Hyperhidrosis surgery?
Answer:
Preganglionic fibers from the spinal cord synapse in sympathetic ganglion at the segment from which they arise travel up or down the sympathetic chain to synapses within other ganglia. Postganglionic fibers marry peripheral nerves to innervate the sweat glands. The sympathetic outflow to the arm originate from the T2 to T6 ganglia, and for some patients T1 fibers (from the stellate ganglion, a fusion of T1 and C8) also innervate the arms. Fibers to the obverse come primarily from the stellate ganglia (C8 and T1), near some contribution from T2 and T3. Resection of the stellate ganglion is more likely to effect Horner’s syndrome than resection of T2 and T3 ganglia. In appendix, there is an anatomical variation—the resolve of Kuntz—seen in 10% of patients. It arises from the T2 and T3 spinal segment and bypasses the cervical chain to connect the brachial plexus. The feet are innervated by L2 to L4. To affect palmar sweating, T2 and sometimes T3 ganglion must be ablated, and for axillary sweating, at least T3 and sometimes T4 and T5. For plantar sweating, the L2 to L4 ganglion should be ablated, but, because sexual side effects can occur near ablation at this level, sympathectomy for plantar symptoms is from time to time done. For facial hyperhidrosis, ablation of T2 and T3 can decrease sweating, as can sympathectomy of the lower third of the stellate ganglion.
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