Facial hyperhidrosis has a symptom of excessive sweating on the face with or without underlying disease. It can be surgically treated by video-assisted thoracic surgery (VATS). We encountered three cases of facial hyperhidrosis which we treated by VATS, which was performed by resection of the lower third of stellate ganglion and T2-T3 sympathetic ganglia with chains. Postoperative symptom was improved in all cases. There were no postoperative complications such as Horner's syndrome or postsympathectomy neuralgia.
Ganglia, Sympathetic ; Horner Syndrome ; Hyperhidrosis* ; Neuralgia ; Postoperative Complications ; Stellate Ganglion ; Sweat ; Sweating ; Sympathectomy* ; Sympathetic Nervous System ; Thoracic Surgery, Video-Assisted

Orofacial pain is a common complaint of patients that causes distress and compromises the quality of life. It has many etiologies including trauma, interventional procedures, nerve injury, varicella-zoster (shingles), tumor, and vascular and idiopathic factors. It has been demonstrated that the sympathetic nervous system is usually involved in various orofacial pain disorders such as postherpetic neuralgia, complex regional pain syndromes, and atypical facial pain. The stellate sympathetic ganglion innervates the head, neck, and upper extremity. In this review article, the effect of stellate ganglion block and its mechanism of action in orofacial pain disorders are discussed.
Complex Regional Pain Syndromes ; Facial Pain* ; Ganglia, Sympathetic ; Head ; Humans ; Neck ; Neuralgia, Postherpetic ; Quality of Life ; Stellate Ganglion* ; Sympathetic Nervous System ; Upper Extremity

BACKGROUND: The stellate ganglion block controls the pain and the vascular insufficiency in the innervating regions. Recently, the therapeutic indications of the stellate ganglion block are widely extended to the psychosomatic disorder. Therefore, this study was designed to observe the effect of the stellate ganglion block on stress using the Porsolt's behavioral despair model of rats. METHODS: Fifty-five male Sprague-Dawley rats were given five forced-swimming tests at 24-hour intervals. The first test through which rats learn helplessness lasted 15 minutes and following four tests given 30 minutes after every superior cervical ganglion block lasted 5 minutes respectively. The superior cervical ganglion block was achieved by using 0.2 ml of 1% lidocaine in the experimental group(n=30), and 0.2 ml of normal saline instead of lidocaine in the control group(n=25). The duration of mobility was measured during the first 5 minutes in all tests. RESULTS: A difference was found between the control and the experimental group in the performance ratios after the superior cervical ganglion block(P<0.01), but the number of trials of the superior cervical ganglion block did not effect the duration of mobility. CONCLUSIONS: These results suggest that the superior cervical ganglion block reduces the duration of immobility independently of the number of trials of the superior cervical ganglion block.
Animals ; Humans ; Lidocaine ; Male ; Psychophysiologic Disorders ; Rats* ; Rats, Sprague-Dawley ; Stellate Ganglion ; Superior Cervical Ganglion* ; Sympathetic Nervous System

BACKGROUND: A stellate ganglion block (SGB) causes increased blood flow in the maxillofacial region, exhibiting the potential for regenerative effects in damaged tissue. The focus of this study was to understand the efficacy of SGB for regenerative effects against nerve damage. A rat model of the superior cervical ganglion block (SCGB) was created instead of SGB, and facial blood flow, as well as sympathetic nervous system function, were measured. METHODS: A vertical incision was made on the left side of the neck of a Wistar rat, and a 5-mm resection of the superior cervical ganglion was performed at the back of the bifurcation of the internal and external branches of the left common carotid artery. Blood flow in the skin at the mandibular angle and mean facial temperature were measured using a laser-Doppler blood flow meter and a thermographic camera, respectively, over a 5-week period after the block. In addition, the degree of ptosis and miosis were assessed over a period of 6 months. RESULTS: The SCGB rat showed significantly higher blood flow at the mandibular angle on the block side (P < 0.05) for 3 weeks, and significantly higher skin temperature (P < 0.05) for 1 week after the block. In the SCGB rat, ptosis and miosis occurred immediately after the block, and persisted even 6 months later. CONCLUSIONS: SCGB in rats can cause an increase in the blood flow that persists over 3 weeks.
Animals ; Carotid Artery, Common ; Horner Syndrome ; Miosis ; Models, Animal ; Neck ; Rats ; Regional Blood Flow ; Skin ; Skin Temperature ; Stellate Ganglion ; Superior Cervical Ganglion ; Sympathetic Nervous System ; Thermography

Involvement of the peripheral nerveous system by diabetes is referred to as diabetic neuropathy. The frequency of diabetic neuropathy ranges from 5% to 60% and the pain management is one of the greatest problem. The patient was a 57-year-old man who has been treated with diabetes(DM type IIa) for about 12 years. The symmetrical pain, swelling and sensory loss on feet were started 3 months before admission and the burning pain was intensified at night with resultant insomnia. The systoms were aggravated 1 month ago and they were not relieved by any medication and physical therapy. We attempted lumbar epidural block to the patient and the result was good. So we performed a permanent lumbar sympathetic ganglion block with neurolytics(99.9% alcohol) for the long term relief of pain. The patient was satisfied with the result of the block and discharged.
Burns ; Diabetic Neuropathies* ; Foot ; Ganglia, Sympathetic ; Humans ; Metabolism ; Middle Aged ; Pain Management* ; Sleep Initiation and Maintenance Disorders ; Sympathetic Nervous System

Myocardial ischemia (MI) causes somatic referred pain and sympathetic hyperactivity, and the role of sensory inputs from referred areas in cardiac function and sympathetic hyperactivity remain unclear. Here, in a rat model, we showed that MI not only led to referred mechanical hypersensitivity on the forelimbs and upper back, but also elicited sympathetic sprouting in the skin of the referred area and C8-T6 dorsal root ganglia, and increased cardiac sympathetic tone, indicating sympathetic-sensory coupling. Moreover, intensifying referred hyperalgesic inputs with noxious mechanical, thermal, and electro-stimulation (ES) of the forearm augmented sympathetic hyperactivity and regulated cardiac function, whereas deafferentation of the left brachial plexus diminished sympathoexcitation. Intradermal injection of the α₂ adrenoceptor (α₂AR) antagonist yohimbine and agonist dexmedetomidine in the forearm attenuated the cardiac adjustment by ES. Overall, these findings suggest that sensory inputs from the referred pain area contribute to cardiac functional adjustment via peripheral α₂AR-mediated sympathetic-sensory coupling.
Animals ; Ganglia, Spinal ; Hyperalgesia/etiology* ; Myocardial Ischemia/complications* ; Pain, Referred/complications* ; Rats ; Sympathetic Nervous System

This experiment aimed to investigate the effect of adrenergic system in the subnucleus commissuriu of nucleus solitrius tractus (CNTS) on renal nerve discharges. Norepinephrine (NE) was microinjected into the CNTS of rabbits and mean arterial blood pressure (MAP) and renal nerve discharges (FRND) were synchronously recorded. The results indicated that (1) microinjection of norepinephine into the CNTS of rabbit could significantly attenuate the frequency of renal nerve discharge, and at the same time decrease markedly the mean arterial pressure. (2) Microinjection of 0.3 nmol yohimbin into CNTS had no significant influence on FRND and MAP, but could attenuate and even reverse the effects of NE on FRND and MAP. These results suggest that microinjection of NE into CNTS may activate the alpha-adrenorecptor located in CNTS and secondarily produce a depressor effect by attenuating the activity of periphenal sympathetic nervous system.
Blood Pressure/drug effects ; Depression, Chemical ; Kidney/*innervation ; Microinjections ; Norepinephrine/*pharmacology ; Solitary Nucleus/*physiology ; Sympathetic Nervous System/drug effects ; Sympathetic Nervous System/*physiopathology ; Vasomotor System/physiopathology

BACKGROUND: Thoracic sympathetic block surgery is a safe and effective procedure for palmar hyperhydrosis, and this maintains sufficient moisture and prevents compensatory hyperhidrosis. To avoid compensatory hyperhidrosis, the authors performed sympathetic block surgery just above the R4 level to maintain sympathetic tone affecting the caudal area. MATERIAL AND METHOD: A total of 71 subjects (45 males and 26 females) were categorized into two groups. Group 1 (31 patients, mean age: 25.5 years) had clips placed both on the upper and lower part of R4 sympathetic ganglion, and group 2 (40 patients, mean age: 25.9 years) underwent clipping of the upper part of R4. Telephone surveys were done to collect data on 8 categories, and the average follow up interval was 24.9 months (group 1) and 18.9 months (group 2). RESULT: For group 1, 41.9% experienced no sweating and 48.4% replied they experienced some sweating depending on the surrounding conditions. Group 2 showed that 60% experienced no sweating and 35% replied they experienced some sweating depending on the surrounding conditions. 58.1% in group 1 experienced sweating right after the surgery, and 40.0% in group 2 experienced the same. Group 1 (38.1%) and group 2 (37.5%) replied they experienced no hand dryness and more patients in group 2 than in group 1 had hand dryness, but without uncomfortable symptoms. 71.0% (group 1) and 62.5% (group 2) replied they had no compensatory hyperhidrosis or related symptoms. One patient in group 1 and two in group 2 reported they regretted undergoing the procedure. The regions of compensatory hyperhidrosis were the back, thigh and chest in group 1 and the group 2 reported the back, chest, and abdomen in the order of frequency. Fewer incidences of the gustatory hyperhidrosis were noted in group 2. Most of the patients were satisfied with their treatment. CONCLUSION: Clipping the upper part of the R4 ganglion or R4 sympathetic block are both effective for treating palmar hyperhidrosis and these treatments decrease the occurrence or symptoms of compensatory hyperhidrosis. The upper R4 sympathetic block procedure is easier and safer with fewer incidences of gustatory hyperhidrosis and a higher percentage of patient satisfaction.
Abdomen ; Endoscopy ; Follow-Up Studies ; Ganglia, Sympathetic ; Ganglion Cysts ; Hand ; Humans ; Hyperhidrosis* ; Incidence ; Male ; Patient Satisfaction ; Reflex ; Sweat ; Sweating ; Sweating, Gustatory ; Sympathetic Nervous System ; Telephone ; Thigh ; Thorax

Some reports provide conclusive evidence of close interactive regulation between the taste receptor and sympathetic nervous system. We report a middle-aged male patient with gustatory change after cervical sympathetic ganglion block (CSGB) who had been suffering from hypersensitivity to sour taste since developing complex regional pain syndrome (CRPS) type 1, diagnosed according to the revised CRPS criteria. Despite receiving two high doses of prednisolone therapy, he experienced the recurrence of CRPS symptoms. We attempted other therapy treatments, including pamidronate intravenous infusion, non-steroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, and CSGB. Following each CSGB administration, the patient reported decreased hypersensitivity to sour-tasting foods, such as kimchi and oranges, with decreased pain and reduction of dysautonomic symptoms. This case demonstrates that overactivation of the sympathetic nervous system may influence sensitivity and regulation of gustatory receptors; therefore, a patient demonstrating CRPS symptoms, including taste alterations, may respond positively to CSGB therapy.
Analgesics, Opioid ; Antidepressive Agents, Tricyclic ; Citrus sinensis ; Diphosphonates ; Ganglia, Sympathetic ; Humans ; Hypersensitivity ; Infusions, Intravenous ; Male ; Prednisolone ; Recurrence ; Stress, Psychological ; Sympathetic Nervous System

Myokymia is one of involuntary movement, which is characterized by undulatory muscle spasm, similar to the worm's crawl. Sometimes muscle pain, itchy sensation, dysautonomia and other symptoms are associated with it. Derangement of the peripheral or central nervous system after nerve or tissue damage is suspected as the source of impulse generators causing this symptom. We encountered a patient with neuropathic pain and myokymia after thoracotomy. Although several medications and nerve blocks have been applied, all have failed to provide symptom relief. We experienced improvement of the pain and involuntary movement with a thoracic sympathetic ganglion block and gabapentin.
Central Nervous System ; Dyskinesias ; Ganglia, Sympathetic* ; Humans ; Myalgia ; Myokymia* ; Nerve Block ; Neuralgia* ; Primary Dysautonomias ; Sensation ; Spasm ; Thoracotomy*