Hyperhidrosis and facial flushing
By Dr. José Manuel Mier Odriozola. Chest Surgeon
What is hyperhidrosis?
It is defined as an excessive production of sweat in one or more regions of the body, generally due to an excess secretion of sweat dependent on the innervation of the sympathetic nervous system. The anatomical regions that are most frequently affected are the face, armpits and palms.
We must start from the fact that sweating is not a disease, but one of the methods by which the body can regulate body temperature, depending on physical activity, weather, etc. This can be done thanks to nerves (part of the sympathetic nervous system), which run along the spinal column inside the thorax. After years of study, today we know that certain nerves are responsible for bringing the nervous stimulus to those regions affected by hyperhidrosis, in such a way that it can act directly on them, blocking their stimulus, without affecting the path of the rest of the sympathetic nervous system. .
One of the great problems of this disorder is that the majority of the population does not understand it as a problem that must be attended to, only the patient who suffers from it and the doctors who are in contact with them, we notice the extent that this disorder it can occur in an individual’s life.
Among the problems that we see in the consultation most frequently associated with palmar, axillary or facial hyperhidrosis are disorders in work, social and affective life, since we find patients with an inability to manipulate papers, pencils, tools, electronic equipment, food, cloth, fur, etc. With the repercussions that this can represent, such as job loss, professional limitations, as well as personal relationship problems, since they are people who do not like to shake hands, caress, etc. All this can lead to various psychological disorders.
Among the organic problems produced by excessive sweating, fungal infections of the skin and nails can be observed.
For which patients is this intervention indicated?
It is the patient who considers that the disorder he suffers causes a limitation or disorder in relation to the environment that surrounds him, thus limiting his normal behavior and daily activities.
What is the surgical treatment?
Under general or local anesthesia, two incisions of between 5 and 10mm are made in the axillary region, through which an optic is inserted to examine the thorax, visualize the sympathetic nerve and its different branches and through the second incision it is introduced the instrument that dissects the nerve that we are going to block to achieve the desired effect (that does not sweat a certain region).
Once the nerve is dissected, titanium clips are placed that compress the nerve and immediately nullify its function. This same procedure is performed in the same way on the contralateral side.
The results are immediate. After the surgery, the patient remains admitted to the hospital for a few hours, being able to resume their daily activity in cases where significant physical activity is not required, even the next day.
Possible side effects of surgery
The most common is excessive compensatory sweating. It is logical to think that if the amount of sweat that the patient produces will remain the same and one of the channels through which it is eliminated has been blocked with our intervention, more sweat may be caused by another region of the body. When this happens in an excessive and annoying way, it is called severe compensatory sweating (it occurs in approximately 10% of those operated on). If this happens, the surgery for the placement of clips on the sympathetic nerve has the virtue that by means of a new intervention the clip can be removed and hypothetically the patient would remain the same as before the first intervention, making Hyperhidrosis surgery a potentially reversible procedure.
Some other side effects or complications typical of any type of surgery can occur, such as infection of any of the wounds, intraoperative bleeding, pneumothorax, inability to identify the nerve (due to old adhesions, excessive obesity, etc.) and the complications of anesthesia.
Facial Flushing is not a disease, it is a physiological phenomenon mediated by the sympathetic nervous system, which occurs normally, for example when it is hot or exercising, it is generally accompanied by facial and body sweating.
Sometimes this phenomenon can occur in a very notable and uncontrollable way in situations that may be uncomfortable for the patient, to the point of generating psychological problems or personal interaction of the patient with other people, in the workplace or affective.
Like the problem of Hyperhidrosis, this disorder can be cured with a minimally invasive surgical procedure, which consists of interrupting the sympathetic nerve just in the branch that goes to the face, using a 4 mm clip on each side of the thorax. The procedure is performed in outpatient surgery, presents excellent immediate results and the side effects of the surgery are extremely rare, among them the most serious is Horner’s Syndrome, which is composed of a drooping eyelid, a decrease in the caliber of the pupil and dry eye It is extremely rare and using the technique of “clipping” for the cancellation of the nerve that goes to the face almost never occurs because there is no damage to the stellate ganglion, which if damaged is responsible for this syndrome.
Within the experience written in articles in the international medical press, as well as works exhibited at international conferences, our team has numerous publications.
-Both hyperhidrosis and facial flushing, are problems that have a solution
-It is performed in outpatient surgery
-It is a very safe, fast procedure and without serious complications as long as it is performed by an expert Chest Surgeon in this procedure.
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