Nasal Lining Research Articles

Inflammation in cystic fibrosis airways: relationship to increased bacterial adherence.

It is unclear whether inflammation in the cystic fibrosis (CF) lung relates predominantly to bacterial infection, or occurs as a direct consequence of mutant cystic fibrosis transmembrane conductance regulator (CFTR) protein. Interleukin (IL)-8 secretion from CF and non-CF cell lines, and from CF and non-CF human primary nasal epithelial cells incubated with or without Pseudomonas aeruginosa, was measured. Activation of nuclear factor-kappaB (NF-kappaB) in unstimulated CF and non-CF nasal epithelial cells, cell lines and murine tissues was measured by gel-shift assays. No significant difference in basal IL-8 production or NF-kappaB activation was observed between CF and non-CF primary nasal cells. However, CF cells exhibited a significantly (p<0.01) increased IL-8 secretion following P. aeruginosa stimulation. Equalization of the increased P. aeruginosa adherence observed in CF cells, to non-CF levels, resulted in comparable IL-8 secretion. Further, IL-8 production did not differ with mutations which result in either correctly localized CFTR, or in partial/total mislocalization of this protein. Similar levels of NF-kappaB activation were observed in a number of organs of wildtype and CF mice. Finally, IL-8 secretion and NF-kappaB activity were not consistently increased in CF cell lines. Cos-7 cell transfection with plasmids expressing deltaF508 or G551D mutant CFTR protein resulted in increased activation of a p50-containing NF-kappaB complex, but IL-8 secretion was similar to wild-type cells. The authors conclude that the stimulus produced by Pseudomonas aeruginosa is the predominant inflammatory trigger in their models.

Primary correction of the unilateral cleft nasal deformity.

An 18-year experience with the management of the unilateral cleft nasal deformity in 1200 patients is presented. A primary cleft nasal correction was performed at the time of lip repair in infancy; a secondary rhinoplasty was done in adolescence after nasal growth was complete. The technical details of the authors' primary cleft nasal correction are described. Exposure was obtained through the incisions of the rotation-advancement design. The cartilaginous framework was widely undermined from the skin envelope. The nasal lining was released from the piriform aperture, and a new maxillary platform was created on the cleft side by rotating a "muscular roll" underneath the cleft nasal ala. The alar web was then managed by using a mattress suture running from the web cartilage to the facial musculature. In 60 percent of cases, these maneuvers were sufficient to produce symmetrical dome projection and nostril symmetry. In the other 40 percent, characterized by more severe hypoplasia of the cleft lower lateral cartilage, an inverted U infracartilaginous incision and an alar dome supporting suture (Tajima) to the contralateral upper cartilage were used. Residual dorsal hooding of the lower lateral cartilage was most effectively managed with this suture. This primary approach to the cleft nasal deformity permits more balanced growth and development of the ala and domal complex. Some of the psychological trauma of the early school years may be avoided. Also, because of the early repositioning of the cleft nasal cartilages, the deformity addressed at the time of the adult rhinoplasty is less severe and more amenable to an optimal final result.

The forehead flap for nasal reconstruction.

Reconstruction of extensive nasal defects often represents a significant challenge owing to several unique qualities of the nose, such as complex topography, mobile free margins, and multiple nasal subunits. Furthermore, loss of internal nasal lining and/or structural skeletal support may be present following removal of extensive skin cancers. To describe our experience with the use of forehead flap reconstruction for extensive nasal defects. Retrospective case series. Academic health care hospital system. One hundred forty-seven patients with extensive nasal defects repaired with a forehead flap. The functional and aesthetic results were assessed. The characteristics of defects repaired with the forehead flap and the need for lining and/or cartilage were examined. The forehead flap was used to repair 147 nasal defects after Mohs excision of nonmelanoma skin cancer. Full-thickness skin was lost in all cases, structural skeletal support in 68 cases (46%), and internal mucosal lining in 45 cases (31%). Our experience and surgical technique using the forehead flap are described. The forehead flap represents one of the best methods for repair of extensive nasal defects. Near-normal functional and cosmetic results can be achieved.

The Early Secondary Gingivoperiosteoplasty

The Early Secondary Gingivoperiosteoplasty

Cystic Fibrosis Transmembrane Conductance Regulator Does Not Affect Neutrophil Migration across Cystic Fibrosis Airway Epithelial Monolayers

Recent studies have shown that airway inflammation dominated by neutrophils, ie, polymorphonuclear cells (PMN) was observed in infants and children with cystic fibrosis (CF) even in the absence of detectable infection. To assess whether there is a CF-related anomaly of PMN migration across airway epithelial cells, we developed an in vitro model of chemotactic migration across tight and polarized CF(15) cells, a CF human nasal epithelial cell line, seeded on porous filters. To compare PMN migration across a pair of CF and control monolayers in the physiological direction, inverted CF(15) cells were infected with increasing concentrations of recombinant adenoviruses containing either the normal cystic fibrosis transmembrane conductance regulator (CFTR) cDNA, the DeltaF508 CFTR cDNA, or the beta-galactosidase gene. The number of PMN migrating in response to N-formyl-Met-Leu-Phe across inverted CF(15) monolayers expressing beta-galactosidase was similar to that seen across CF(15) monolayers rescued with CFTR, whatever the proportion of cells expressing the transgene. Moreover, PMN migration across monolayers expressing various amounts of mutated CFTR was not different from that observed across matched counterparts expressing normal CFTR. Finally, PMN migration in response to adherent or Pseudomonas aeruginosa was equivalent across CF and corrected monolayers. The possibility that mutated CFTR may exert indirect effects on PMN recruitment, via an abnormal production of the chemotactic cytokine interleukin-8, was also explored. Apical and basolateral production of interleukin-8 by polarized CF cells expressing mutated CFTR was not different from that observed with rescued cells, either in baseline or stimulated conditions. CF(15) cells displayed a CF phenotype that could be corrected by CFTR-containing adenoviruses, because two known CF defects, Cl(-) secretion and increased P. aeruginosa adherence, were normalized after infection with those viruses. Thus, we conclude that the presence of a mutated CFTR does not per se lead to an exaggerated inflammatory response of CF surface epithelial cells in the absence or presence of a bacterial infection.

Nasal reconstruction with an expanded dual forehead flap

Nasal reconstruction with an expanded dual forehead flap is described. This method provides for nasal lining and covering with one forehead flap. The relationship between the two flaps is more flexible than a folded flap. Rigid support can be placed between the two flaps. This is an effective method for the reconstruction of a composite nasal defect when it is difficult to find an appropriate local lining flap.

Hepatocyte Growth Factor Inhibits Amiloride-Sensitive Na+Channel Function in Cystic Fibrosis Airway Epithelium in vitro

Cystic fibrosis (CF) airway epithelial cells have a reduced cAMP-dependent Cl−conductance channel (CFTR) function but an increased level of amiloride-sensitive Na+channel (ENaC) activity. Recently, expression of theα-subunit of the ENaC protein complex was shown to be down-regulated by activation of the extracellular signal-regulated protein kinase (ERK) pathway. In the present study we have examined the actions of a potent regulator of the ERK pathway, recombinant human hepatocyte growth factor (rhHGF), on the function of ENaC in confluent, polarized monolayers of both primary cultures of CF airway cells and an SV40-transformed CF nasal epithelial cell line (JME CF/15). Treatment of JME/CF 15 cells with rhHGF at concentrations of 100 ng/ml and above was found to dramatically decrease the activity of amiloride-sensitive Na+transport. This effect required basolateral exposure of the cytokine. Addition of 100 ng/ml rhHGF to JME/CF 15 cells decreased Ieqwith a t1/2of 18 h, with a maximal inhibition of 90% by 36 h. By 48 h, stimulation with rhHGF induced a down-regulation of its receptor,c-met, expressed in these cells. The decrease in Ieqof JME/CF 15 monolayers was not immediately reversed upon removal of rhHGF. Treatment with rhHGF did not appear to affect monolayer resistances nor Cl−currents induced by mediators such as isoproterenol, histamine or bradykinin. Studies with primary cultures of CF airway cell sheets demonstrated comparable sensitivity and time-course properties for the inhibition of amiloride-sensitive currents following rhHGF addition. These observations are consistent with the possible application of an extracellular signalling molecule, such as the cytokine HGF, to reduce the abnormally high activity of amiloride-sensitive Na+ion channels observed in CF airway cells.

The use of otherwise redundant skin to provide nasal lining in the reconstruction of full-thickness alar defects by nasolabial flap repair

SUMMARY.The use of otherwise redundant nasolabial flap skin is described for lining in reconstruction of full-thickness alar defects. The techniques have been successfully used to reconstruct full-thickness alar defects in four patients. The overall procedure has the advantage of providing well-vascularised tissue of appropriate colour, texture and thickness for external skin and nasal lining in one-stage reconstruction.

The infradome graft: a new technique to improve dome reshaping in rhinoplasty.

As the open approach rhinoplasty has gained popularity, newer techniques for aggressive reshaping of the alar cartilage have become available. The most effective way to increase alar dome definition is the dome plication technique described by Daniel, which places a horizontal mattress suture, applied with incremental tension, between the medial and lateral crura. The disadvantage of this technique is that it can produce either overtightening or distortion of the cartilage, with excessive pinching of the nasal tip. Also, as it relies on a single nylon suture to fight against the cartilage's shape memory, it has the potential for relapse. The present article describes a new technique to overcome these problems. It consists of placing two parallel strips prepared from the resected alar cartilage excess under the domes. These grafted cartilages block the plication suture, thus avoiding the risk of excessive pinching of the domes and ensuring symmetry and stability. Using this technique, I have consistently obtained a nasal tip that is well defined over the nasal dorsum line in my patients.

Subperiosteal Rhytidectomy Provides Superior Correction of Midfacial Aging

I completely agree with using a more superficial technique for the neck and lower portions of the face. I will often undermine all the way around, defat, and perform superficial musculoaponeurotic system work in the lower portions of the face. But when it comes to correcting midfacial aging, primarily nasolabial fold problems, inferior locations of the nasal jugal line, concavity in the lower lid, and laxity in the lateral canthal area, I perform the subperiosteal dissection. My approach can be performed either through a subciliary lower lid incision or through a gingival buccal incision. Subperiosteal dissection is then carried out over the maxilla, malar zygomatic, and lateral orbital rim area; the arch itself is dissected subperiosteally in an anterior-to-posterior direction. Through the temporal incision, the plane of dissection is superficial to the deep temporal fascia. This is carried inferiorly to the sentinel vein. The posterior one third of the arch is then identified. The periosteum …

Presurgical columellar elongation and primary retrograde nasal reconstruction in one-stage bilateral cleft lip and nose repair.

We present a new combined approach to primary bilateral cleft lip, nose, and alveolus repair using presurgical nasoalveolar molding combined with a one-stage lip, nose, and alveolus repair. Presurgical alveolar molding is used to bring the protruding premaxilla back into proper alignment with the lateral segments in the maxillary arch. Presurgical nasal molding produces tissue expansion of the short columella and nasal lining. A coordinated surgical approach involves a one-stage repair of the lip, nose, and alveolus. The nasal repair uses a retrograde approach in which the prolabial flap and columella are reflected over the nasal dorsum by continuing the dissection behind the prolabium up the membranous septum and over the septal angle. Tissues are dissected out from between the tip cartilages, and the domes are sutured together in the midline. This method joins a new class of bilateral cleft repairs that place the primary emphasis on correction of the deformity of the nasal tip cartilages.

Differential expression of lactoseries carbohydrate epitopes HNK-1, CD15, and NALA by olfactory receptor neurons in the developing chick.

The formation of the nasal lining with its sensory and its nonsensitive respiratory epithelium requires a spatially ordered pattern of cellular differentiation. Aiming at identifying cell recognition molecules that may be involved in cellular differentiation steps, we applied a panel of antibodies to terminal carbohydrate sequences of the lactoseries on the developing chick olfactory epithelium. This approach is based on the idea that these terminal sugar residues may be involved in certain steps of maturation. Restricted expression of three epitopes NALA, HNK-1, and CD15 was observed in olfactory receptor neurons. The first immature olfactory receptor neurons were observed by day 3 of incubation, expressing the HNK-1 epitope, whereas a total epithelial staining was observed for NALA. By day 9 of incubation high numbers of HNK-1 positive immature olfactory receptor neurons were observed. At the same time mature olfactory receptor neurons showed immunoreactivity for CD15, whereas NALA was still expressed throughout the whole epithelial cell population. However, there was a pronounced staining in the population of mature olfactory receptor neurons. Around hatching only CD15 was detectable in (mature) olfactory receptor neurons, whereas HNK-1 and NALA immunoreactivity have switched to glandular and sustentacular cells respectively. The differentiation-dependent expression patterns of these three cell surface molecules suggest them as suitable markers to explore mechanisms that determine embryonic olfactory receptor neurogenesis.

Lining options in nasal reconstruction

A nose must have an inside, an outside, and a central lamella which will provide support, a nasal shape, and brace the reconstruction against the forces of wound healing. In full-thickness defects, lining frequently determines the final aesthetic result. Lining should be vascular, permitting primary healing without tissue loss, late infection, or extrusion of cartilage grafts. It must be thin and supple It must allow the placement of primary support grafts, which will instill an external nasal shape and brace it against wound contracture. The most common choices for lining include the prefabricated forehead flap, the staged sequential skin graft technique for nasal lining, and intranasal lining flaps with primary cartilage grafts. Adjacent turnover flaps based on scar around the periphery of a defect may also be useful although they are thick, stiff, and limited in length. The pros, cons, and availability of each technique must be evaluated to determine which will best fit the needs of the defect and condition of the patient.

Subtotal Nasal Reconstruction Using a Bi Valved Paramedian Forehead Flap

Many surgical options have been proposed for total or subtotal reconstruction of the nose after extirpative surgery or trauma. Careful replacement of all anatomic layers including the structural framework and internal and external nasal lining is essential to successful reconstruction. If adequate internal lining is present, reconstruction of the structure of the nose and the external nasal lining is often straightforward. Difficulty arises with providing sufficient internal nasal lining in patients who underwent full thickness reconstruction of half of the nose with a bi-valved paramedian forehead flap. A different plane of dissection is used for the flap and structural grafts are placed between the layers of the axial pattern flap. The anatomy, plane of flap dissection, and biomechanics of flap transfer are presented as well as the specific technique for nasal reconstruction. The bi-valved paramedian forehead flap presents another surgical option for reconstruction of full thickness defects of the nose.

Total nasal reconstruction with alloplastic and autogenous grafts.

The basic principles of successful total nasal reconstruction include providing a sufficient amount of tissue coverage, creating an adequate structural framework, and fashioning a viable inner lining. Relative uniformity of opinion exists regarding sources for tissue coverage and nasal lining. A variety of options exists, however, regarding the type of material used for nasal framework. Alloplastic metals, such as vitallium or titanium mesh, combined with autogenous soft tissue coverage, are reliable alternatives for use in total nasal reconstruction.

Nasal Cavity Lining Fluid Ascorbic Acid Concentration Increases in Healthy Human Volunteers Following Short Term Exposure to Diesel Exhaust

To determine if diesel exhaust (DE) exposure modifies the antioxidant defense network within the respiratory tract lining fluids, a randomized, single blinded, crossover control study using nasal lavage and flexible video bronchoscopy with bronchial and broncho-alveolar lavage was performed. Fifteen healthy, nonsmoking, asymptomatic subjects were exposed to filtered air or diluted diesel exhaust (300mg m-3 partic-ulates, l.6ppm nitrogen dioxide) for one hour on 2 separate occasions, at least three weeks apart. To examine the kinetics of any DE-induced antioxidant reactions, nasal lavage fluid and blood samples were collected prior to, immediately after, and 51/2 hours post exposure. Bronchoscopy was performed 6 hours after the end of DE exposure. Ascorbic acid, uric acid and reduced glutathone (GSH) concentrations were determined in nasal, bronchial, bronchoalveolar lavage and plasma samples. Malondialdehyde (MDA) and protein carbonyl concentrations were determined in plasma and bronchoalveolar lavage samples. Nasal lavage ascorbic acid concentration increased 10-fold during DE exposure [1.02 (0.26–2.09) Vs 7.13 (4.66–10.79) μmol/L-1, but returned to basal levels 5.5 hours post-exposure [0.75 (0.26–1.51) μmol/L-']. There was no significant effect of DE exposure on nasal lavage uric acid or GSH concentration. DE exposure did not influence plasma, bronchial wash, or bronchoalveolar lavage antioxidant concentrations and no change in MDA or protein carbonyl concentrations were found. The physiological response to acute DE exposure is an increase in the level of ascorbic acid in the nasal cavity. This response appears to be sufficient to prevent further oxidant stress in the respiratory tract of normal individuals.

Nasal lining flaps in contemporary reconstructive rhinoplasty.

The advances that have taken place in the last decade in reconstructive rhinoplasty are based in strong major on the development of internal lining mucosal flaps used to resurface the interior of reconstructed full thickness nasal defects. This paper provides an in-depth analysis of these thin well vascularized flaps harvested from the remaining mucosa and vestibular skin of the nasal passage. They provide the foundation which is overlaid with cartilage grafts to replace skeletal support and covering flaps to resurface the grafts. This contemporary concept of layered reconstruction, replacing missing tissue with like tissue has revolutionized the approach to reconstructive rhinoplasty and has raised it to a higher level of sophistication resulting in enhancement in aesthetic and functional results.

The transverse nasal line: an embryonic fault line

The transverse nasal line has long been neglected and frequently overlooked. This narrow pink or hyperpigmented line or groove extends transversely between the upper two-thirds and the lower third of the nose. It is often hereditary and may be the locus of comedones and milia. Eighteen examples are reported by us, along with a possible embryological interpretation.

Nasal reconstruction using a combination of alloplastic materials and autogenous tissues: a surgical alternative.

Re-creation of a functional and aesthetically acceptable nose after partial nasal defect requires accurate reproduction of nasal lining, support, and coverage. Most authors recommend an approach to reconstruction with cantilevered bone grafting and paramedian forehead flap placement. The authors propose an alternative approach for selected patients with total or near-total nasal defects combining both alloplastic and autogenous tissues. This method uses vitallium or titanium mesh for the dorsal framework formation, tissue-expanded paramedian forehead flap for soft tissue coverage, and composite chondrocutaneous auricular grafts for tip reconstruction. Nine individuals underwent nasal reconstruction using this method. The indications, details, and potential advantages of this technique are described with accompanying photographic results. A flexible approach using a combination of alloplastic materials and autogenous tissues provides additional reconstructive options for individuals with total or near-total nasal defects.

Predictive variables for the outcome of early functional treatment of Class III malocclusion

The aim of this study was to select a model of cephalometric and occlusal predictive variables for the results of early treatment of Class III malocclusion, due to mandibular protrusion in the deciduous dentition. Lateral cephalograms and dental casts of 45 subjects (22 boys and 23 girls) with Class III malocclusion in the deciduous dentition were analyzed at the start of treatment (mean age 5.57 ± 0.85 years). The patients were treated with a functional appliance (removable mandibular retractor). All subjects were reevaluated after a mean period of 9.54 ± 2.28 years comprising active treatment plus retention. At this time, the sample was divided into two groups according to occlusal criteria: successful group (23 subjects) and unsuccessful group (22 subjects). Stepwise variable selection on the measurements at the time of first observation identified three predictive variables: the inclination of the condylar axis in relation to the stable basicranial line (CondAx-SBL), the inclination of the nasal line to the mandibular line (NL-ML), and the transverse width of the mandibular arch measured at the first deciduous molars. Discriminant analysis assigned a classificative power of 95.55% to the predictive model. On the basis of the equation generated by the multivariate statistical method, outcome of early treatment for each new case with Class III malocclusion in the deciduous dentition can be accordingly predicted. The important role of both vertical and transverse relationships in Class III prognosis was emphasized. (Am J Orthod Dentofac Orthop 1997;112:80-6.)