Nasal Septal Mucosa Research Articles

The role of fenestrated vessels for the secretory process in the nasal mucosa: A histological and transmission electron microscopic study in the rabbit

Both nasal glands and nasal vessels are supposed to be responsible for the humidification of inhaled air. After previous studies on the vasculature of the nasal septal mucosa in the rabbit, we examined vessels of the anterior concha in order to find a morphological equivalent to explain the role of endonasal vasculature in the secretory process of this tissue. The main findings of our study include the detection of fenestrated endothelial walls of both capillaries and venous sinuses located underneath and directly adjacent to the basal cell layers of the epithelium. The same phenomenon-fenestrated vessels underneath the epithelium with the fenestrated parts facing the epithelial cells-has been described in other parts of the body and has been called "polar differentiation." In accordance with the interpretations of other authors, we conclude that these features are responsible for the regulation of endonasal fluid exchange.

Squamous Cell Carcinoma of the Nasal Septum Mucosa

Primary squamous cell carcinomas of the nasal septum constitute only 9% of all malignant tumors of the nasal cavity. We present 16 cases occurring during a 14-year period. As the initial signs of these carcinomas are no different from non-neoplastic disease, a high index of suspicion is necessary in order to correctly diagnose these lesions. It seems to us that when the diagnosis of nasal septum carcinoma is established, the best method of treatment is wide surgical excision and immediate repair of the defect by a split-skin graft.

The Cocaine User

The current popularity of cocaine use poses special hazards for the patient and the plastic surgeon during rhinoplasty. It is incumbent upon the surgeon to inquire preoperatively about possible recreational use of cocaine. As the preferred site of cocaine administration, the nasal septal mucosa is exposed to both the intense vasoconstrictive action of cocaine and the irritative effects of numerous contaminating additives. Pathologic changes in the septal mucosa should be recognized by preoperative rhinoscopy and evaluated by biopsy. In this series of 13 patients, fewer than half were properly identified as cocaine users during the preoperative consultation. Preoperative rhinoscopic findings varied from grossly unremarkable septal mucosa to visible perforation and microscopic evidence of granulomas, inflammation, and necrosis. Surgical complications consisted of localized septal collapse, delayed mucosal healing, and inadequate correction of septal deflection. Submucous resection and septoplasty should be avoided in patients with a known history of intranasal cocaine application. Although rhinoplasty can be safely performed in selected patients with a history of cocaine use, it may be extremely limited, unfeasible, or hazardous in those with significant mucosal and cartilaginous impairment as well as in those patients who refuse or are unable to relinquish the drug.

Permeability changes in guinea pig nasal epithelium after exposure of hypotonic solution

One ml of tap water (hypotonic solution) was poured into the nasal cavities of 40 tracheostomized guinea pigs. After the time interval ranging from 0 to 8 hours, 2ml of hoarseradish peroxidase saline solution (HRP Sigma typeVI: 3mg per ml in saline) was poured into the nasal cavity and septal mucosa was removed at five minutes after the HRP exposure. The mucous membranes were fixed with 2.5% glutalaldehyde in 0.1M phosphate buffer and were reacted for localization of peroxidase activity by the method of Graham and Karnovsky. After being postfixed with 2% OsO4 in 0.1M phosphate buffer, the blocks were dehydrated through graded ethanol. After embedding into epoxy resin, the 1μm thick sections and 80nm ultrathin sections were made and observed under a light microscope and an electron microscope (HITACHI H-600) with the accelerating voltage of 50KV.The following results were obtained.1) Immediately after hypotonic water exposure, the permeability of nasal epitherium became more accelerated.2) HRP precipitates were present in the intercellular space and also in the cytoplasm of some goblet and cilliated cells.3) It was also confirmed that HRP could enter the intercellular space through the tight junction.4) The nasal mucosa remained permeable at least for 6 hours after the tap water exposure and its permeability gradually returned to normal thereafter.Based upon the present experiments, it was concluded that hypotonic water exposure of the nasal cavity could change epitherial permeability although morphological changes of the junctional complexes were not obvious.

口蓋裂患者の鼻腔粘液線毛機能

We examined nasal mucociliary transport by the saccharin method and nasal ciliary beating frequency by the photoelectric method in cleft palate patients and normal subjects. The saccharin time was longer in cleft palate patients than that in normal subjects. Cleft palate patients were devided into two groups: group 1 with sinusitis and group 2 without sinusitis. The saccharin time was longer in group 1 than in group 2 and longer in group 2 than in normal subjects. Ciliary beating frequency of the nasal septal mucosa was lower in cleft palate patients than in normal subjects. Cleft palate patients appeared to have impaired nasal mucociliary function.

抗コリン剤臭化イプラトロピウムの鼻粘膜繊毛上皮に及ぼす影響の基礎的研究

Ipratropium bromide (IpBr) as an intra-nasal spray has been used to reduce nasal discharge. Its effect on the function and morphology of the nasal ciliary epithelium was investigated.Human nasal mucosa cultured in RPMI-1640 medium was used for counting ciliary activity by a photo-electric method. Nasal septal mucosa of C3H mice was employed for morphological observation by a scanning electron microscope.It was found that 40μg of IpBr sprayed twice into each nostril, which is the recommended dose of Atrovent®, was harmless. Furthermore, four applications a day appear to be safe from the evidence of elimination from the nasal cavity within 30min. Toxicological studies showed that spraying into both nasal cavities causes no problem.

Mustardé Flap Lower Lid Reconstruction after Malignancy

The Mustardé rotational cheek flap has been used to reconstruct the lower eyelids of 55 patients since 1964. Results and complications were well-documented with preoperative and postoperative photographs, and the patients have been followed from one to 14 years with a mean age follow-up of seven years. The most frequent complications were downward contraction and sagging of the flap and ectropion of the lid margin. To prevent them, the zygomatico-cheek flap must be carefully designed, rotated, and sutured as high as possible so that immediately postoperatively, the palpebral fissure is only a narrow slit. The flap's lining should be of nasal septal mucosa and cartilage joined with permanent sutures to the medial and lateral canthal tendons.

Tarsal Pedicle Flap for Lower Eyelid Reconstruction

When reconstructing the lower eyelid with use of a temporal-zygomatic skin flap, the inner lining can be provided by a tarsal pedicle flap from the upper eyelid. The flap is hinged in the superior cul de sac and is similar to the letter T on its side, obviating the need to use nasal septal cartilage and mucosa. This method maintains the upward curve of the lower eyelid and restores the lateral canthal angle while causing very little noticeable shortening of the horizontal fissure.

Distribution of epithelia and glands of the nasal septum mucosa in the rat.

A histotopographic study of the nasal septum mucosa in rats was made using semi-serial sections stained with PAS-hematoxylin, reconstructed in form of maps representing the structure in a sagittal plane. The stratified squamous, respiratory and olfactory epithelia and Masera's organ cover 14.8, 43.6, 41.6 and 1.8%, respectively, of the septal surface (117.1 mm2). In the vestibular region, only ducts of PAS-negative glands of the respiratory region are found, and below the septum there is the infraseptal gland with PAS-negative acini. In the respiratory region, PAS-negative acinous glands form two groups: the superior and the inferior one occupying 10.5 and 1.5%, respectively, of the septal area. PAS-positive acinous glands are in the inferior half of the respiratory region and in a small anteroinferior portion of the olfactory region. Besides goblet cells broadly distributed, the respiratory epithelium presents scattered intraepithelial PAS-positive glands which are concentrated in the anterior portion and close to the nasopharyngeal duct. In the olfactory region prevail Bowman's PAS-positive glands which are also present in the mucosa of Masera's organ, but are not seen in the olfactory mucosa of Jacobson's organ. In the latter, PAS-positive glands are found in the respiratory mucosa. Globular leukocytes, cells of connective tissue origin, are constantly infiltrating the superior regions of the respiratory and olfactory epithelia, being more numerous in female rats.

A VERY RARE MALFORMATION OF THE TONGUE--CONGENITAL UNILATERAL ADHESION OF THE TONGUE WITH FACIAL HEMIATROPHY

A case, fifteen-year-old boy, of congenital unilateral adhesion of the tongue with facial hemiatrophy on the same side was reported.Slight disturbance of speech was noted on admission. The right anterior pillars was located anteriorly, making adhesion to the lateral edge of the tongue, while the right posterior pillar was not found. The right inferolateral surface also showed adhesion to the oral base, so that the patient was unable to stretch out his tongue straight.Plastic surgery was tried to incise the adhesion and to transplant the nasal septal mucosa to prevent the re-adhesion.Besides malformed tongue, slight asymmetry of skull, mandibule and high portion of right clavicule were demonstrated in X-ray films.However, no disturbed movement of sternoclavicular joint was noted.This facial hemiatrophy is likely to be the the same embryological anomaly as seen in the atresia of the ear. Some similarity to orofaciodigital syndrome was also discussed.

THE STUDY OF LOCAL HEMOSTATICS IN THE FIELD OF OTO-RHINO-LARYNGOLOGY

Bleeding encountered in the field of oto-rhino-laryngology is mainly parenchymatous in nature. However, very little has been studied about the method of local hemostasis.Using rabbits, the author studied the capillary blood flow in nasal mucosa and auricles under the microscope, and various local hemostatics were applied and their effects were observed. Results obtained were as follows:1) Capillary blood vessels in rabbit nasal septal mucosa were specific in their arrangement and in reticular pattern, being different from those in other parts of the body. The similar has been observed in human septal mucosa.2) The author selected Manetol, one of the tissue thromboplastin preparations, to inject into the tissue for the purpose of local hemostasis. Clinically, this was added to local anesthetic, which was Xylocaine with epirenamine and, injected into the tissue with favorable local anesthetic and hemostatic effect3) Hydrogen peroxide solution, an effective local hemostatic for parenchymatous bleeding, was applied and its hemostatic mechanism was studied. It was found that hemostatis was obtained by the occlusion of capillary lumina by oxygen bubbles.4) As a new local hemostatic, ferric ammonium sulfate (iron alum) solution was used and its prominent hemostatic effect and astrictive were reported. Olinicaliy, this solution showe no major destructive effect on the tissue, althougth some irritation to the tissue was noted. An attempt was made to remove its irritative effect so that it could be used routinely.

STUDIES ON VASCULAR PERMEABILITY AND MUCOSAL ABSORPTION IN THE FIELD OF OTO-RHINOLOGY

Absorption ability of nasal septum mucosa in healthy subjects and those with spontaneous nasal bleeding was compared using normal saline containing radioactive Na24. Fundamental experiments concerning absorption and permeation also performed using radioactive I131 and guinea pigs. Results were as follows:1) Comparing with healthy subjects, cases with spontaneous nasal bleeding showed an increase in fluid absorption through nasal septum mucosa, in parallel with an increase in system vascular permeability.2) In sensitized guinea pigs, fluid and protein absorption ability was increased in the early stageeven before the manifestation of morphogical changes. Protein permeability was also slightly increased.3) At the site of local anaphylaxis, in the early stage, there was a difference in the speed of fluid absorption through the mucosa and skin. Absorption through the mucosa was faster than that through the skin.4) No change in fluid absorption was seen in guinea pigs with anemia due to experimental blood loss or with vitamin C deficiency.5) Absorption ability, like permeation ability, is one of the characteristics of blood vessels. The examination of absorption ability presents an important guide in diagnosis, evaluation of the prognosis; and treatment of the diseases.

COLOR INDEX OF THE NASAL SEPTUM: A CRITICAL STUDY OF THE VASOMOTOR MECHANISM OF THE NOSE

The etiology of nasal disease is complex, with important underlying constitutional factors remaining unrecognized or improperly interpreted. Jarvis¹and his coworkers believed that an important constitutional factor in the production of infections and allergic nasal disease is an acid-base imbalance, that these imbalances can be rectified by diet, and that they can be recognized by the color of the nasal septal mucosa. A recent report²gave the results of a critical study of the supposed value of the color of the nasal septum as an index of acid-base imbalance resulting from dietary insufficiencies. The following conclusions were drawn: 1. No correlation could be found between the color of the nasal mucosa and acid-base disturbances. 2. Diets high in foods producing alkaline or acid metabolic products failed to influence either the color of the septal mucosa or the symptoms of allergic or infectious nasal disease. Following this report, Jarvis