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PubMed1978

Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis.

An endoscopic technique is described for thoracic sympathectomy. After establishment of a pneumothorax, the thoracoscope is introduced into the pleural cavity. The telescope is equipped with a wire electrode, a grasping forceps, and a suction coagulation probe for endoscopic electroresection of the sympathetic trunk. In 63 patients, 124 endoscopic sympathectomies were performed. All patients were relieved of sweating in the hands; 18.6% still had some perspiration of the axilla. Side effects of thoracic sympathectomy were compensatory and gustatory sweating that, in four patients, were more embarrassing than the original form of hyperhidrosis. Fifty-five patients were highly satisfied with the result of endoscopic sympathectomy, which is considered the appropriate minor procedure for the treatment of upper limb hyperhidrosis, causing minimal discomfort to the patient and almost invisible scars.

Adolescent↗
PubMed2004

Sternocleidomastoid muscle flap preventing Frey syndrome following parotidectomy.

Frey syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in an attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid muscle (SCM) flap, have been used to prevent this condition. The purpose of this study was to evaluate the impact of using this flap on Frey syndrome. A series of 138 patients who underwent subtotal or total parotidectomy from January 1995 to December 2001 were divided into two groups. One group had an SCM flap reconstruction (n = 24), and the other group did not (n = 19). A subjective clinical questionnaire and the objective Minor's starch iodine test were used to evaluate the incidence of this syndrome. The postoperative period varied from 12 to 90 months. The frequency exact test of Fisher and the nonparametric test of Mann-Whitney were applied. The association with the absence of sweating and the presence of the SCM flap was significant (p = 0.0002). There was no association with flushing or pain and the flap. There was a significant association with the starch iodine test and the presence of the flap (p = 0.0016). The only significant association of the epidemiologic and clinical characterization of the patients with a negative or positive Minor's test was between sweating and a positive Minor's test (p = 0.0001). The only significant aspect in the diagnosis of Frey syndrome is gustatory sweating. There is a significant association with a negative Minor's test and the presence of the SCM flap and with sweating and a positive Minor's test. The SCM flap is an efficient method for preventing Frey syndrome following parotidectomy.

Aged↗
PubMed1997

Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.

OBJECTIVE: To assess the complications in a group of patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. The extraordinarily high incidence of postoperative compensatory hyperhidrosis in our series is stressed and explained. METHODS: The retrospective study included chart reviews and outpatient assessments. Seventy-two patients underwent T2 or T2-T3 endoscopic sympathectomy for primary palmar hyperhidrosis. Patients' hyperhidrosis severity, precipitating factors, postoperative complications, surgical results, and satisfaction were assessed. Severity of palmar hyperhidrosis and compensatory hyperhidrosis was classified by two grading scales. RESULTS: The success rate of sympathectomy was 93%. All patients except one suffered from compensatory sweating, which was the main cause of patients' dissatisfaction postoperatively. Seventeen percent of the patients (12 of 72 patients) experienced new symptoms of gustatory sweating (facial sweating associated with eating). Twenty-one patients experienced other complications, including pneumothorax, Horner's syndrome, nasal obstruction, and intercostal neuralgia. CONCLUSION: Transthoracic endoscopic sympathectomy is an effective and simple modality to treat palmar hyperhidrosis. However, all patients need to be warned of the common complications, particularly compensatory hyperhidrosis, before surgery.

Adult↗
PubMed1990

Auriculotemporal syndrome (Frey's syndrome) presenting as tic douloureux. Report of two cases.

Two cases of auriculotemporal nerve syndrome (Frey's syndrome) presenting as trigeminal tic douloureux are reported. This condition, characterized by gustatory sweating and facial hyperemia, is occasionally associated with pain, which is usually described as aching or burning, and long-lasting. In these two cases, however, a tantalizing gustatory pain occurred in excruciating brief paroxysms. The pathophysiology of the syndrome, with particular reference to pain, and possible treatment modalities are discussed.

Aged↗
PubMed2005

Frey's syndrome after condylar fracture: case report.

Frey's syndrome is the occurrence of hyperesthesia, flushing and warmth or sweating over the distribution of the auriculotemporal nerve and/or greater auricular nerve while eating foods that produce a strong salivary stimulus. Frey's syndrome is also known as auriculotemporal syndrome and gustatory sweating. We present a case of Frey's syndrome after a condylar fracture and its treatment by internal rigid fixation. A review of the literature is provided along with mention of a simple test (Minor's test) that can help in the diagnosis of this syndrome.

Adult↗
PubMed2006

Thoracoscopic sympathectomy for Raynaud's phenomenon--a long term follow-up study.

OBJECTIVES: To assess the long term results of thoracoscopic sympathectomy for Raynaud's phenomenon. DESIGN, MATERIALS AND METHODS: A retrospective study of 34 consecutive patients who were treated for Raynaud's phenomenon by thoracoscopic sympathectomy from 1996 to 2005. Eight patients presented with ulcerations of the digits and 10 had severe ischaemia without ulcerations. The hospital records were retrieved and questionnaires were mailed to the patients for follow-up. RESULTS: The questionnaire was answered by 91% of patients after a median follow-up time of 40 months. An immediate effect was seen in 83% of the patients but symptoms recurred in 60% during the follow-up period. Compensatory sweating occurred in 63 and 30% reported gustatory sweating. Thirteen patients (43%) regretted having the operation. CONCLUSION: The majority of patients with Raynaud's phenomenon have an excellent immediate effect from thoracoscopic sympathectomy and one third achieve a long lasting effect. Side effects are frequent. We now only use thoracoscopic sympathectomy in severe cases of Raynaud's phenomenon.

Adult↗
PubMed2004

Facelift approach with a hybrid SMAS rotation advancement flap in parotidectomy for prevention of scars and contour deficiency affecting the neck and sweat secretion of the cheek.

Tumors of the parotid gland are generally be removed by the standard external bayonet-shaped incision approach without reconstruction of the parotid bed. The disadvantage of this approach is frequently an obvious scar affecting the neck and a conspicuous hollow contour around the angle of the mandible in addition to a sweat secretion of the cheek (Frey syndrome). To overcome these disadvantages, especially the facial depressed deformity subsequent to parotid surgery, during the last several years, the author has concentrated on facelift incision used in combination with a hybrid SMAS rotation advancement flap. Twelve patients (7 male; 5 female) ranging in age from 32 to 73 years (mean age, 57.8 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine-needle cytology result. Parotidectomy was performed using the modified facelift incision in conjunction with the rotation advancement hybrid SMAS flap. All patients were followed up every 3 months during the first year. During follow-up, the patients were specifically asked about their satisfaction with their postoperative appearance and whether they would consent to the operation again. The vascularized hybrid vicryl mesh/SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy and prevents the gustatory sweating. There are no drawbacks to the use of the modified facelift incision to remove tumors of the parotid gland.

Adenoma, Pleomorphic↗
PubMed1983

A critical level of diabetic autonomic neuropathy.

Diabetic autonomic neuropathy was expressed quantitatively using the coefficient of variation of R-R intervals (CVR-R) in ECG and its critical level where diabetics were plagued with various symptoms was investigated. The subjects were 58 diabetics under the age of 40 years. ECGs were recorded in the resting supine position and the degree of autonomic neuropathy was expressed as CVR-R by processing 100 consecutive R-R intervals. Symptoms caused by diabetic autonomic neuropathy were determined using a questionnaire. CVR-R were 1.10 +/- 0.34% (mean +/- SD) and 4.31 +/- 2.01% in patients with and without orthostatic hypotension respectively, the former being significantly lower. CVR-R were 1.30 +/- 0.88% and 3.81 +/- 1.31% in those with and without impotence respectively, the former being significantly lower. CVR-R were 0.80 +/- 0.14% and 3.85 +/- 2.17% in those with and without diabetic diarrhea respectively, the former being significantly lower. Concerning sweating abnormality CVR-R were significantly reduced in subjects exhibiting gustatory sweating (1.52 +/- 0.74%) and hypohidrosis (2.26 +/- 1.44%) when compared to those without these symptoms. From the results obtained, a CVR-R of 2% can be considered as the critical level which determines whether symptoms due to diabetic autonomic neuropathy will appear or not.

Adolescent↗
PubMed2006

Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating.

BACKGROUND: Compensatory sweating is noted frequently after sympathectomy and may be difficult to control in some patients. This prospective trial was projected to measure the impact of limited denervation on compensatory sweating while performing endoscopic thoracic sympathectomy. METHODS: One hundred seventy-eight patients (127 female and 51 male) with severe primary hyperhidrosis unsuccessfully treated by conservative means entered the study. Group A was treated with sympathectomy from T2 to T4. In group B sympathectomy was performed from T3 to T5. Physical condition was measured after 1, 6, and 24 months by means of the SF-36 Health Survey Test. RESULTS: Evaluation rate was 94.9%. Horner's syndrome was not detected, recurrence rate was 0.6%, and rate of persistent pneumothorax was 2.3%. Compensatory sweating was reported with 17.1% in group A and diminished to 4.9% in group B. Gustatory sweating was comparable in both groups (4.3% versus 4.9%). Satisfaction rate was 97% in patients with palmar hyperhidrosis, 95% for axillary hyperhidrosis, and 87% for facial hyperhidrosis. Discomfort originating from compensatory sweating was less than symptoms from primary hyperhidrosis 24 months after endoscopic thoracic sympathectomy in more than 90%. Only 7.1% of the entire group was not satisfied. CONCLUSIONS: Our study demonstrates that limiting denervation beyond T2 ganglion offers good clinical results in axillary as well as palmar hyperhidrosis and may reduce the risk for compensatory sweating. In women, reduction was as high as 75% and in men, near 50%. Our impression is that severe compensatory sweating and the majority of stellate ganglion lesions occur as a result of starting sympathectomy at level T2.

Adult↗
PubMed1987

Postherpetic gustatory flushing and sweating.

An 11-year-old girl who had suffered right facial herpes zoster at the age of 6 years was left with anesthetic scars in the distribution of the third division of the trigeminal nerve. Since then, certain tastes provoked flushing and sweating localized to the scarred areas, lasting for 10 to 15 minutes after a latency of a few seconds. The response was evoked most readily from the ipsilateral posterior section of the tongue and was virtually abolished by local administration of anesthesia to the tongue. It remained unaltered after blockade of the sphenopalatine and stellate ganglia but was diminished by blockade of the mandibular nerve. Thermoregulatory sweating and flushing were diminished in the scarred areas. Patchy destruction of sympathetic fibers, which are known to accompany peripheral trigeminal nerve branches, and reinnervation of the affected areas by parasympathetic fibers that normally mediate salivation may explain the phenomenon. It is thus analogous to the gustatory flushing and sweating that may follow damage to the auriculotemporal nerve in the region of the parotid gland (Frey's syndrome).

Child↗
PubMed2000

[Endoscopic sympathectomy for palmar and plantar hyperhidrosis: results in 107 patients].

INTRODUCTION: Transthoracic endoscopic sympathectomy for palmar hyperhidrosis is a safe and effective method. However, no radical and definite treatment exists for plantar hyperhidrosis. We report our experience, immediate post-operative and mid-term results after transthoracic and lumbar endoscopic sympathectomy for palmar and plantar hyperhidrosis. PATIENTS AND METHODS: One hundred and seven of 117 patients cured between January 94 and December 98, answered a questionnaire regarding their past history, the early post-operative results, side effects and complications caused by the operation and mid-term results with particular emphasis on patient satisfaction. RESULTS: Seventy-eight thoracic and lumbar endoscopic sympathectomies and 125 thoracic endoscopic sympathectomies were performed. The patients were 30 men (median age 30 years) and 77 women (median age 26 years). Only women underwent lumbar endoscopic sympathectomy because of risk of retrograde ejaculation. No severe complications were noted. The success rate was 96 p. 100 for palmar hyperhidrosis and 98,5 p. 100 for plantar hyperhidrosis. No recurrences were noted in 97 p. 100 of the patients with median follow-up of 28 months. The main side effect was compensatory sweating which was the reason for dissatisfaction for 5 p. 100 of the patients. Cutaneous dryness and gustatory sweating were also described. However, 95 p. 100 of the patients were "satisfied" or "very satisfied". CONCLUSION: Our experience proved that lumbar endoscopic sympathectomy is as safe and effective for treatment of plantar hyperhidrosis, as thoracic endoscopic sympathectomy for palmar hyperhidrosis.

Adolescent↗
PubMed1988

Harlequin syndrome: the sudden onset of unilateral flushing and sweating.

Facial flushing and sweating were investigated in five patients who complained of the sudden onset of unilateral facial flushing in hot weather or when exercising vigorously. One patient probably suffered a brainstem infarct at the time that the unilateral flush was first noticed, and was left with a subtle Horner's syndrome on the side opposite to the flush. The other four had no other neurological symptoms and no ocular signs of Horner's syndrome. Thermal and emotional flushing and sweating were found to be impaired on the non-flushing side of the forehead in all five patients whereas gustatory sweating and flushing were increased on that side in four of the five patients, a combination of signs indicating a deficit of the second sympathetic neuron at the level of the third thoracic segment. CT and MRI of this area failed to disclose a structural lesion but latency from stimulation of the motor cortex and thoracic spinal cord to the third intercostal muscle was delayed on the non-flushing side in one patient. The complaint of unilateral flushing and sweating was abolished in one patient by ipsilateral stellate ganglionectomy. The unilateral facial flushing and sweating induced by heat in all five patients was thus a normal or excessive response by an intact sympathetic pathway, the other side failing to respond because of a sympathetic deficit. The onset in the four cases of peripheral origin followed strenuous exertion, which suggested that an anterior radicular artery may have become occluded at the third thoracic segment during torsion of the thoracic spine.

Adult↗
PubMed2003

Experience with limited endoscopic thoracic sympathetic block for hyperhidrosis and facial blushing.

Endoscopic thoracic sympathetic block (ESB) has recently become a popular modification of sympathetic surgery, as it offers the potential chance of reversibility. In order to reduce side effects such as compensatory sweating limited ESB at the levels of the T2, T3 or T4 ganglia has been recommended (Lin/Telaranta classification). We present our experience and initial results with this technique. From 6/2001 to 2/2003, 184 ESB procedures were performed in 94 patients. ESB4 was carried out in 53 patients for hyperhidrosis (HH) of the upper limb. In 23 patients ESB3 was performed for craniofacial HH and 18 patients suffering from facial blushing were treated by ESB2. Median follow-up was 5.2-7.5 months.Success rates were similar (~100%) in all groups. Compensatory sweating was found in 25% in the ESB3 compared to 12.5 % in the ESB2 and 8.5 % in the ESB4 group (p < 0.05). Gustatory sweating did not differ significantly between the groups (6.3 % in ESB2, 5% in ESB3 and 2.1 % in ESB4 group). Five patients were reoperated in the ESB3 group (3 because of a side-difference of the effect in the face, 1 patient due to incomplete Horner's syndrome and 1 due to massive compensatory sweating). In the ESB4 group all patients were satisfied with the outcome, whereas in the ESB2 group 6.3% and in the ESB3 group 13.9% were partly satisfied. Limited sympathetic surgery offers comparably high success and satisfaction rates along with a low rate of side effects.

Adaptation, Physiological↗
PubMed2000

Botulinum toxin for treatment of craniofacial hyperhidrosis.

The effect of botulinum toxin A (BTX) was studied on 12 patients with idiopathic craniofacial hyperhidrosis. After confirming the diagnosis by Minor's iodine starch test we first treated one-half of the forehead with an injection of 2.5-4 ng BTX (Dysport) equidistantly intracutaneously. After 4 weeks we assessed the efficacy by another Minor's iodine starch test and then treated the other half. Another 4 weeks later a standardized telephone interview was carried out. After 1-7 days the craniofacial sweating in the area injected had completely ceased in 11 patients and was mildly reduced in the remaining one. The efficacy was confirmed by repeated Minor's iodine starch tests. Mild weakness of frowning was the only side effect, lasting 1-12 weeks and completely resolving in all patients. Although sweating has not yet recurred in most patients at follow-up periods up to 27 months, one patient had a relapse 9 months after treatment. Following reports on palmar and axillary hyperhidrosis and gustatory sweating (Frey's syndrome) this is apparently the first report on the use of BTX in the treatment of idiopathic craniofacial hyperhidrosis. BTX seems a promising new treatment for localized hyperhidrosis.

Adult↗
PubMed1989

Biology of sweat glands and their disorders. II. Disorders of sweat gland function.

Part I of this article (J Am Acad Dermatol 1989; 20:537-63) focused on normal sweat gland function. Part II provides a discussion of hyperhidrosis and hypohidrosis. Hyperhidrotic disorders affect the palms and soles and the axillae and are associated with previous spinal cord injuries, peripheral neuropathies, brain lesions, intrathoracic neoplasms, systemic illness, and gustatory sweating. Hypohidrotic disorders include anhidrotic ectodermal dysplasia, hereditary sensory neuropathy, Holmes-Adie syndrome, and generalized anhidrosis.

Humans↗
PubMed2003

Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis.

BACKGROUND: Immediate results of endoscopic thoracic sympathectomy (ETS) for hyperhidrosis are good. Adverse effects are well known but are supposed to decrease with time. We report the long-term results of ETS with regard to efficacy, side effects and patient satisfaction. METHODS: From 1993 to 1998, 382 patients suffering from hyperhidrosis of the upper limbs were operated on by means of bilateral ETS. One hundred twenty-five could be reached. There were 91 females and 34 males with a mean age of 28 years. The mean follow-up was 3.8 years (range: 24 to 84 months). Patients answered a detailed questionnaire from an independent observer addressing the following issues: stability of the initial result, outcome of side effects, degree of satisfaction. RESULTS: The global recurrence rate was 8.8%: 6.6% for palmar hyperhidrosis and 65% for axillary hyperhidrosis. Compensatory sweating was observed in 86.4% of the patients. It was considered as minor by 61% of them, as embarrassing by 31.5%, and as disabling by 7.5%. Other reported side effects were: Horner's syndrome in 3 patients (2.4%), healing in 2 of them; chronic rhinitis in 3 (2.4%); gustatory sweating in 9 (7.2%); and hand dryness in 42%. Sixty-five percent of the patients were fully satisfied, 28.7% were globally satisfied, and 6.3% regretted the operation. Ninety-two percent of the patients claimed they would ask for the operation if it were to be redone. CONCLUSIONS: This study confirms that results of ETS are good and stable for palmar hyperhidrosis but deteriorate for axillary hyperhidrosis. Compensatory sweating does not improve with time and is the main cause of dissatisfaction. Recommendations drawn from these results are the following: (1) patients suffering from isolated axillary hyperhidrosis should rather be treated by local therapy; (2) patients should be better informed of adverse effects.

Adult↗
PubMed2004

[Botulinum toxin in otorhinolaryngology].

BACKGROUND AND OBJECTIVES: Through its anticholinergic effect, botulinum toxin is a suitable therapeutic option for dysfunctions of the muscular and the autonomic nervous system. PATIENTS/METHODS: Beside the classical indications like facial hyperkinesis (i.e. blepharospasm, hemifacial spasm), the treatment of complex dystonias (oromandibular dystonia, spasmodic dystonia, cervical dystonia), gustatory sweating, hypersalivation and crocodile tears is successful. Botulinum toxin is an alternative treatment of tension type headache and migraine. A new indication of botulinum toxin application may involve the treatment of nasal hypersecretion through the effect on the nasal glands. RESULTS: The positive therapeutic effect starts a few days after treatment and lasts longer in disorders of the autonomic nervous system. Because of its temporally limited therapeutic effect, the patients need further treatment. Side-effects are rare. CONCLUSIONS: Botulinum toxin is an effective treatment for a variety disorders with different etiologies and has very few side effects.

Autonomic Nervous System Diseases↗