The Application of Laser Doppler Flowmetry for Allergic Rhinitis and Rhinitis Medicamentosa

BACKGROUND AND OBJECTIVES: Allergic rhinitis (AR) and rhinitis medicamentosa (RM) have different mucosal color and pathophysiology. To investigate whether the mucosal color and nasal blood flow are different between the diseases in spite of same symptoms, we designed this study. MATERIALS AND METHODS: 20 patients with allergic rhinitis and 21 patients with rhinitis medicamentosa were compared with 20 normal volunteers using mucosal color grading and Laser Doppler flowmetry. The Laser Doppler flowmetry was performed with a Periflux 4001 (Perimed, Jrtlla, Sweden) and perfusion unit (PU), velocity unit (VU), and concentration Unit (CU) were measured. The Laser Doppler flowmetry data in AR and RM were compared with those of the normal subjects, and between AR and RM. RESULTS: The perfusion score of AR and RM were lower than the control (p<0.05) and it was statistically significant that the mucosal color of AR were pale and of RM were reddish, comparing to the control group (p<0.05). CONCLUSION: The nasal blood flow was decreased with AR and RM compared to control but the mucosal color of AR and RM were different because of the difference of pathophysiology of diseases. When diagnosing RM, observation of mucosal color and measurement of nasal blood flow will be helpful besides the history of long-term use of nasal decongestant.ope

Surgical Anatomy of the Anterior Ethmoidal Canal in Ethmoid Roof : Anatomical and Computed Tomographic Analysis

Backgrounds and objectives: This study was undertaken to examine three main relationships. First, the distance and angle from the anterior ethmoid canal to the limen nasi and the sill were measured. Second, The location of the anterior ethmoid canal was examined in relation to the lamellas and the skull base. Third, the existence of bony defects in the canal and the course through the anterior cranial fossa were studied. Materials and methods: This study employed both sagittal computed tomography and cadaver dissection. Seventy sagittally divided heads from randomly chosen Korean adult cadavers were used. Sagittal computed tomography was performed on all specimens. Then they were meticulously dissected under a surgical microscope. Results: The mean distance and angle between the limen nasi and the anterior ethmoid canal was 49.0 mm and 54.5 °, respectively. The anterior ethmoid canal was located between the 2nd and 3rd lamella in 61 of 70 cases. In 60 of 70 cases, it was attached to the base of the skull, and in the remaining 10 cases, it ran 2 to 3 mm below the skull base. When viewed from the superior side, the course of the anterior ethmoid canal formed a diagonal line from the lateral to the medial side. Partial bony defects of the anterior ethmoid canal were observed in eight cases and complete bony defects in none. Conclusion: This study provides surgeons with a better understanding of the anatomy of the anterior ethmoid canal.ope

Mucociliary Differentiation according to Time in Human Nasal Epithelial Cell Culture

In cell culture studies using human nasal epithelial cells, information regarding the state of differentiation, cell phenotype, and gene expression for mucus production would be important to have in relations to different culture time as these factors may vary according to the length of culture period. The primary purpose of this research was to determine whether the number of the ciliated cells increases as a function of differentiation in normal human nasal epithelial (NHNE) cells. When an increase was observed in the number of ciliated cells, we determined the composition ratio of ciliated cells and secretory cells according to the culture duration. At the same time, we also examined the levels of mucin and lysozyme secretion at the same time. The presence of ciliated cells was not evident up to 2 days after confluence. However, 3.1±0.2%, 7.4±0.5%, and 14.5±0.6% of the cells were ciliated 7, 14, and 28 days after confluence, respectively. Meanwhile, the percentage of secretory cells were 35.6±2.8%, 32.8±2.5%, 32.8±2.5%, and 49.4±1.4% on the 2, 7, 14 and 28 days after confluence, respectively. The amount of secreted mucin showed an abruptly increasing pattern by the 14th day of confluence, but showed no significant changes thereafter. The amount of secreted lysozyme increased as a function of differentiation. We concluded that in in vitro studies with NHNE cells, the time point of treatment should vary according to the purpose of the study.ope

Vascular Anatomy on the Nasal Tip in Koreans

Background and Objectives：The blood supply of the nasal tip and columella was examined to determine whether the blood supply to the nasal tip could be damaged from transcolumellar incision during an external rhinoplasty approach in Koreans. Materials and Methods：The blood vessels that supply the nasal tip were examined by dissecting 51 cadavers, and their corresponding 102 nasal sections were injected with red latex prior to the dissection. The size and distribution of the vessels were measured with unaided eyes to determine the primary supplying vessels. The subdermal layer in which the vessels lie and the course of the vessels were also investigated. Results：The main vessels of the nasal tip proved to be the lateral nasal artery (78%) and the dorsal nasal artery (22%). Columellar branches were narrower in diameter than the lateral nasal and dorsal nasal arteries and varied in their size and appearance, and therefore they appeared insufficient to be main vessels to supply blood. These arteries passed through the musculoaponeurotic layer, but they were also close to the main surgical plane in the dome of the lower lateral cartilage. Conclusions：We speculate that the blood supply to nasal tip in Koreans is primarily derived from the lateral nasal or dorsal nasal arteries, with variable contribution from the columellar arteries. Therefore, it is the most important to determine the surgical plane below the musculoaponeurotic layer in order to prevent necrosis of skin flap or deformity due to damage of vessels in the case of external rhinoplasty. (Korean J Otolaryngol 2000;43:830-5)ope

Sphenoid sinus pneumatization and its relation to bulging of surrounding neurovascular structures

OBJECTIVES: We investigated the bulging and dehiscence of neurovascular structures in the sphenoid sinus and their relationships to the pneumatization of the sphenoid sinus. METHODS: One hundred sagittally hemisected cadaveric heads were examined. The degree of pneumatization of the sphenoid sinus was determined. Bulging and dehiscence of the internal carotid artery (ICA), optic nerve, maxillary nerve, and vidian nerve were examined, and the distances between these structures and the anterior or superior wall of the sphenoid sinus were measured. Additionally, the degree of bony thickness over these structures was determined. RESULTS: The prevalences of bulging of the optic nerve, segments 1 and 3 of the ICA, and the maxillary and vidian nerves were 56%, 34%, 65%, 41%, and 52%, respectively. The greater the degree of pneumatization, the more frequently did the structures bulge into the sphenoid sinus. The optic nerve was found to be in close proximity to the anterior and superior walls of the sphenoid sinus. The bone over the surrounding structures was very thin, especially for the complete sellar type. CONCLUSIONS: The prevalence of bulging of the optic nerve, the ICA, and the maxillary and vidian nerves increased in proportion to the degree of sphenoid sinus pneumatization.ope

Pneumatization of the sphenoid sinus and its surrounding neurovascular structures

Background and Objectives : Sphenoid sinus faces the cavernous sinuses in which neurovascular structures such as the cavernous segment of the internal carotid arteries (ICA), optic nerve, and trigerminal nerve are located. In addition, it separates the pituitary gland from the nasal cavity. Therefore, surgeons are required to understand its detailed anatomy for transsphenoidal approach (TSA) or optic nerve decompression. This study is aimed to investigate the surgical anatomy of the sphenoid sinus and its clinical application using Korean adult cadaveric heads. Material and methods : One hundred sagittally-divided adult cadaveric heads were used. After removing the sinus mucosa meticulously, careful examination and photodocumentation were done serially. The analysed items were the pneumatization type of the sphenoid sinus, the relationship between the pneumatization type of the sphenoid sinus and the incidence of bulging of the optic canal, segment 1 and 3 of ICA, maxillary nerve, and pterygoid nerve, and the incidence of bony dehiscence and thickness of bone at the bulging site of various neurovascular structures. Result : The sellar type was found in 90% of the subjects. The incidence of bulging of neurovascular structures were from 34% to 65%, and the incidence of bony dehiscence at the bulging site were from 0% to 9.6%. The more pnermatized the sphenoid bone was, the higher the prevalence of bulging became. The average thickness of bone was less than 0.5 mm. In the complete sellar type, the distances from the anterior wall of the sphenoid sinus to the bulging site at the optic canal, and to segment 1 and 3 of ICA were about 1.9 mm, 19.3 mm, and 9.5 mm, respectively. The distances from the superior wall of the sphenoid sinus to the bulging site at the optic canal and to the maxillary nerve were about 3.7 mm and 17.3 mm, respectively. Bulging of the optic canal attached to the anterior and the superior walls of the sphenoid sinus was 45% and 34%, respectively. Conclusion : By elucidating the relationship between the sphenoid sinus and surrounding vital neurovascular structures, this study might be able to provide essential anatomical knowledge for surgeons to reduce surgical complication in applying to the sphenoid sinusope

The Change of Nasal Blood Flow after a Total Laryngectomy Determined by Laser Doppler Blood Flowmetry

Background and Objectives : The effects of airflow cessation on the human nasal mucosa can be conveniently studied in laryngectomees and the blood flow to nasal mucosa is an important factor in maintaining normal nasal function. Therefore, we investigated the changes in nasal mucosa blood flow after a total laryngectomy with laser Doppler flowmetry. Materials and Method : Twenty-four laryngectomees were studied and compared with 35 normal volunteers. Among 24 total laryngectomees, 9 were esophageal speakers. The laser Doppler flowmetry was performed using a Periflux 4001 (Perimed, Jrtlla, Sweden) and Perfusion unit (PU), Velocity unit (VU), and Concentration Unit (CU) were measured. The laser Doppler flowmetry data in the laryngectomees were compared with those of the normal subjects, and between the esophageal and non-esophageal speakers. Results : The difference between laryngectomees and normal subjects was statistically significant with the exception of the CU (p<0.05). Furthermore, no correlations were found between blood flow and age, and between blood flow and postoperative duration. The difference between esophageal speakers and non-esophageal speakers was statistically significant with the exception of the level of concentration (p<0.05). Conclusion : The nasal blood flow decreased after a total laryngectomy. When airflow improved, an increases in the level of blood flow was recorded. And the change of the nasal blood flow most likely occured within the first year after a total laryngectomy.ope

Expression and regulation of MUC8 & MUC5AC by various cytokines in normal human nasal epithelial cells

Background and Objectives : Sinusitis is one of the most commonly reported diseases in the world. A network of inflammatory mediators is known to be involved in the pathogenesis of chronic sinusitis and nasal mucus secretion may also be under the control of an inflammatory mediator network. To date, 12 human mucin genes have been identified; however, the regulation of MUC8 has not yet been found out. In this study, we described the regulation of the MUC8 mRNA expression by inflammatory mediators and investigated its cellular location. Materials and Method : MUC8 mRNA and MUC5AC mRNA were detected in culture using passage-2 normal human nasal epithelial(NHNE) cells after the treatment with a mixture of following inflammatory mediators; TNF-α, IL-1β, LPS, IL-4, PAF. The translocation of MUC8 mRNA from the nucleus to the cytoplasm was investigated by treating the inflammatory mediators with in situ hybridization. Results : We found that a mixture of inflammatory mediators increased the MUC8 mRNA expression but decreased the MUC5AC mRNA expression in cultured normal human nasal epithelial cells. Among the inflammatory mediators, Interleukin-4 was responsible for the decrease in the MUC5AC mRNA expression and the MUC5AC mucin secretion. We also found that MUC8 mRNA resides in the nucleus of goblet cells and is transported into the cytoplasm following the treatment with inflammatory mediators. Conclusion : These results indicate that MUC8 may play an important role in the pathogenesis of mucus hypersecretion in chronic sinusitis.ope

Structural Changes of Inferior Turbinate in Patients with Septal Devation : Surgical Implication

Septal deviation causes various nasal symptoms and other sinonasal disease. We evaluated the relationship between septal deviation and morphologic changes of the inferior turbinate. PNS CT of 31 patients (septal deviation group) and 20 normal subjects (normal control group) were reviewed. We measured the thickness of the inferior turbinate and the angle between the lateral nasal wall and the inferior turbinate in each group. Each measurements were analyzed using t-test and compared. The thic-kness of the inferior turbinate and the angle between the lateral nasal wall and the inferior turbinate showed no difference between the right and left side in the control group. The same measurement of the convex side in the septal deviation group were not different from those of the control group. However, the thickness of the inferior turbinate and the angle between the lateral nasal wall and the inferior turbinate differed significantly from the control group data. Changes of the inferior turbinate in septal deviation were caused not only by hypertrophy of the inferior turbinate, but also by the increased angle between the lateral nasal wall and the inferior turbinate.ope

Congenital Choanal Atresia：Analysis of 7 Cases

Background and Objectives：Congenital choanal atresia is a relatively uncommon disease whose causes can be explained by embryological etiology. To date, many authors have expressed various opinions about the timing of surgery and surgical approach. We retrospectively analyzed 7 cases of congenital choanal atresia to find out the treatment results and to propose the timing of surgery and the method of surgical approach. Materials and Methods：Seven congenital choanal atresia patients who had been treated between 1981 to 1997 were retrospectively analyzed with charts and X-ray reviews. The symptoms, associated anomalies, site of atresia, features of the atretic plate, surgical approaches, duration and materials used for stenting, reoperation, duration and results of follow-up were analyzed. Five patients were female and 2 patients were male. Associated anomalies were observed in 1 case (14%). Of 6 patients who underwent surgery, 3 received transnasal approach the other 3 received the transpalatal approach. The atretic site was bilateral in 5 cases (71%) and unilateral in 2 cases (29%). Stent was used in all surgical cases. Results：Of the 10 sides evaluated, bony atresia was observed in 3 sides (30%), membranous atresia in 2 sides (20%), and mixed bony-membranous atresia in 5 sides (50%). Three patients who were treated by transpalatal approach and 1 patient who was treated by transnasal approach were successfully treated without reoperation. Two newborn patients who were treated by transnasal approach could achieve normal growth and development by mouth feeding and nasal breathing. They had granulation tissue or stenosis of the opening but they were successfully treated by reoperation and longer period of stenting. Conclusion：We recommend that neonatal congenital choanal atresia patients should be treated by transnasal approach with longer periods of stenting immediately following the diagnosis. (Korean J Otolaryngol 2000;43:296-9)ope