Question Title: Facial hyperhidrosis vs. T1-T4

Forum: Neurology Forum
Topic: Neurology - General

Posted by CCF Neurology MD on October 06, 1997 at 21:11:44:

In Reply to: Facial hyperhidrosis vs. T1-T4 posted by Jan on September 27, 1997 at 06:17:43:

: I'am suffering from facial hyperhydrosis. I,ve got messages that cutting T2
between T2 and T1 (but the closest possible to T2) could cure the situation.
I would like to have more information on this, an get more information on the
functions of T1 to T4.

Thanks in advance,

Jan

Dear Jan:

The terms "T1", "T2", etc. represent nerve roots exiting from the spinal column below vertebrae T1, T2, etc. respectively. These roots include important motor fibers (to the hand from T1, for instance), sensory fibers (for skin and deep sensation), and autonomic (sympathetic) fibers. These autonomic fibers branch off from the roots a short distance outside the spine and supply structures called the ganglia of the sympathetic chain. Nerve fibers arising from these ganglia, in turn, supply various structures including skin sweat glands (to cause sweating), skin hair muscles (to cause goose-flesh), the pupil of the eye (to cause dilatation), and the heart (to cause an increased heart rate). The pupil is mainly supplied by fibers arising from root T1, facial sweating by fibers from roots T1 and T2, and the heart and palm sweating by fibers from roots T1 to T4 or so. Removing the sympathetic fibers/ganglia at the T1 level has somewhat undesirable complications, while removing sympathetic fibers/ganglia at lower levels (T2 to T4/5) has been shown to reduce palmar and perhaps facial hyperhidrosis without unacceptable complications.
This procedure that you allude to is called upper thoracic sympathectomy, and is performed by thoracic surgeons, either surgically or endoscopally.

Hyperhidrosis is only a cosmetic and social problem. You should agree to or choose an invasive irreversibe destructive surgical procedure only after very patient and thoughtful consideration. Although quite safe in good hands, the procedure can have occasional immediate life-threatening complications. Also, in the long term, the outcome may be less than desirable. For instance, compensatory hyperhidrosis (excessive sweating elsewhere - feet, for instance), and gustatory hyperhydrosis (excessive sweating while eating) are the rule rather than the exception after this surgery.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.

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