septal body: revisited

The term septal body refers to a thickened area of the nasal septum that is located superior to the inferior turbinate and anterior to the middle turbinate. Despite its important role in changing nasal airflow resistance, little attention was given to it. Clinically, a well developed septal body may be misdiagnosed as high septal deviation. The aim of the present work was to reassess the histological characteristics of the septal body mucosa and the morphometric differences between it and the adjacent septal mucosa. This information was then used to determine the exact location and surface area of the septal body. The study was performed on 30 cadaveric specimens [60 sides]. Serial numbered sections of the whole septal mucosa were stained with hematoxylin and eosin as well as PAS alcian blue stains. Morphometric analysis was performed to determine the histological differences between the septal body mucosa, the anterior septal mucosa, and the inferior septal mucosa. The precise boundaries of the septal body area were then defined in a way similar to the Mohs micrographic surgical technique. The histological characteristics of the septal body mucosa included: thick [more than 60 microns] pseudo stratified ciliated respiratory epithelium with goblet cells, abundant seromucinous glands, and many blood sinusoids. Morphometric analysis showed that the septal body mucosa had thicker epithelium and more glandular acini and blood sinusoids than the rest of the septal mucosa. Mapping of the septal body area showed that its anterior end is 2.2 cm +/- 0.3 behind the caudal edge of the septal cartilage, and its inferior border is 1.1 cm +/- 0.2 above the floor of the nose. The mean horizontal diameter of the septal body was 2.0 cm +/- 0.15, and the mean vertical diameter was 1.5 cm +/- 0.11. The present study determined the morphometric characteristics of the septal body as well as its location and surface area. The intimate relationship of the septal body to the internal nasal valve and the histological characteristics of its mucosa should stimulate research into its potential role in modifying nasal airflow pattern and resistance, and controlling the ability of the nose to change the humidity and temperature of the inspiratory air stream

respiratory nasal mucosa after endoscopic sphenopalatine artery coagulation. A histological and histochemical study

Epistaxis is regarded as the commonest emergency requiring admission to the otolaryngology departments. Endoscopic coagulation of sphenopalatine artery is indicated in patients with posterior epistaxis unresponsive to nasal packing. Although many studies dealt with the efficacy of the procedure in controlling severe Epistaxis, few studied its effect on the nasal structure and functions. The aim of the present work was to study the effect of sphenopalatine artery coagulation on the secretory activities as well as the histological and histochemical changes of the nasal mucosa. The study was performed on 20 adult patients suffering from persistent or recurrent posterior epistaxis. Punch biopsies from the inferior turbinate were stained with hematoxylin and eosin and PAS alcian blue for histological examination while histochemical examination was done for the activity of succinic dehydrogenase, alkaline phosphatase and cholinesterase enzymes. Histologically; the nasal mucosa showed marked decrease in the size of both the seromucinous acini and blood sinusoids in the subendothelial connective tissue stroma in the post operative biopsies. Hitochemically; all enzymatic activities showed noticeable decrease in the postoperative biopsies. No degenerative changes were noticed in any postoperative biopsy. Sphenopalatine artery coagulation is an effective method in controlling recurrent or persistent posterior nasal bleeding that affects to some extent the secretory functions of the nasal mucosa on short term with no long term harmful effects

Endoscopic coagulation of sphenopalatine neurovascular bundle for intractable allergic rhinitis: a histopathological study

Manifestations of allergic rhinitis are due to a primary immunologic response which leads to a battery of neurovascular reactions. The sphenopalatine foramen [SPF] transmits both the blood and nerve supply to and from the nasal mucosa. We aimed at controlling the allergic reaction by endoscopically coagulating the neurovascular bundle at the SPF. The results were evaluated in patients with intractable allergic rhinitis by comparing the histopathological changes in biopsy specimens from the middle turbinate on the operated sides with control biopsies from the unoperated sides both at 1 month and at 2 years postoperatively. Qualitative and morphometric quantitative histopathological evaluation of the middle turbinate mucosa showed dramatic diminution of the mucosal reactivity and inflammatory cellular infiltrate compared with the control levels at one month postoperatively: At 2 years postoperatively, there is a gradual weaning of these effects Endoscopic coagulation of the sphenopalatine neurovascular bundle is a minimally invasive technique that seems promising in controlling intractable allergic rhinitis that fails to respond to medical treatment

Endoscopic sinus surgery for allergic rhinosinusitis. The use of postoperative local nasal immunotherapy [LNIT]

Higher recurrence rates were reported following endoscopic surgery in allergic patients. Steroids have been frequently used postoperatively in these particular patients. However, steroids are well known to cause undesirable local and systemic effects. This study was carried out to study the effect of postoperative local nasal immunotherapy [LNIT] in improving the results of endoscopic surgery in allergic patients. A total of sixty adult patients with allergic rhinosinusitis were included in the study. Preoperative evaluation included clinical evaluation, allergy tests and CT scans of the paranasal sinuses. At the time of surgery, tiny biopsies were taken from the mucosa of the inferior turbinate. Patients were prospectively randomized into one of two groups [30 patients in each]; the first group received postoperative LNIT, and the second group [control group] continued the standard postoperative care until the time of final evaluation. The patients were followed up for 9 months. The follow up criteria included symptom score, total loratidine intake and electron microscopic examination of nasal biopsies. Endoscopic sinus surgery followed by LNIT significantly decreased the scores of all symptoms. The postoperative scores of the LNIT group were significantly less than those of the control group. Postoperative examination of the nasal mucosa of the LNIT group showed regression of the allergic changes and a clear suppression of the IgE-mediated allergic reaction. LNIT can-be a viable postoperative alternative to topical steroids in allergic patients undergoing endoscopic sinus surgery

Aerodynamic nasopulmonary relationship before and after septoplasty

Twenty patients suffering from long standing nasal obstruction due to septal deviation were analyzed for changes in their pulmonary ventilatory performances. Following corrective septal surgery for restoration of upper airway patency, the pulmonary function tests, the blockage index [BI], and the gases tension demonstrated significant improvement. The BI, which is a function of the peak expiratory flow rate [PEFR], was introduced as a reliable subjective parameter for assessment of nasal airflow. Its value in evaluating the success of corrective nasal septum surgery was discussed on the light of the nasopulmonary relationship

effects of topical prostaglandin E2 on the nasal blood vessels. A study on patients with allergic rhinitis

In the present work, the effects of topical prostaglandin E2 [dinoprostone] on the nasal blood vessels of patients with allergic rhinitis were studied. The outstanding changes were constriction of the arterioles and capillaries [to a lesser extent] and tight closure of the interendothelial junctions. These changes caused a diminution of nasal blood flow and edema formation, a reduction in the size of the turbinates and consequently an increase in nasal patency. However, the drug had no effect on the nasal venules. The present research revealed the possibility of using dinoprostone topically to relieve nasal obstruction in allergic patients

Surgical anatomy of the lingual nerve and submandibular duct in the sublingual space

The surgical anatomy of the sublingual space has been studied in 100 cadavers. Special stress was laid upon the anatomical variations and relations of the lingual nerve and submandibular duct and their surgical importance. Accessory submandibular ducts have been found in 3 cadavers [3%]. The classical double crossing has been observed in 77 cadavers [77%]. In these cadavers the site of lateral crossing has been found most commonly at the junction of the posterior and middle thirds of the duct. In the remaining cadavers [23%] the lingual nerve displayed variable relations to the submandibular duct