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Vol. 103. Num. 6.July - August 2012
Pages 453-560
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Vol. 103. Num. 6.July - August 2012
Pages 453-560
Original Article
DOI: 10.1016/j.adengl.2012.07.001
Results of Video-Assisted Thoracoscopic Sympathectomy for Facial Blushing
Resultados del tratamiento videotoracoscópico del blushing
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M.A. Callejasa,??
Corresponding author
7891mcp@comb.cat

Corresponding author.
, R. Grimaltb, S. Mejíaa, J.M. Peric
a Unidad de Cirugía Torácica de Acceso Mínimo, Hospital Platón, Barcelona, Spain
b Servicio de Dermatología, Hospital Clínic i Universitari, Barcelona, Spain
c Unidad de Psicología Clínica, Hospital Clínic i Universitari, Barcelona, Spain
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Figures (2)
Tables (3)
Table 1. Protocol for Evaluating and Treating Blushing.
Table 2. Outcomes (Efficacy and Postoperative Reflex Sweating) by Type of Procedure.
Table 3. Results of Sympathectomy for Blushing As Reported in the Literature: Efficacy and Postoperative Reflex Sweating.
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Abstract
Background

Involuntary craniofacial erythema, or blushing, due to autonomic dysfunction can be a cause of psychological distress. Although anecdotal reports have suggested that pharmacologic treatments or cognitive behavioral therapy can be used to treat the condition, no rigorous analyses of their efficacy have been reported.

Objectives

To assess the efficacy of video-assisted thoracoscopic sympathectomy and to study phobic anxiety and other personality traits in a series of patients with involuntary facial blushing.

Materials and methods

We carried out a retrospective observational study of patients treated with bilateral video-assisted thoracoscopic sympathectomy for blushing over a 7-year period (2001-2008). All the patients were treated by a dermatologist, a psychologist, and a thoracic surgeon and were informed of the predicted outcomes.

Results

A total of 204 patients with a mean age of 34 years (range, 15-67 years) were included; the numbers of males and females were similar. Only 10% had unpredicted outcomes; in such cases, either the procedure was insufficiently effective or postoperative reflex sweating developed (and was considered serious in 2%). There were no deaths and only 1 case of transient Horner syndrome. Video-assisted thoracotomy was required for pleural symphysis in 1 patient; 5 patients developed pneumothorax, but only 1 of them required pleural drainage.

Conclusions

Video-assisted sympathectomy is a safe, effective and definitive treatment for disabling blushing. Anxiety that is detected before surgery is a reaction to blushing rather than a cause of it.

Keywords:
Blushing
Sympathectomy
Autonomic dysfunction
Resumen
Introducción

El blushing es una disautonomía que afecta al área craneofacial y se manifiesta en forma de rubor facial que puede conllevar trastornos psíquicos. La eficacia del tratamiento farmacológico y de la terapia cognitivo conductal es anecdótica y no hay estudios rigurosos que demuestren su validez.

Objetivo

Evaluar la efectividad de la simpaticotomía videotoracoscópica, así como las variables de personalidad y ansiedad fóbica en una serie de pacientes cuyo motivo de consulta fue el enrojecimiento facial incontrolable (blushing).

Material y métodos

Se realizó un estudio observacional retrospectivo durante un periodo de 7 años (2001-2008) en los pacientes afectos de blushing a los que se les efectuó simpaticotomía torácica bilateral videotoracoscópica. Todos los pacientes fueron visitados por un dermatólogo, un psicólogo y un cirujano torácico e informados de los efectos secundarios y expectativas de la intervención.

Resultados

Doscientos cuatro pacientes, con una distribución por sexos similar y una edad media de 34 años (rango: 15-67) fueron incluidos en el estudio. Solamente un 10% tuvo un resultado no esperado de la invervención, debido a la poca eficacia o a un excesivo sudor reflejo posquirúrgico que fue considerado grave en un 2% de los casos. No hubo mortalidad y solo un caso de síndrome de Horner transitorio. Se realizó una toracotomía videoasistida por sínfisis pleural y 5 pacientes desarrollaron un neumotórax, de los cuales uno requirió drenaje pleural.

Conclusiones

La simpaticotomía videotoracoscópica es un tratamiento seguro, eficaz y permanente del blushing incapacitante. La ansiedad medida prequirúrgicamente es reactiva al blushing y no al revés.

Palabras clave:
Rubor
Simpatectomía
Disautonomía neurovegetativa

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