Now if you look at this gentleman (apologies to those who don't want to), you'll notice his face isn't quite symmetric. In 2000, he had an operation to remove a malignant melanoma from the left side of his face. Now, suppose (hypothetically) that when this gentleman eats, his left cheek becomes wet. There's no open wound or fistula. When given a lemon to bite down on, his left ear and parotic regions become flushed and sweaty.Challenge: What's the diagnosis?
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1. Who is this person?Image is in the public domain, from Wikipedia.org.
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Hypothetical
This is John McCain. The symptoms described here are "gustatory sweating" or Frey's syndrome. This often results from trauma, radiation, or surgery (parotidectomy) to the area, and the most widely accepted mechanism is aberrant neuronal regulation resulting in parasympathetic cholinergic innervation of cutaneous sympathetic receptors. When the person eats, he sweats.
Sources: NEJM; Wikipedia.
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