric dentist to avoid unnecessary medical procedures and provide reassurance to the dental team in the setting of this benign condition.

Botulinum toxin type-A (BTX-A) injection for treating chronic migraine (CM) has developed into a new technique covering distinct injection points in the head and neck regions. The postulated analgesic mechanism implies that the injection should be administered to sensory nerves rather than to muscles. This study aimed to determine the topographical site of the auriculotemporal nerve (ATN) and to propose the effective injection points for treating CM. ATNs were investigated on 36 sides of 25 Korean cadavers. The anatomical structures of the ATN were investigated focusing on the temporal region. A right-angle ruler was positioned based on two clearly identifiable orthogonal reference lines based on the canthus and tragus as landmarks, and photographs were taken. The ATN appeared superficially in the anterosuperior region of the tragus. The nerve is located deeper than the superficial temporal artery. And it runs between the artery and the superficial temporal vein. In the superficial layer, it is divided into anterior and posterior divisions. The anterior division runs in a superior direction, while the posterior division runs in front of the ear and the several branches are distributed to the skin. We suggest that the optimal BTX-A injection points for CM are in the temporal region. The first point is about 2 cm anterior and 3 cm superior to two orthogonal reference lines defined based on the tragus and canthus, and the second point is about 4 cm superior to the first point. The third and fourth points are recommended about 2 cm superior to the first point, but respectively 1 cm anterior and posterior to it.

Auriculotemporal nerve (ATN) is a branch of the posterior division of mandibular nerve. It presents two roots at its origin, which encircle the middle meningeal artery. In the present study of thirty hemi-sections of head and neck the roots of the ATN and its relation with middle meningeal artery (MMA) were observed and photographed. The number of roots in these thirty specimens were as follows: Single root – was observed in four specimens, two roots – were observed in twenty two specimens, three roots – were observed in three specimens and five roots – were observed in a single specimen. Since the infratemporal region is filled with the temporomandibular joint (TMJ), the muscles of mastication, important blood vessels and nerves, the variations described in the present study, may enlighten the surgeon towards the possible entrapment of the nerve roots due to the pressure exerted due to dislocation of TMJ or due to hypertrophic masticatory muscles.

Las variaciones en el curso de la arteria maxilar se describen a menudo, con sus relaciones con el músculo pterigoideo lateral. En el presente caso informamos una variación exclusiva en el curso de la arteria maxilar que no fue publicada antes. En un cadáver masculino de 75 años arteria maxilar derecho estaba pasando por el bucle del nervio auriculo-temporal. La arteria meníngea media provenía de la arteria maxilar con un bucle del nervio auriculo-temporal. La arteria maxilar pasaba profunda con respecto al nervio dentario inferior pero superficial al nervio lingual. El conocimiento de estas variaciones es importante para el cirujano y también serviría para explicar la posible participación de estas variaciones en la etiología del dolor mandibular. Variations in the course of the maxillary artery are often described with its relations to the lateral pterygoid muscle. In the present case we report a unique variation in the course of the maxillary artery which was not reported before. In a 75 years old male cadaver the right maxillary artery passed through the loop of the auriculotemporal nerve. The middle meningeal artery was arising from the maxillary artery within the nerve loop of auriculotemporal nerve. Further the maxillary artery passed deep to the inferior alveolar nerve but superficial to the lingual nerve. The knowledge of these variations is important for surgeons and it would also explain the possible involvement of these variations in etiology of the craniomandibular pain.