Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps.

Background: Allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP) is very common clinically. Conventionally, the treatment for these patients is surgical method for CRSwNP followed by treatment with a nasal steroid spray or other antiallergic drugs to control AR. In recent years, some rhinologists introduced vidian neurectomy (VN) or posterior nasal neurectomy (PNN) into endoscopy to treat refractory AR and reported an encouraging outcome. Furthermore, we explore the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP. Objective: To investigate the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP. Methods: Eighty-five patients with ARwCRSwNP who were admitted to our hospital from November 2016 to July 2018 were enrolled in two groups. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN; group B underwent conventional FESS alone. VAS, RQLQ, SNOT-22 and postoperative nasal endoscopy were used to evaluate the improvement in symptoms and the recurrence of nasal polyps. Results: The experimental group had better control of sneezing (p < .05) and rhinorrhea (p < .01) than the control group. For those who underwent surgery more than 6 months prior in both groups, the recurrence rate was 29.6% (8/27) in the experimental group and 44.4% (8/18) in the control group, and there was no significant difference (χ2 = .483, p = .487). Conclusion: FESS combined with PNN can improve the symptoms of sneezing and rhinorrhea caused by ARwCRSwNP more obviously than FESS alone, but there is no clear statistical advantage of this procedure for improving the overall symptoms and controlling the recurrence of nasal polyps.

Surgical options for the allergic rhinitis patient.

PURPOSE OF REVIEW: Allergic rhinitis is a very common disorder that affects millions of patients annually and the hallmark complaint of nasal obstruction significantly impacts the quality of life. Many surgical options exist for the treatment of allergic rhinitis, directed primarily at the underlying nasal obstructive component. The purpose of this review is to highlight and discuss the various surgical modalities and their historical efficacy. RECENT FINDINGS: Much of the literature has focused on reduction of the inferior turbinate for symptomatic improvement in patients afflicted with allergic rhinitis. Endoscopic sinus surgery and septoplasty play little role in the management of allergic rhinitis, unless when seen in conjunction with other conditions such as rhinosinusitis. SUMMARY: Although no single modality has evolved as the gold standard for the treatment of allergic rhinitis, the mainstay of surgical intervention targets the inferior turbinate. It is very important for the otolaryngologist to be familiar with an armamentarium of surgical techniques.

Perineural invasion and spread in head and neck cancer.

Perineural involvement is a well-recognized clinicopathologic entity found in head and neck (H&N) cancers, including mucosal epithelial carcinomas and salivary gland malignancies. Perineural disease remains a diagnostic, prognostic and therapeutic challenge for the multidisciplinary H&N oncology team. Nerves are important routes of tumor spread in H&N malignancies, yet the biology and prognostic implications of perineural tumor growth are not fully understood. On balance, the available evidence suggests that it is associated with an increased risk of locoregional recurrence but the impact on survival remains uncertain. Perineural involvement has implications for locoregional disease diagnosis and management. MRI is the best imaging modality to detect tumor extent. Advanced radiotherapy technologies such as intensity-modulated radiation therapy and image-guided radiation therapy have the potential for more accurate targeting and treatment of anatomically complex patterns of disease spread. This review is limited to nondermatologic H&N cancers.

The morphology of the rat vibrissal follicle-sinus complex revealed by three-dimensional computer-aided reconstruction.

The vibrissal follicle-sinus complex (FSC) is a sensory receptor of the mammalian integumentary system that is located around the mouth. The purpose of the present study was to identify the actual 3-dimensional structure of the rat vibrissal FSC. Rat skin tissue was serially sectioned at a thickness of 10 µm and then stained with Masson's trichrome. The serial sections were reconstructed 3-dimensionally using Reconstruct software. The rat vibrissal follicle is a spindle-shaped structure that is embedded within a blood sinus and enveloped within a thick collagenous capsule. The vibrissal FSC is innervated by the deep vibrissal and superficial vibrissal nerves. The deep vibrissal nerve, travelling in the basal-to-apical direction, penetrates the thick collagenous capsule of the vibrissal FSC. The sinus system can be divided into a superior portion, known as the ring sinus, and an inferior portion, known as the cavernous sinus. The ring sinus contains a C-shaped structure, the ringwulst, which is suspended from the mesenchymal sheath of the follicle. Collagenous trabeculae can be seen in the cavernous sinus but not in the ring sinus. The ring sinus encircles the follicle obliquely and asymmetrically. The ringwulst encircles the follicle incompletely, in a C-shaped fashion. This study has demonstrated the previously underappreciated 3-dimensional structure of the vibrissal FSC, which differs from previously reported descriptions, and provides data that will enhance the understanding of vibrissal function.

Evaluation of the feasibility of the vidian neurectomy using computed tomography.

For around 50 years, various approaches to the vidian neurectomy have been advocated. This indicates that there is no single surgical technique that is superior to all others. In this report, we analyze the included angle between the posterior end of middle turbinate and the anterior opening of the vidian canal. The aim of this paper is to use preoperative CT scanning to find a key anatomical structure to predict the feasibility of the vidian neurectomy. A retrospective research was performed. A total of 63 patients with 106 endoscopic vidian neurectomies between September 2006 and April 2010 were selected. The study population included 50 men and 13 women, with a mean age of 28. A paranasal sinus CT scan was obtained and analyzed. The included angle was measured and compared to the operating success rates. In the successful group (78 sides, 73.58%), the included angle from axial and coronal CT imaging was 30.2 ± 4.9° and 26.4 ± 9.1°, respectively. In the 28 failed sides (26.42%), the value was 33.8 ± 4.8° and 44.3 ± 8.1°, respectively. Statistical analysis confirmed that the difference between those two groups was significant (P < 0.05). The present study reports the relationship between the vidian canal and the middle turbinate, which is represented by their included angle. The findings support the decision to intervene the surgical side with a smaller angle, because of the significantly higher success rate.

Symptomatic SUNCT syndrome associated with ipsilateral paranasal sinusitis.

Sinusitis has rarely been associated with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. We describe a case of symptomatic SUNCT syndrome caused by sinusitis, which showed typical features of SUNCT syndrome. The patient's symptoms completely resolved without recurrence after endoscopic sinus surgery followed by antibiotic treatment. We suggest that ipsilateral paranasal sinusitis accompanied by the spreading of inflammation through a dehiscence in the lamina papyracea could lead to the development of SUNCT syndrome.

Autonomic function and dysfunction of the nose and sinuses.

Patients with inflammatory disorders of the upper airway exhibit varying degrees of ANS dysfunction, including the sympathetic, parasympathetic,and sensory components. Current evidence is insufficient with regard to the exact role of ANS dysfunction and its relationship to these disorders.Thus, the interaction of the ANS and sinonasal inflammation deserves further study.

Orbital passage of pterygopalatine ganglion efferents to paranasal sinuses and nasal mucosa in man.

Parasympathetic nerves of pterygopalatine ganglion origin are considered to enter the orbit and distribute to the nasal mucosa with the anterior ethmoidal nerve. As their distribution has never been demonstrated the present study was undertaken to seek evidence of their passage and to identify their relationship with the ethmoidal nerves. The soft tissues of the pterygopalatine fossa and orbit from sixteen sides of twelve cadavers were removed in one piece and either dissected or cut coronally into slabs and prepared histologically using montages of thin resin-embedded sections at intervals suitable for nerve path tracing. Several of the rami orbitales passing mediodorsally from the ganglion enter the orbit apically, branch and enter the posterior ethmoidal foramen terminating in the lining of the paranasal sinuses and others advance to enter the anterior ethmoidal canal to reach the nasal mucosa. No junctions were made with ethmoidal nerves within the orbit or the canal. Failure of surgical lesions of the anterior ethmoidal nerve as a treatment for vasomotor rhinitis may be attributed to the sparing of the separate parasympathetic nerves. Appropriate chemical lesions, on the other hand, could ensure destruction of isolated parasympathetic nerves while limiting damage to the larger anterior ethmoidal nerve.

Sinusitis: bench to bedside. Current findings, future directions.

Sinusitis, an inflammatory disease of the sinus, is one of the most commonly reported diseases in the United States, affecting an estimated 14% of the population. The prevalence of sinusitis is rising. Between 1990 and 1992, persons with sinusitis reported approximately 73 million restricted activity days-an increase from the 50 million restricted activity days reported between 1986 and 1988. Because critical questions remain unanswered about its cause, pathophysiology, and optimal treatment, sinusitis continues to generate significant health care costs and affects the quality of life of a large segment of the U.S. population. To identify critical directions for research on sinus disease, the American Academy of Allergy, Asthma and Immunology and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., convened a meeting in January 1996 in collaboration with the National Institutes of Allergy and Infectious Disease. This document summarizes the proceedings of that meeting and presents what is intended to be the background for future investigation of the many unanswered questions related to sinusitis.

Sinusitis: bench to bedside. Current findings, future directions.

Sinusitis, an inflammatory disease of the sinus, is one of the most commonly reported diseases in the United States, affecting an estimated 14% of the population. The prevalence of sinusitis is rising. Between 1990 and 1992, persons with sinusitis reported approximately 73 million restricted activity days--an increase from the 50 million restricted activity days reported between 1986 and 1988. Because critical questions remain unanswered about its cause, pathophysiology, and optimal treatment, sinusitis continues to generate significant health care costs and affects the quality of life of a large segment of the U.S. population. To identify critical directions for research on sinus disease, the American Academy of Allergy, Asthma and Immunology and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., convened a meeting in January 1996 in collaboration with the National Institutes of Allergy and Infectious Disease. This document summarizes the proceedings of that meeting and presents what is intended to be the background for future investigation of the many unanswered questions related to sinusitis.

Relationship of the optic nerve to the posterior paranasal sinuses: a CT anatomic study.

PURPOSE: To delineate the relationship between the optic nerves and the posterior paranasal sinuses using CT data. METHODS: Direct coronal sinus CT scans of 150 consecutive patients with chronic inflammatory sinus disease were reviewed by two radiologists. Axial oblique reconstructions along the course of the optic nerve were obtained for the first 100 patients. The direct relationship between the optic nerve and the posterior ethmoid and sphenoidal sinuses was recorded, as were identations into the sinus wall, course of the nerve through the sinus region, pneumatization of the anterior clinoid process, and bone dehiscence. RESULTS: The relationship of the optic nerve to the posterior paranasal sinus fell into one of four discrete categories, type 1 through type 4. All 300 nerves were intimately related to the sphenoidal sinus. A small minority (3%) were in contact with the posterior ethmoidal sinus. Only type 4 nerves had contact with the posterior ethmoid air cell. Type 1 nerves course adjacent to the sphenoid sinus without indentation of the wall (228 nerves, 76%). Type 2 nerves course adjacent to the sphenoidal sinus, causing indentation of the sinus wall (44 nerves, 15%). Type 3 nerves course through the sphenoid sinus (19 nerves, 6%). Type 4 nerves course immediately adjacent to the sphenoidal sinus and the posterior ethmoidal air cell (9 nerves, 3%). Bone dehiscence over the optic nerve was found in 24% of the nerves; 4% of the optic nerves in our study had an associated pneumatized anterior clinoid process and 77% of these had an associated dehiscence over the optic canal. CONCLUSIONS: In all our cases the course of the optic nerve was adjacent to the sphenoidal sinus. Only 3% were in contact with the posterior ethmoidal sinus. Anatomic configurations that predispose the optic nerve to injury include type 2 or 3 optic nerves, bone dehiscence over the nerve, and pneumatization of the anterior clinoid process. These configurations are common and should be routinely sought out so that devastating complications from sinus surgery can be avoided.

A comparison of morphological effects on the rabbit nasal and sinus mucosa after surgical denervation and topical capsaicin application.

In order to study morphological effects on the nasal and sinus mucosa, New Zealand White rabbits underwent either unselective, regional sectioning of sensory and parasympathetic nerve branches or topical treatment of the mucosa with capsaicin. Ten days after treatment, mucosal specimens were analyzed by light and electron microscopy. Immunohistochemistry was used to evaluate neuropeptides present, in particular substance P, calcitonin gene-related peptide, vasoactive intestinal peptide and neuropeptide Y. In surgically denervated rabbits, mucosal glands were found to be enlarged and contained an increased number of zymogen granules having a bipartite substructure. Topical capsaicin application caused localized epithelial changes in the sinus mucosa and maxilloturbinal region of the nose, including clotting of cilia and an increased number of goblet cells. Reduced amounts of all neuropeptides investigated were found in the surgically denervated animals, while topical capsaicin treatment had only marginal effects on the mucosal neuropeptide content. The morphological changes observed after surgical denervation suggest an imbalance between neural stimulation and secretory capacity of the mucosal glands. These findings could explain the difference in clinical effect noted between sectioning of the vidian nerve and topical treatment with capsaicin in patients with perennial rhinitis.

Sino-bronchial reflex, asthma and sinusitis.

Sinusitis should be suspected in cases of chronic, difficult to control asthma or other pulmonary diseases. Appropriate measures to diagnose and treat sinus disease are listed, and an upright Waters roentgenogram may be all that is required for diagnosis. A true sino-bronchial reflex is proposed in these patients. Nasal receptors and reflexes are effective in the physiology of the nose, and in many cases, the diagnosis and treatment of rhinitis and sinusitis results in the improvement of various chronic pulmonary conditions.

[Peculiarities of the innervation of paranasal cavity mucosa in Ovis aries]. / Su alcune particolarita' dell'innervazione della mucosa dei seni paranasali in Ovis aries.

The innervation of the mucous membranes in the paranasal cavities of "ovis aries" appears homogeneous as regards the various nasal sinuses. It is represented by numerous nervous bundles which are in the deep and middle parts of the mucous membranes, and have sensory terminals and fibres assigned to the vessels and glandular adenomeres. In the subepithelial stratum can be noted a superficial plexus from which come off the fibres assigned to the epithelial elements of the mucous membranes.

[Diagnostic and therapuetic local anesthesia in facial neuralgia (author's transl)]. / Diagnostische und therapeutische Lokalanästhesie beim Gesichtsschmerz.

Diagnostic and therapeutic local anesthesias (DLA and TLA) in experienced hands are also an important method first of establishing the cause of certain facial neuralgias and then of treating them successfully. Diagnostic and therapeutic local anesthesias presuppose a thorough examination of all factors which may arise in a particular facial neuralgia. If local anesthesia reveals a peripheral cause for the facial neuralgia concerned, a lasting relief of pain can then be obtained through extinction of the source of pain so that the body can restore, at first temporarily and under certain circumstances after consistent repetition of therapeutic local anesthesia at the same spot continuously, the disordered functions in this area (dysesthesia, dyskinesia, dyscrasia, dysthymia). DLA and TLA are only one method of peripheral neurotherapy.