Over several years of experience in treating patients with recurrent and/or persistent sweating of the face after undergoing T2 sympathectomy, Dr. Nielson has found that persistence of any sympathetic nerve innervation across the second rib level, just above the T2 ganglion, plays a significant role in persistent sweating conditions of the face after undergoing a T2. T3, or T4 sympathectomy.
It is apparent in some patients that there are neuronal contributions from lower levels such as the T3 that pass up over the second rib level on their way to the face that participate in the sweating symptoms of the face. Some physicians misunderstand the sympathetic nerve innervation of the face and believe in order to cure facial sweating it is important to cut the sympathetic nerve at the T1 level or above, thereby causing the dreaded Horner’s Syndrome. In Dr. Nielson's experience, he has found this not to be the case.
In summary, for successful treatment of facial sweating, it is imperative that all sympathetic nerve innervation crossing the second rib level be divided as opposed to clamped or having lower levels cut or clamped. Also, accessory nerve branch pathways bypassing the T2 ganglion can or may contribute to persistent facial symptoms.
