Successful treatment of facial blushing by endoscopic transthoracic sympathicotomy

Abstract

Facial blushing is one of the cardinal symptoms of social phobia and has a strong negative impact on the quality of life. Traditional therapeutic options are psychotherapy and pharmacological treatment. The results of these treatments on facial blushing are poorly documented. To investigate whether endoscopic bilateral transection of the upper thoracic sympathetic chain is efficient in the treatment of facial blushing, 244 consecutive patients were treated with bilateral endoscopic transthoracic sympathicotomy (ETS). The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0-10). There was no mortality nor conversion to open surgery. No Horner's syndrome occurred. Two patients with postoperative pneumothorax were treated with intercostal drainage and one small pulmonary embolus was detected. The questionnaire was answered by 219 patients (90%) a mean (+/- SEM) of 8 months (+/- 9 days) after surgery. Facial blushing (mean +/- SEM) was reduced from 8.7 +/- 0.1 to 2.2 +/- 0.2, P < 0.0001, by the operation. Heart palpitations in stressful situations were also reduced (3.7 +/- 0.3 to 1.3 +/- 0.1, P < 0.0001). The quality of life was substantially improved. The main side-effect was redistribution of sweating from the upper to the lower part of the body. Increased sweating of the trunk occurred in 75% of the patients. Overall, 85% of the patients were satisfied with the result and 15% were to some degree dissatisfied, mainly due to insufficient effect, but only four patients (2%) regretted the operation. As this is an open study, the results must be viewed with caution. ETS, however, appears to be an efficient, safe and minimally invasive surgical method for the treatment of facial blushing.

Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach

“…To maximally reduce the occurrence of this complication, a proper identification of the first rib is mandatory [12]. Pulmonary embolism and intraoperative cerebral damage have already been described following sympathectomy [8,9,13]. In our patient suffering from this severe postoperative complication, no findings were observed during operation, which could explain the event.…”

“…The patients were in a halfsitting dorsal decubitus position with abducted arms, allowing a simultaneous bilateral approach in the same position which saves operation time. The technique with a modified transurethral electroresectoscope has already been described by Drott et al [9]. However, the port site was located caudal to the mid portion of the clavicle in their patients.…”

Rosacea

“…Beta-blockers in low doses (e.g., nadolol, 20 to 40 mg daily) 22 as well as clonidine and spironolactone have been used to treat flushing in patients with rosacea, but evidence from randomized trials is lacking to support the effectiveness of these agents. Endoscopic transthoracic sympathectomy has been used successfully to treat socially disabling blushing 23 ; however, its use as a treatment for rosacea is not recommended, owing to rare but serious complications such as pneumothorax and pulmonary embolism, as well as postoperative increases in episodes of abnormal sweating.…”

Avaliação Psicológica em Doentes com Rosácea: Um Estudo de Caso-Controlo com Symptom Checklist -90 - Revised

“…5 Moreover, the disorder conveys patients a disgraceful appearance, which, along with the resulting sense of shame and social inadequacy portend important repercussion in their daily lives. 8 Psychological factors are relevant both in the initiation and course of rosacea. In fact, for the last century, both social and emotional impact, diminished self-esteem and psychiatric comorbidities have been reported to occur in these patients.…”