Role of surgical thoracic sympathetic interruption in treatment of facial blushing: a systematic review

ABSTRACT

Objectives: This paper aims to review the evidence to support the effectiveness of sympathectomy as a treatment for facial blushing in terms of relief of facial blushing, patient satisfaction, recurrence of blushing, patients regretting treatment and its associated complications.

Methods: A systematic search strategy was performed in Ovid-Medline, Embase, Cochrane library and NICE. Studies reporting outcomes of sympathetic interruption in the treatment of facial blushing were retrieved.

Results: Nine studies met the inclusion criteria with 1369 patients included in the final analysis. The age range of patients was 8 to 74 years (from 7 studies) with 56% females. Mean follow up was 21 months in 8 studies (range 6 to 30 months). The pooled proportion of patients who had good relief of facial blushing was 78.30% (95% C.I. 58.20% – 98.39%). Complete satisfaction was reported in 84.02% (95% C.I. 71.71% – 96.33%). Compensatory sweating and gustatory sweating were the commonest complications occurring in 74.18% (95% C.I. 58.10% – 90.26%) and 24.42% (95% C.I. 12.22% – 36.61%) respectively. The estimated proportion of patients regretting surgery was 6.79% (C.I 2.08% 11.50%).

Conclusion: Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective treatment for facial blushing. However, lack of randomized trials comparing sympathetic interruption with non-surgical methods of treatment and heterogeneity of included studies with respect to assessment of outcome measures preclude strong evidence and definitive recommendations.

KEYWORDS:

• Blushing
• flushing
• sympathectomy
• autonomic nerve block

Acknowledgments

The authors would like to place on record our sincere thanks to Miss Sophie Patterson, Librarian, UCL Medical School campus library, Royal Free Hospital, London for her help with performing the search for the review and Mrs Janet Reynolds, Librarian, Watford General Hospital, Watford, Hertfordshire for obtaining the full text articles when required. We also would like to express our gratitude to Dr Sreekumaran Nair, Professor of Biostatistics & Head Department of Statistics, Statistical Editor, Cochrane Public Health Group Director, Public Health Evidence South Asia, Dr. TMA Pai Endowment Chair in Systematic review and Evidence Based Public Health, Manipal University, Manipal, India, for his guidance and expert opinion.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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Funding

This paper was not funded.