European Journal of Anatomy

Official Journal of The Spanish Society of Anatomy
Cover Volume 16 - Number 1
Eur J Anat, 16 (1): 57-67 (2012)

A morphological study of the nerve of Kuntz

V. Shantharam1, K.Y. Manjunath1, Roopa Raveendranath2

1Dept. of Anatomy, Annapoorna Medical College, Salem-636 308, Tamilnadu, India 2Dept. of Anatomy, St. Johnâ??s Medical College, Bangalore-560 034, Karnataka, India

ABSTRACT Hyperhidrosis is an idiopathic disorder of the autonomic nervous system characterized by hyperactivity of the exocrine sweat glands, resulting in excessive palmar, axillary, pedal, craniofacial or whole body sweating. Currently, trans-thoracic endoscopic sympathectomy, consisting of ablation of ganglion or resection of one segment of sympathetic trunk, is the treatment of choice for palmar hyperhidrosis. The important causes of unsuccessful sympathectomy include sympathetic regeneration and alternate sympathetic pathways. The most cited alternate pathway is the nerve of Kuntz. In the present study, the frequency of the nerve of Kuntz was investigated in 46 adult and 10 foetal cadavers. The nerve of Kuntz was found in 42 sides among 112 sides studied. The variants of this nerve observed in the present study were classified according to scheme proposed by Chung et al. (2002) as A, B, C and D types. 13.39% of type A, 11.61% of type B, 8.93% of type C and 3.57% of type D nerve of Kuntz were found in the present study. Studies suggest that the palmar hyperhidrosis is common in Asian population especially women. But as such very few studies on nerve of Kuntz are available from Asia. Today, a great number of thoracoscopic sympathectomies undertaken have redefined the role of alternate neural pathways. Experience of many surgical studies has also demonstrated the need to be aware of the anatomy of the sympathetic chain. Current study assumes importance in keeping the surgeon alert regarding the variations of the sympathetic chain while operating on the local population which can reduce recurrence of palmar hyperhidrosis after a seemingly successful upper limb sympathectomy.

Keywords: Hyperhidrosis, Nerve of Kuntz, Sympathectomy, Thoracic sympathetic chain

European Journal of anatomy
ISSN 2340-311X (Online)