Original article
General thoracic
Thoracoscopic Sympathectomy for Isolated Facial Blushing

Presented at the Poster Session of the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
https://doi.org/10.1016/j.athoracsur.2005.12.017Get rights and content

Background

Facial blushing is one of the most peculiar of human expressions and has become a cardinal symptom of social phobia. The pathophysiology is unclear and the prevalence is unknown. Thoracoscopic sympathectomy may cure the symptom, but very few surgeons treat patients with isolated facial blushing. The literature is limited, and there are few long-term follow-up studies.

Methods

A follow-up study by questionnaire in 180 consecutive patients who underwent thoracoscopic sympathectomy for isolated facial blushing at two Danish university hospitals during a 6-year period. Patients routinely underwent T2 sympathectomy at the university hospital in Aarhus (n = 101) and T2-T3 sympathectomy at the university hospital in Odense (n = 79).

Results

The questionnaire was returned by 96% of the patients after a median follow-up time of 20 months. Overall, 90% of the patients had some effect from the operation, and the result was excellent or satisfactory in 75%. There was no significant difference between the two extents of sympathectomy. Compensatory sweating occurred in 88% of all patients and was significantly more frequent after T2-T3 sympathectomy (p = 0.02) Ten percent of our patients regretted the operation because of side effects or no effect of the operation.

Conclusions

This study demonstrates that thoracoscopic sympathectomy is an effective treatment for isolated facial blushing. The majority of patients achieve an excellent or satisfactory long-term result. Our results suggest that a T2 sympathectomy is superior for patients with isolated facial blushing because side effects are lower compared with a T2-T3 sympathectomy.

Section snippets

Patients and Methods

From our databases, we identified two groups of consecutive patients who were treated for facial blushing by thoracoscopic sympathectomy at the Department of Cardiothoracic Surgery, Odense University Hospital and Aarhus University Hospital, Denmark, during a 6-year period (January 1999 to December 2004). Objective methods for quantifying blushing before surgery were not applied. The indication for operation was disabling isolated facial blushing as defined by the patient. Only patients with

Results

The two hospitals were comparable with no significant differences in sex (72% were female), age (median, 37 years; range, 16 to 67), hospital stay (median, 2 days; range, 1 to 5), or postoperative hospital stay (median, 0 days; range, 0 to 2). The median follow-up time of all patients was 20 months (range, 1 to 60). No conversion to open technique was necessary, and there was no operative mortality. One patient from Aarhus had temporary unilateral Horner′s syndrome, which resolved after 2 days.

Comment

A recent national survey concluded that the projected prevalence of hyperhidrosis in the United States is 2.8%, equivalent to 7.8 million individuals [14]. There are no published estimates on the prevalence of facial blushing, but it is a cardinal symptom of social phobia, which has a prevalence as high as 10% [6]. Over the last 2 years, more than half of the patients referred for thoracoscopic sympathectomy in Denmark suffered from disabling facial blushing, indicating that this problem is

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