Distribution of the internal nasal branch of the infraorbital nerve to the nasal septum: Application to rhinoplasty.

BACKGROUND: The course of the nerves along the nasal septum has not been clearly studied, and surgical procedures such as rhinoplasty require a more detailed topography of the nerve supply inside the septum. Therefore, we aimed to investigate the distribution of the internal nasal branch of the infraorbital nerve inside the nasal septum and to define the relationship between it and the nasal cartilages. METHODS: Fourteen sides from eight fresh frozen and embalmed Caucasian cadaveric heads were dissected. The specimens were derived from three males and five females. The ages of the cadavers at death ranged from 65 to 84 years. The course of the internal nasal branch and its relationship between the nasal cartilages were observed using a surgical microscope. RESULTS: On all sides, the internal nasal branch approached the medial crus of the major alar cartilage from behind and traveled anteriorly below the medial crus of the major alar cartilage while giving off anterior inferior septal, middle inferior septal, and posterior inferior septal branches. CONCLUSIONS: Based on the results of this study, we suggest that procedures of the nasal cavity such as rhinoplasty could be modified to avoid injuring the main trunk of the internal nasal branch of the infraorbital nerve inside the nasal septum.

[АNTINOCICEPTIVE PROTECTION ON A STAGE OF CONCLUDING OF SURGICAL INTERVENTION AND EARLY POSTOPERATIVE PERIOD].

Efficacy of antinociceptive defense at the terminal period of operation and in early (6 h) postoperative period, using additional injection of phentanil, paracetamol and nalbufin in anesthesiological support, and applying sevofluran in 107 patients, оperated on facial skull, in 2 stage of operative risk in accordance to ASA, was a nalyzed. Insufficient antinociceptive protection at the end of operation and in early postoperative period while using phentanil and nonsteroidal antiinflammatory medicines only for anesthesia, was established, basing on analysis of hemodynamic indices, pain syndrome severity and indices of metabolic stress. Application of paracetamol have promoted raising of the antinociceptive protection efficacy during short period (up to 2 h) only. Prescription of nalbufin have had guaranteed enhanced efficacy and duration of antinociceptive protection in early postoperative period, that's why its wide application is recommended.

The Importance of the Trigeminal Cardiac Reflex in Rhinoplasty Surgery.

BACKGROUND: Trigeminocardiac reflex (TCR) consists of bradycardia or asystole along with hypotension and apnea coinciding with stimulation of the trigeminal nerve. During rhinoplasty procedures, we noticed that local anesthetic solution (LAS) application to the columellar area results in bradycardia. We planned to conduct a randomized prospective study on 47 patients undergoing rhinoplasty to demonstrate the characteristics of TCR arising from the columella. METHOD: Local anesthetic solution containing 2% prilocaine with 1:80,000 adrenaline was applied under standard general anesthesia protocol. In group 1 (study group, n = 24), 2 mL of LAS was applied to the columella. In group 2 (control group, n = 23), 2 mL of LAS was applied to the nasal dorsum. In group 3 (control group, n = 20), after LAS was applied to nasal dorsum in group 2, we waited for 10 minutes. Then, 2 mL of LAS was applied to the columella. Here, recordings were taken for the columella.Heart rate (HR) and blood pressure (BP) were recorded just before needle insertion (baseline level), at the time of needle insertion (NIT) to the columella or dorsum, and after the 1st, 5th, 10th, 30th, and 60th seconds. RESULTS: Transient bradycardia (≥20% drop in HR) was observed in 33% of the patients in group 1.Decrease in HR compared to the baseline level in group 1 was significantly greater than that of groups 2 and 3 at all times (P ≤ 0.05).Systolic BP in NIT and in 60th second in group 1, only in NIT in group 2 was significantly lower than that of baseline levels (P ≤ 0.05). CONCLUSIONS: We concluded that stimulation of a sensory branch of the trigeminal nerve in the columellar area leads to TCR under general anesthesia by eliciting clinical hypotension with a drop in systolic BP and in HR of more than 20% compared to the baseline level.Knowing the existence of a certain TCR area will be helpful to the surgeon and anesthesiologist to exercise extra vigilance and to make continuous and meticulous monitoring of the electrocardiogram, HR, and BP during which the TCR may be precipitated such as local anesthetic infiltration to the columellar area in rhinoseptoplasty operations.

Schwannoma of the nasal septum: an unusual finding.

Schwannomas of the nasal cavity are rare benign tumors, and those that arise from the nasal septum are even rarer. When they do occur, they usually become symptomatic early because of the close confines of the nasal cavity. We describe a case of nasal septal schwannoma that was noteworthy in that the patient-a 28-year-old woman-waited 8 months after the onset of symptoms to seek medical care. Her symptoms included complete right-sided nasal obstruction, occasional epistaxis, and hemifacial pain. The tumor was completely removed via an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.

[Immunohistochemical study of human fetal vomerona structures the nasal septum, by applying neuron-specific beta3-tubulin antibodies].

The functioning of Jacobson's or vomeronasal organ (VNO) in man is the subject-matter of discussion today. It is generally taken that VNO as an anatomic structure also remains in the adult; however, its receptor apparatus still degenerates in the fetal stage of ontogenesis. Nevertheless, the data available in the literature on the time and specific features of degenerative changes in the human fetal VNO are conflicting and ambiguous. The authors examined the human fetal nasal septum from the 8th week of development to birth, by applying the traditional histological procedures and neuron-specific beta3-tubulin antibodies. An immunohistochemical study could first show the receptor apparatus of the human fetal VNO at weeks 8-26 of development. The immunohistochemical study on a series of sections could reveal the regularities of spatial receptor distribution depending on the time of fetal development. In addition, the developed human fetal vomeronasal nerve and ganglion at weeks 8-26 were described, in human fetuses at weeks 8-26. The neuron-specific marker test has shown the nerve fibers departing directly from the VNO wall, which is inconsistent with the data available in the literature on vomeronasal nerve degeneration in this sign just after the 18th week of development.

Responses to trigeminal irritants at different locations of the human nasal mucosa.

BACKGROUND: Previous work suggests differences in the distribution of human intranasal trigeminal receptors. The aim of this study was to investigate these topographic differences for different concentrations of different trigeminal irritants using an electrophysiologic measure of trigeminal activation, the negative mucosa potential (NMP). MATERIALS AND METHODS: A total of 15 healthy volunteers participated. Presented by a computer-controlled olfactometer CO2 (30% and 40% v/v), ethyl acetate (5.5% and 9.3% v/v) and acetic acid (205 and 40% v/v) were used for stimulation. NMP was recorded at the middle septum, the middle turbinate, and the floor of the nasal cavity. RESULTS: Maximum amplitudes of the NMP were found at the middle septum and were lowest at the nasal floor. Response amplitudes were related to stimulus concentrations. There was no significant difference between responses to the three different stimuli in relation to three recording sites. CONCLUSIONS: In agreement with previous work, the present data suggest that there are topographic differences in the responsiveness of the mucosa to chemical irritants.

[The human vomeronasal organ]. / Das vomeronasale Organ des Menschen.

Odors influence human behavior. The perception of so-called pheromones is frequently mentioned in the context of a functional vomeronasal organ. Vomeronasal ducts can be detected in approximately half of the population. Its functionality, still a matter of debate, seems to be unlikely, at least after birth. It is easily conceivable that pheromone-induced changes in behavior are mediated through receptors in the human olfactory epithelium.

Sensory-nerve-mediated nasal vasodilatory response to inspired acetaldehyde and acetic acid vapors.

This study was designed to characterize the acute nasal vasodilatory responses to the sensory irritants acetaldehyde and acetic acid. For this purpose, the upper respiratory tract of the urethane-anesthetized male F344 rat was isolated by insertion of an endotracheal cannula, and irritant-laden air was drawn continuously through that site at a flow rate of 100 ml/min for 50 min. Vascular function was monitored by measuring inert vapor (acetone) uptake throughout the exposure. Both acetaldehyde and acetic acid induced an immediate concentration-dependent vasodilation as indicated by increased steady-state acetone uptake rates. This response was observed at exposure concentrations of 25 ppm or 130 ppm or higher for acetaldehyde or acetic acid, respectively. The response to either vapor was significantly diminished in rats pretreated with the sensory nerve toxin capsaicin (50 mg/kg, 7 days prior to exposure), providing evidence that sensory nerves play a role in the response. Acetaldehyde is metabolized by aldehyde dehydrogenase to acetic acid. Pretreatment with the aldehyde dehydrogenase inhibitor cyanamide (10 mg/kg, 1 h prior to exposure) reduced the vasodilatory response to 200 ppm but not to 50 ppm acetaldehyde. These results suggest that formation of acetic acid is important in the sensory nerve-mediated vasodilatory response to high, but perhaps not to low, concentrations of acetaldehyde.

Novel subdivisions of the rat accessory olfactory bulb revealed by the combined method with lectin histochemistry, electrophysiological and optical recordings.

Wistaria floribunda agglutinin and peanut agglutinin were found to bind histochemically to the anterior and posterior regions, respectively, of the vomeronasal nerve and glomerular layers in the rat accessory olfactory bulb. Furthermore, Ricinus communis agglutinin showed strong binding to the anterior region of the vomeronasal nerve and glomerular layers, whereas it bound weakly and/or moderately to the rostral two-thirds of the posterior glomerular layer but not at all to the caudal one-third. This suggests that the posterior region is further divided into two subregions. An electrophysiological mapping study in sagittal slice preparations demonstrated that stimulation given within the anterior vomeronasal nerve layer elicited field potentials within the anterior region of the external plexiform layer, whereas shocks to the rostral two-thirds and the caudal one-third of the posterior vomeronasal nerve layer provoked field responses within the rostral two-thirds and within the caudal one-third of the posterior external plexiform layer, respectively, indicating that the posterior external plexiform layer is also divided into two subregions. Real-time optical imaging showed similar results as above, except that neural activity also spread into mitral cell layers. Furthermore, the most anterior and posterior ends of the neural activity evoked in the rostral two-thirds of the posterior region immediately adjoined the posterior border of that evoked in the anterior region and the anterior border of that evoked in the caudal one-third of the posterior region, respectively. Moreover, the granule cell layer was also found to have similar boundaries. Thus, optical imaging studies demonstrated individual precise boundaries of these subdivisions, which were positioned right beneath those defined by Ricinus communis agglutinin histochemistry. The presence of functional segregation in each layer leads us to conclude that there are at least three different input-output pathways in the rat vomeronasal system.

Effects of GABAergic agonists and antagonists on oscillatory signal propagation in the guinea-pig accessory olfactory bulb slice revealed by optical recording.

To investigate the action of GABAergic agents on oscillatory signal propagation induced by electrical stimulation of the vomeronasal nerve layer, optical and electrophysiological recordings were carried out in slice preparations of the guinea-pig accessory olfactory bulb. In response to electrical stimuli, characteristic optical signals appeared in each layer: in the vomeronasal nerve layer, a transient presynaptic response; in the glomerular layer, pre- and postsynaptic responses; in the external plexiform, mitral cell and granule cell layers, a damped oscillatory response. Application of the GABAergic agonists, that is, GABA, muscimol (a GABAA receptor agonist) and baclofen (a GABAB receptor agonist), suggested that the GABAB action existed mainly in the glomeruli, whereas the GABAA action was present in both the glomeruli and the external plexiform layer. Bicuculline (a GABAA receptor antagonist) produced long-lasting but nonoscillating excitation in the external plexiform and mitral cell layers, indicating that the GABAA action contributes to the formation of oscillatory responses. When double-pulse stimulation was applied to the vomeronasal nerve layer, the test responses in the glomerular layer and external plexiform and mitral cell layers were depressed, but those in the vomeronasal nerve layer were not. Application of 2-hydroxysaclofen (a GABAB receptor antagonist) mostly blocked paired-pulse depression occurring in the glomerular layer and restored the reduced transmission to mitral cells, but had only a small effect on the depressed oscillatory response in the external plexiform and mitral cell layers. These observations suggest that GABAB action in the glomerular layer might, at least, regulate information flow from vomeronasal afferents to apical dendrites of mitral cells, like a gate inhibition. However, actions other than GABAB could also be involved in the depression of the oscillation in the external plexiform and mitral cell layers.

Sensory disorders after separation of the nasopalatine nerve during removal of palatal displaced canines: prospective investigation.

During a prospective study after separation of the nasopalatine nerve at the foramen incisivum during exposure or removal of impacted and palatal displaced maxillary canines, 59 patients were examined neurologically for 4 weeks postoperatively over an investigation period of 18 months. During the first week after the operation, subjective as well as objective sensory disorders were found in all of the patients, but after 4 weeks at the most no neurological deficit could be detected in any patient.

Inositol-1,4,5-trisphosphate accumulation induced by urinary pheromones in female rat vomeronasal epithelium.

The mechanisms involved in pheromone-induced responses in the vomeronasal neurons, especially in mammals, are still unclear. In the present study, we examined the effects of rat urine samples containing various types of pheromones regulating gonadal functions on the accumulation of cAMP and inositol 1,4,5-trisphosphate (IP3) in a vomeronasal membrane preparation from the female Wistar rat. Stimulation of the preparation with forskolin induced cAMP accumulation, but stimulation with urine samples excreted from the male Wistar rat, the female Wistar rat, and the male Donryu rat did not change cAMP levels. These results were consistent with the electrophysiological results showing that dialysis of a high concentration of cAMP into the vomeronasal neuron does not induce currents. Stimulation with the three urine samples induced the accumulation of IP3 in the membrane preparation. These results are consistent with previous electrophysiological results [K. Inamura, M. Kashiwayanagi, K. Kurihara, Inositol-1,4,5-trisphosphate induces responses in receptor neurons in rat vomeronasal sensory slices, Chem. Senses 22 (1997) 93-103; K. Inamura, M. Kashiwayanagi, K. Kurihara, Blockage of urinary responses by inhibitors for IP3-mediated pathway in rat vomeronasal sensory neurons, Neurosci. Lett. 233 (1997) 129-132]. After the treatment with Pertussis toxin (PTX), the male Wistar urine did not induce IP3 accumulation significantly. Application of the male Wistar urine decreased ADP-ribosylation of Gi with PTX, while that of the male Donryu urine decreased ADP-ribosylation of Go. Thus, the present results support a mechanism by which the responses of the rat vomeronasal neurons to urinary pheromones are mediated by IP3, Gi and/or Go.

Anatomic and magnetic resonance imaging bases for the naso-maxillo-cheek flap technique.

A transfacial approach to the deep cranio-maxillo-facial areas by the naso-maxillo-cheek flap technique (NMCF) is indicated for the treatment of some bulky tumors of the naso-pharynx. The procedure requires precise preoperative imaging. This study presents the morphologic bases of this surgical access and the reasonable limits of the excision preoperatively determined by magnetic resonance imaging (MRI). 18 facial and skull specimens were submitted to surgical facial dismantling by the NMCF technique according to Curioni's method. The clinical application in a 66-year-old patient suffering from a neuroblastoma of the olfactory nerve extended into the naso-pharynx is presented. Pre- and postoperative MRI correlations were made in transverse, sagittal and frontal acquisitions. Several structures were preserved in the procedure: facial reliefs, inferior orbital rim and orbital floor, posterior wall of the maxillary sinus covering the pterygopalatine fossa, lateral and medial pterygoid plates and pterygopalatine ganglion with its branches, lateral facial neurovascular pedicle, teeth and soft palate. Other structures were sacrificed: arteries and nerves located at the sites of skin and mucosal incision, and at the sites of osteotomies, ie the infraorbital nerve, the distal part of the greater palatine nerve, the nerves supplying the naso-pharynx, the nasal septum and the nasal conchae, nasolacrimal groove and lacrimal canal. The NMCF technique gives wide access to the deep nasal and nasopharyngeal areas. It is essential to preserve the lateral facial neurovascular pedicle to prevent necrosis of the midface structures. Preservation of the bony architecture surrounding the osteotomy sites is of great importance to allow precise final bone reassembly. Preoperative MRI appears of paramount importance to determine the borders of the lesion and the possibility of block resection.

Differential laminin isoform expression in the developing rat olfactory system.

Members of the laminin family influence mammalian cells in a variety of ways, mediating adhesion, proliferation, migration, and growth of neuronal processes. Specific laminin domains act through a number of cellular interaction sites to mediate these activities. In the developing olfactory system, axons grow from the olfactory epithelium to synaptic sites in the olfactory bulb a matrix rich in laminins and known mediators of laminin-axon interactions include integrins and a galectin-1/glycoconjugate adhesion system. Using biochemistry, immunocytochemistry, and in situ hybridization, we identified alpha 2, alpha 3, beta 1, beta 2 and gamma 1 laminin isoforms in the late embryonic and neonatal rat olfactory system. However, alpha 1-containing laminin could not be detected in association with olfactory neurons. Immunocytochemistry revealed that beta 2 laminin is preferentially expressed in the ventral and lateral nerve layer of the olfactory bulb and in the main olfactory axon tracks, but is undetectable in the accessory system during embryonic and early postnatal development. In contrast, beta 1 and gamma 1 laminins are evenly distributed throughout the olfactory bulb and in both the main and accessory olfactory axon tracks. The differential localization of laminin chains in vivo is likely to have functional significance for the development and maintenance of the olfactory system.

Pheromone transduction in the vomeronasal organ.

Single-cell physiology and cloning efforts have extended studies of the vomeronasal organ to cellular and molecular levels. Recent work has shown that transduction in the vomeronasal organ is probably mediated by signalling pathways distinct from those that mediate transduction in the main olfactory system. An advance in understanding transduction has come with the cloning from rat vomeronasal organ of a family of putative pheromone receptor genes that bear no sequence similarity to previously cloned receptors. Other work has examined the expression of putative signalling components and found a zonal organization of the epithelium. Patch-clamp studies have described the basic electrical properties of vomeronasal neurons and explored second-messenger pathways.

Evidence for different chemosensory signal transduction pathways in olfactory and vomeronasal neurons.

Both the olfactory and vomeronasal epithelia mediate chemosensory reception. Here we report that several molecules that are highly expressed in the olfactory epithelium and therefore are likely to be important mediators of olfactory signal transduction (Golfalpha, adenylyl cyclase III and the olfactory cyclic nucleotide gated ion channel) are not present in the vomeronasal epithelium. Therefore it appears that distinct molecules mediate chemosensory signal transduction in the olfactory and vomeronasal epithelia. The genes for Golfalpha, adenylyl cyclase III, the olfactory cyclic nucleotide gated ion channel, Ggamma8 and olfactory marker protein which are all expressed in the olfactory epithelium have consensus Olf-1 binding sites. The transcription factor Olf-1 was found to be highly expressed in the olfactory epithelium and was detected at a similar level in the vomeronasal epithelium. The expression pattern of Olf-1 did not correlate with that of molecules involved in olfactory signaling but was more similar to the expression pattern of Ggamma8 and olfactory marker protein which are found both in olfactory and vomeronasal neurons. Therefore, expression of Olf-1 in the olfactory epithelium and the presence of Olf-1 binding sites in a number of different genes found to be expressed in the olfactory epithelium are not sufficient to explain the observed gene expression patterns.

The human vomeronasal organ: prenatal developmental stages and distribution of luteinizing hormone-releasing hormone.

The purpose of this study was to describe in 49 normal human prenatal specimens, 15-156 mm crown-rump length (CRL), the histomorphological development of the bilateral vomeronasal organ localized in the mucosa of the nasal septum. In addition, immunohistochemical localization of luteinizing hormone-releasing hormone (LHRH) was undertaken. The material was classified into five developmental stages (NAS I/V), based on the morphology of the nasal cavity. The vomeronasal organ was visible in stages NAS II, III and IV, corresponding to 21-102 mm CRL. Positive immunohistochemical reaction for LHRH neurons was pronounced in the vomeronasal organ in NAS II and III, corresponding approximately to fetal ages 8-12 gestational weeks (21-51 mm CRL). The study demonstrates in normal human prenatal material that LHRH can be recorded in the bilateral vomeronasal organs during approximately 4 weeks of intrauterine life.

Proximal regions of the olfactory marker protein gene promoter direct olfactory neuron-specific expression in transgenic mice.

Olfactory marker protein (OMP) expression is highly restricted to mature olfactory neurons (ON). Less than 0.3 kb of upstream 5' flanking sequence of the OMP gene directs lacZ expression preferentially to ON in several independently derived lines of transgenic mice. A larger transgene with 0.8 kb of upstream flanking sequence also gave lacZ expression in ON and in a few ectopic sites in the central nervous system (CNS). In addition to the main olfactory epithelium, endogenous OMP is also expressed in chemosensory neurons of the vomeronasal and septal organs, and lacZ expression was detected in neurons of these sites as well. This confirmed the presence of regulatory sequences in the proximal portion of the OMP gene. Endogenous OMP expression in ON was normal in all transgenic lines. Strikingly, in several transgenic lines lacZ expression was restricted to subsets of ON. In one such line, ON axons were intensely stained for lacZ and projected to a subset of olfactory bulb glomeruli. Although identifiable subsets of ON and their termination fields have been described previously, this is the first demonstration of this phenomenon in transgenic mice. These lines of transgenic mice thus provide in vivo models for characterization of genetic elements regulating developmental and functional organization of the olfactory neuroepithelium.

Apoptosis in the normal olfactory epithelium of the adult guinea pig.

Among nerve cells of vertebrates, the olfactory epithelia are uncommon in their capacity for cell turnover. Apoptosis is well known to play a key role in maintaining homeostasis in continuously renewing tissues. We examined whether true apoptosis occurred in the normal olfactory epithelia of healthy adult guinea pigs using nucleic acid labeling. Subsequently, apoptosis was recognized in olfactory nerve cells, indicating that apoptosis might play a role in turnover of the olfactory epithelium.