Effect of botulinum toxin in stellate ganglion for craniofacial hyperhidrosis: a case report

Abstract

Craniofacial hyperhidrosis causes sweating of the face and scalp due to excessive action of the sweat glands and manifests when patients become tense/nervous or develop an elevated body temperature. If noninvasive treatments are ineffective, invasive treatments such as a sympathetic block and resection are considered. A 32-year-old woman with no specific medical history was referred for uncontrolled craniofacial hyperhidrosis that included excessive sweating and hot flushing. Physical examination showed profuse sweating, and infrared thermography showed higher temperature in the neck and face than in the trunk. The patient underwent several stellate ganglion blocks, and her symptoms improved; however, the treatment effect was temporary. Botulinum toxin was then injected into the stellate ganglion. At the time of this writing, her sweating had been reduced for about 6 months and she was continuing to undergo follow-up. Craniofacial hyperhidrosis is a clinical condition in which patients experience excessive sweating of their faces and heads. It is less common than palmar and plantar hyperhidrosis. Botulinum toxin injection into the stellate ganglion is simple and safe and produces longer-lasting effects than other treatments, such as endoscopic sympathectomy and a single nerve block.

Botox-Enhanced Stellate Ganglion Blockade for the Treatment of Post-traumatic Stress Disorder

“…Commonly reported adverse effects of Botox injections include swelling or pain at the injection site, itching, and muscle weakness. In addition, recent studies have revealed systemic adverse effects of Botox, including anaphylaxis, dysphagia, and respiratory insufficiency, though most commonly observed in patients who receive high doses or have poor systemic conditions [ 7 ]. Clinical and laboratory data suggest that dysphagia following Botox therapy results from the spread of the toxin to adjacent pharyngeal muscles from the injection site [ 16 ].…”

“…Additionally, the patient received an SGB with pulsed radiofrequency treatment, improving symptoms for more than seven months until sweating returned with greater severity. Finally, Botox was injected into the stellate ganglion, reducing excessive sweating symptoms for over six months with no reported adverse effects [ 7 ].…”

Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

“…In support of the efficacy of Botox injection over ETS as a therapeutic modality for hyperhidrosis, Park et al [33] documented that Botox injection into the stellate ganglion is simple and safe and produces longer-lasting effects for craniofacial hyperhidrosis than endoscopic sympathectomy and a single nerve block.…”

Ultrasound-guided injection of botulinum toxin type A blocks cardiac sympathetic ganglion to improve cardiac remodeling in a large animal model of chronic myocardial infarction

“…All preganglionic neurons, including LSG preganglionic nerves, are cholinergic, and recent preclinical and clinical studies have shown that BTA has the potential to block peripheral sympathetic ganglions. For example, in a case report, Jung et al injected BTA into the stellate ganglions of a patient with craniofacial hyperhidrosis and reported obviously reduced sweating 10 . In the present study, we found that microinjection of BTA into LSG could effectively decrease SNAP-25 expression and inhibit its neural function and activity.…”