Intervascular smooth muscle fibers and muscular bolsters in nasal swell bodies of humans

Effects of adrenergic and cholinergic antagonists on diameter of nasolacrimal drainage system

BACKGROUND

To determine the effect of an adrenergic and a cholinergic antagonist on the diameter of the lumen of the nasolacrimal drainage system.

METHODS

The asymptomatic side of 38 patients (29 women, nine men) with unilateral stenosis/obstruction of the nasolacrimal drainage system was studied. The tear meniscus height (TMH) of the asymptomatic side was normal, and the lacrimal drainage system was patent as revealed by dacryocystography. The nasolacrimal drainage system of the asymptomatic side was infused with 100 mul of 0.01% bunazosin hydrochloride, a selective alpha-1 adrenergic antagonist, or 100 mul of 0.4% tropicamide, a muscarinic and cholinergic antagonist. Dacryocystography was performed to determine the diameter of the lumen of the nasolacrimal drainage system before and after the antagonists.

RESULTS

Bunazosin reduced the diameter of the lumen significantly, and the changes were more marked in the nasolacrimal duct (NLD), especially the middle and the lower regions. The diameter of the lumen of the lacrimal sac was not changed significantly. In contrast, tropicamide did not cause any significant change in the diameter of the lumen of the nasolacrimal drainage system.

CONCLUSIONS

The alterations of the size of the lumen of the nasolacrimal drainage system, especially the NLD, by an adrenergic antagonist suggest that the lumen diameter is under continuous sympathetic tone, and the parasympathetic tone is weak.

[Neural control of the respiratory nasal mucosa]

Respiratory nasal mucosa fulfils the function of pretreating the inspired air. The periodic nasal cycle and pathologic functional disturbances of the endonasal tissue influence the nasal passages. The secretion of the seromucous glands and extravasation from the blood vessels are essential for mucocilliary transport. These physiological mechanisms are partially controlled by neural regulation. Besides classic neurotransmitter neuropeptides such as VIP, CGRP, SP and NPY, nitric oxide also shares this role. A network of sensory, sympathetic and parasympathetic nerve fibres protects the respiratory mucous membranes from external and internal irritation. In addition, blood vessels and glands are influenced by endothelial and humoral factors. For the different types of rhinitis, sensory neuropeptides and inflammatory mediators take part in the pathomechanisms and can lead to a so called neurogenic inflammation of the nasal mucosa.

Long-term results after laser turbinectomy

BACKGROUND AND OBJECTIVE

Different types of lasers have been used for reduction of hypertrophic inferior turbinates in recent years with good results. Reports about the long-term benefits of the laser treatment are rare.

STUDY DESIGN/MATERIALS AND METHODS

At the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, from April 1987 to March 1997, 658 patients with nasal obstruction caused by hypertrophic inferior turbinates were treated with the CO2 or Nd:YAG laser. Of these patients, 118 were able to be followed for a period of 5 years.

RESULTS

After 5 years, 54 of 70 patients (77.1%) treated with the CO2 laser were satisfied. The success rate after Nd:YAG laser surgery was 64.6% (31/48 patients). Severe intra- or postoperative complications were not observed.

CONCLUSION

The results suggest that the CO2 and Nd:YAG laser surgical techniques are suitable for the treatment of hypertrophic inferior turbinates. The main advantages are the decreased bleeding risk and the fact that the operation can be conducted as an outpatient procedure.

[Treatment of the hypertrophic inferior turbinate. 1]

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophied inferior turbinates. If there is inadequate response to conservative medical management, the inferior turbinates should be reduced. The choice of treatment is mainly influenced by whether the nasal airway obstruction is due to hypertrophic mucosa or to an enlarged turbinate bone. The first part of this review describes the various surgical modalities for treatment of swelling of the turbinal mucosa. The indications, advantages, disadvantages, complications, and controversies of each modality (submucous diathermy, cryosurgery, infra-red coagulation, argon-plasma coagulation, radiofrequency, laser surgical techniques) are reviewed and discussed.

Functional morphology of nasal blood vessels in humans

"Secretion" and "obstruction" as predominant clinical symptoms in rhinology affect a great number of patients with disorders of the nose. According to clinical experience as well as morphological investigations, the endonasal vascular system is most likely to be involved in these functional mechanisms. In the present study, we report morphological findings on the angioarchitecture of human nasal mucosa. Meticulous investigation of the structure and ultrastructure of nasal mucosal capillaries revealed differences in the appearance of the endothelial lining. Especially the morphological feature of attenuated fenestrated endothelia in these vessels might be correlated with the functional behaviour under various physiological and pathological conditions. Inspection of the vascular wall of nasal swell bodies revealed differences in the orientation as well as the shape of muscle cells in different parts of this vascular system. The functional role of special morphological features known as muscular bolsters and intervascular muscle fibres for the swelling mechanism of the nasal mucosa is emphasized. Our results enabled us to define the muscular structures that are most probably responsible for constriction and dilatation of nasal swell bodies.