anatomy(m*chigan) question

[mog]

Am not sure whether I'm allowed to put the whole sentenses (with the copyrights issues and all) but as a trial I'll post a question I didn't really understand. If I'm doing something bad please let me know;)

A question from mi***gan for anatomy.... if anybody could help...

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A 45-year-old female patient complains of excessive sweating on the right side of the face and neck and in the right armpit region, where it leaves her clothing constantly stained with moisture. It is now such a terrible social embarrassment that she has become withdrawn and self-conscious. Since no medical treatment has proven effective, she is considering surgical denervation of the sweat glands in the affected areas. Which structure(s) might be removed or cut in order to alleviate her condition?

And the answer is: Cervicothoracic (Stellate) gangion

The explanation was: The cervicothoracic ganglion is a sympathetic ganglion, formed by the fusion of the inferior cervical sympathetic ganglion and the T1 ganglion of the sympathetic trunk. The postsynaptic sympathetic fibers from this ganglia innervate the vascular smooth muscle and sweat glands of the C8 & T1 cutaneous distribution on chest & upper limb. Since the sweat glands in the right armpit are innervated by fibers coming from the stellate ganglion, this ganglion might need to be removed or cut to alleviate the patient's condition.

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What I was wondering is, just to stop sweating, would you usually REMOVE the whole ganglion?? Especially I guess this particular ganglion would have many important functions apart from the sweating one. Wouldn't this pt have horner's syndrome or something more serious than the sweating as a result??? Won't you rather cut the particular nerve fiber to the sweat glands or something instead of getting rid of the whole ganglion??

Thanks for any input!!

[manleyjb]

Am not sure whether I'm allowed to put the whole sentenses (with the copyrights issues and all) but as a trial I'll post a question I didn't really understand. If I'm doing something bad please let me know;)

A question from mi***gan for anatomy.... if anybody could help...

----------------------------------------------------------------------------------------

A 45-year-old female patient complains of excessive sweating on the right side of the face and neck and in the right armpit region, where it leaves her clothing constantly stained with moisture. It is now such a terrible social embarrassment that she has become withdrawn and self-conscious. Since no medical treatment has proven effective, she is considering surgical denervation of the sweat glands in the affected areas. Which structure(s) might be removed or cut in order to alleviate her condition?

And the answer is: Cervicothoracic (Stellate) gangion

The explanation was: The cervicothoracic ganglion is a sympathetic ganglion, formed by the fusion of the inferior cervical sympathetic ganglion and the T1 ganglion of the sympathetic trunk. The postsynaptic sympathetic fibers from this ganglia innervate the vascular smooth muscle and sweat glands of the C8 & T1 cutaneous distribution on chest & upper limb. Since the sweat glands in the right armpit are innervated by fibers coming from the stellate ganglion, this ganglion might need to be removed or cut to alleviate the patient's condition.

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What I was wondering is, just to stop sweating, would you usually REMOVE the whole ganglion?? Especially I guess this particular ganglion would have many important functions apart from the sweating one. Wouldn't this pt have horner's syndrome or something more serious than the sweating as a result??? Won't you rather cut the particular nerve fiber to the sweat glands or something instead of getting rid of the whole ganglion??

Thanks for any input!!




I think the aswer is in the explanation. It says that these nerves innervate the smooth muscle & sweat glands of the C8 & T1 chest and upper arm. You are not blocking the pathway from the hypothalamus to the spinal cord therefore Horner's Syndrome is not an option. You are actually removing the fibers from the specific sweat gland in question. You will retain the remaining sympathetic fibers from the sympathetic trunk. Remember Horner's syndrome results from a tumor that blocks the pathway from the hypothalamus to the superior cervical ganglion & fibers to the pupil and eyelid and sweat glands to the face.

Thank you Dr. A for a great neuro class!!!

[onesolo]

WOW!! Is this what I have to look forward to? I can't wait till Jan. so I get started with my future.

[mog]

Thank you so much manleyjb (member.php?u=8185) for clearing my doubts! It makes sense and now I can sleep... neuro sounds difficult but very interesting.

[mog]

I know nobody is looking at this thread anymore, but I just came across to some websites that say that the satellite ganglion block will lead to horner's syndrome. Some even say that if you are intending to do this block (by injecting local anethetia = temporary block) then horner's syndrome is the sign that you have successfully blocked the satellite ganglion.

I don't know much about horner's syndrome, but if it only means the symptoms caused by the sympathetic fiber interruption, then can the cause also be satellite ganglion block (or in this case resection), not only the hypothalamus - eye pathway??

Now I am again not so sure if this original michigan question is right. This patient will surely have horner's syndrome, and even permenently won't she? Or will this recover after sometime, by compensation of some other fibers???

Otherwise, I still think the side effect (permanent horner's) will be too much for the results (stop sweating).

I was looking thru many websites to clarify it, but just cannot find the answer....