I.Tarfusser
Casa di Cura Villa S. Anna, Merano, Italy
9th International Symposium on Sympathetic Surgery, 17 to 19 June 2011, Odense, Denmark
MATERIAL AND METHODS
Between 2000 and 2011, 13 patients with debilitating facial blushing failing to improve or experiencing severe
recurrence after previous substellate interruption of the sympathetic chain unterwent bilateral clipping of the white
communicating branch T1 (ESB-RC1). 11 patients presented with classical sympathicogeneous erythema of the face, 2
suffered from erythema located exclusively to the cheek and ear region (butterfly type with perioral pallor). The
procedure was carried out 1.9 to 57.6 (average 22.5) months after the original ESB/ETS.
A 3-ports thoracoscopic approach was used. After transecting the sympathetic chain between T1 and T2, the stellate
ganglion was freed up to the lower margin of the first rib where the white ramus communicans was individuated and
compressed with a clip. The procedure was carried out bilaterally. Follow-up was carried out with a questionnaire at 3
months and 1 year postop and recently.
RESULTS
In 2 patients, the procedure had to be aborted because of anatomical difficulties (bleeding risk, awkward access). 1 was
lost to follow-up. From evaluatable 10 patients, 8 had an immediate improvement >80% of their blushing, 6 with
follow-up time > 1 year (1-10 years) are still without blushing and 1 operated 2 months ago. 1 re-became sociophobic
14 months postop reportedly without apparent blushing. Both patients with cheek-ear blushing got definitively rid of it.
In 2 individuals improvement was almost nil (presumably incomplete interruption). Complications and side effects: 3
patients got a mild Horner (1 bilat, 2 unilat), in 1 patient compensatory sweating increased dramatically.
CONCLUSIONS
1. The RC1 seems to carry an individually variable portion of nerve fibers contributing to facial blushing, and especially
fibers addressing the cheek-ear region, responsible for a peculiar type of blushing which is particularly difficult to treat
with conventional ESB T1-2.
2.The risk for Horner's syndrome is higher than for the standard operation, but not 100%, suggesting the presence of
efferences at the C8 level with eye-related functions.
3. Increased risk for severe CS.
4. The procedure may be considered as a last resort in selected patients with debilitating erythrophobia not responding
to or relapsing after ESB T1-2.