Frey Syndrome: A Novel Classification System Based on Symptom Severity.

Objective: To evaluate the incidence of Frey syndrome after parotidectomy in adults and children, and to propose a practical classification system to describe the clinical symptoms and management burden of patients with subjective Frey syndrome. Methods: This was a retrospective chart review and patient survey of all individuals who underwent parotidectomy at two quaternary care institutions over a 10-year period (June 2013-June 2023). Patients were identified using CPT codes for parotidectomy procedures, and all age groups were included. Survey data were collected and managed using REDCap. A novel classification scale was developed to describe Frey syndrome severity based on patient-reported symptom burden (Types 1-3). Results: A total of 285 patients (229 adults and 56 children) completed the survey. Symptoms consistent with Frey syndrome were reported in 22.7% of adults and 55.4% of children, with most cases categorized as mild (Type 1: 19.2% of all adults; 42.9% of all pediatric patients). Eight adults (3.5%) and seven pediatric patients (12.5%) required medical or surgical intervention. Conclusion: Frey syndrome is a recognized complication after parotidectomy. It is typically mild and infrequently requires treatment. The proposed classification system provides a practical tool for describing Frey syndrome severity to stratify patients by symptom burden and to evaluate the incidence of bothersome or painful Frey syndrome. Level of Evidence: Level III.