Nasal anatomy for the dermatological surgeon.

The nose is an important site of skin pathology and skin cancer in particular, underlining the importance of the nose to the practice of dermatology. This article is intended to serve as an overview of the anatomy of the nose for dermatologists and dermatological surgeons. Areas of clinical relevance are emphasized with examples.

Perception of specific trigeminal chemosensory agonists.

The intranasal trigeminal system is a third chemical sense in addition to olfaction and gustation. As opposed to smell and taste, we still lack knowledge on the relationship between receptor binding and perception for the trigeminal system. We therefore investigated the sensitivity of the intranasal trigeminal system towards agonists of the trigeminal receptors TRPM8 and TRPA1 by assessing subjects' ability to identify which nostril has been stimulated in a monorhinal stimulation design. We summed the number of correct identifications resulting in a lateralization score. Stimuli were menthol (activating TRPM8 receptors), eucalyptol (TRPM8), mustard oil (TRPA1) and two mixtures thereof (menthol/eucalyptol and menthol/mustard oil). In addition, we examined the relationship between intensity and lateralization scores and investigated whether intensity evaluation and lateralization scores of the mixtures show additive effects. All stimuli were correctly lateralized significantly above chance. Across subjects the lateralization scores for single compounds activating the same receptor showed a stronger correlation than stimuli activating different receptors. Although single compounds were isointense, the mixture of menthol and eucalyptol (activating only TRPM8) was perceived as weaker and was lateralized less accurately than the mixture of menthol and mustard oil (activating both TRPM8 and TRPA1) suggesting suppression effects in the former mixture. In conclusion, sensitivity of different subpopulations of trigeminal sensory neurons seems to be related, but only to a certain degree. The large coherence in sensitivity between various intranasal trigeminal stimuli suggests that measuring sensitivity to one single trigeminal chemical stimulus may be sufficient to generally assess the trigeminal system's chemosensitivity. Further, for stimuli activating the same receptor a mixture suppression effect appears to occur similar to that observed in the other chemosensory systems.

Intranasal trigeminal sensitivity in subjects with allergic rhinitis.

Trigeminal nerve endings of the human nasal mucosa are activated by chemical, physical or thermal stimuli. Activation of these A(delta) and C fibers can be quantified through the recording of chemo-somatosensory event-related potentials (ERP). The aim of this study was to investigate whether allergy-related activation of trigeminal nerve endings leads to changes in their responsiveness to intranasal trigeminal stimulation. Gaseous carbon dioxide (CO(2)) stimuli were applied in three sessions (baseline, after NaCl solution and after allergen application) to the nasal mucosa of 13 subjects with allergic rhinitis. Chemo-somatosensory ERP were recorded, and subjects rated the intensity of rhinitis symptoms. Administration of allergen produced a significant shortening of chemo-somatosensory ERP peak latencies P1 and N1. Observed changes of latencies were in line with rhinitis symptoms subjects indicated during the session. In addition, there was a negative relation between the general symptom score and ERP peak latencies, obtained both at baseline and after allergen exposure. In conclusion, it is hypothesized that in patients suffering from allergic rhinitis, nasal itching and sneezing after allergen exposure are, at least in part, clinical correlates of the activation of trigeminal nerve endings due to local inflammatory mechanisms. The correlations between ERP latencies and the patients' symptoms indicate that ERP latencies may possess a predictive value of the subjects' responsiveness to allergens.

Differing, spatially restricted roles of ionotropic glutamate receptors in regulating the migration of gnrh neurons during embryogenesis.

We have examined here the role of glutamate in regulating the process of tangential neuronal migration during embryogenesis by investigating the roles of AMPA and NMDA receptors in the migration of the gonadotropin-releasing hormone (GnRH) neurons from the nose to the hypothalamus. We first determined that GluR1-4 subunit mRNAs were present from embryonic day (E) 12.5 along the complete nose-brain migratory pathway of the GnRH neurons, whereas that of the obligatory NMDAR1 transcript was present only in brain regions of GnRH migration. In vivo studies revealed that AMPA receptor antagonism between E12.5 and E16.5 resulted in a significant (p < 0.05) accumulation of GnRH neurons in the nose adjacent to the cribiform plate. In contrast, NMDA receptor antagonism over E12.5-E16.5 or E13.5-E16.5 caused a selective increase (p < 0.05) in the number of GnRH neurons located in their final resting place within the diagonal band of Broca and preoptic area. Dual-labeling studies using GnRH promoter-LacZ transgenic mice, which facilitate the identification of receptors in GnRH neurons, identified the presence of NMDAR1 receptors in approximately 6% of embryonic GnRH neurons located throughout the migratory pathway. Postnatally, the percentage of GnRH neurons expressing NMDAR1 increased to 50%. These results indicate that tonic AMPA receptor activation enhances the migration of GnRH neurons from the nose into the brain, whereas that of NMDA receptor activation slows the final phase of GnRH migration within the forebrain. These in vivo observations demonstrate differing, spatially restricted roles for AMPA and NMDA receptor activation in the process of tangential neuronal migration.

Rinologia e suas relaçöes com a medicina chinesa tradicional / Rhinology and its relations with the traditional chinese medicine

Os aspectos anatômicos e funcionais referentes à Rinologia podem ser associados com os conceitos dos Zang Fu (órgäos/Vísceras) e do Jing Luo (Canais e Colaterais) da Medicina Tradicional Chinesa. Por outro lado, as afecçöes clínicas estudadas em Rinologia, como rinites, obstruçäo nasal, pólipos, sinusites, podem ser explicadas à luz da etiopatogenia energética considerada na Medicina Tradicional Chinesa, trazendo grandes contribuiçöes no entendimento dessas afecçöes.

Modulation of EphA receptor function by coexpressed ephrinA ligands on retinal ganglion cell axons.

The Eph family is thought to exert its function through the complementary expression of receptors and ligands. Here, we show that EphA receptors colocalize on retinal ganglion cell (RGC) axons with EphA ligands, which are expressed in a high-nasal-to-low-temporal pattern. In the stripe assay, only temporal axons are normally sensitive for repellent axon guidance cues of the caudal tectum. However, overexpression of ephrinA ligands on temporal axons abolishes this sensitivity, whereas treatment with PI-PLC both removes ephrinA ligands from retinal axons and induces a striped outgrowth of formerly insensitive nasal axons. In vivo, retinal overexpression of ephrinA2 leads to topographic targeting errors of temporal axons. These data suggest that differential ligand expression on retinal axons is a major determinant of topographic targeting in the retinotectal projection.

A distinct thermoreceptive subregion of lamina I in nucleus caudalis of the owl monkey.

An immunohistochemically distinct zone was identified in the superficial aspect of trigeminal nucleus caudalis of the New World owl monkey that is not immunoreactive for substance P or serotonin, in stark contrast to the dense staining present in the surrounding laminae I and II. Thionin-stained sections in different planes showed that this is a subregion of lamina I containing clusters of neurons that appear to have pyramidal or polygonal somata. Extracellular microelectrode recordings in this region revealed clusters of thermoreceptive-specific (COLD) cells with nasal or labial receptive fields, whereas nociceptive neurons were found in the adjacent portions of lamina I. Anterograde tracer injections in this region produced trigeminothalamic terminal labeling in the site homologous to the lamina I spino-thalamo-cortical relay nucleus identified previously in the Old World macaque monkey and in humans. Retrograde tracer injections involving this thalamic site, where recordings of trigeminal COLD-like neurons were obtained, produced clusters of retrogradely labeled trigeminothalamic neurons in this immunohistochemically distinct subregion of lamina I, nearly all of which are pyramidal neurons. We conclude that the nocturnal owl monkey has a specialized perinasal thermoreceptive trigeminothalamic sensory pathway that is probably of behavioral significance during olfactory sniffing. In addition, these observations corroborate other findings that have indicated that lamina I COLD cells are pyramidal neurons and are not physiologically modulated by substance P or serotonin, in contrast to nociceptive neurons.

Differential formation of topographic maps on the cerebral cortex and superior colliculus of the mouse by temporally correlated tactile- tactile and tactile-visual inputs.

Coincident electrical activity of nerve fibres seems to play a fundamental role in the development of ordered connections in the CNS. To test this hypothesis on the formation of topographic maps we connected two cutaneous regions of the body of newborn mice by implanting an artificial bridge of pig hair. Through this procedure we produced the mechanical fusion of the ear with either the shoulder or the nose. In these conditions the ear not only was connected with shoulder or nose, but was also in relation with the nasal or the inferior portion of visual space. Therefore the probability of temporally correlated tactile-tactile inputs (ear-shoulder or ear-nose) as well as tactile-visual inputs (ear-inferior or ear-nasal visual space) increased. By recording from the primary somatosensory cortex and superior colliculus, we found that the formation of topographic maps was based on different principles. The somatosensory cortex developed in terms of tactile-tactile correlated inputs, showing somatosensory neurons with receptive fields extending through the fused parts of the body. Conversely, the superior colliculus processed tactile-visual correlated inputs; we found somatosensory-visual bimodal neurons with visual receptive fields extending into the portion of visual space where the artificial bridge was directed. These results suggest that the fusion of two body parts is represented in terms of cutaneous coordinates in the cortex and external world (visual) coordinates in the superior colliculus. Therefore the differential tactile-tactile and tactile-visual coincident activity seems to be correlated to the different meaning of information processing of these two brain regions.

Plexin: a novel neuronal cell surface molecule that mediates cell adhesion via a homophilic binding mechanism in the presence of calcium ions.

Plexin (previously referred to as B2) is a neuronal cell surface molecule that has been identified in Xenopus. cDNA cloning reveals that plexin has no homology to known neuronal cell surface molecules but possesses, in its extracellular segment, three internal repeats of cysteine clusters that are homologous to the cysteine-rich domain of the c-met proto-oncogene protein product. The exogenous plexin proteins expressed on the surfaces of L cells by cDNA transfection mediate cell adhesion via a homophilic binding mechanism, under the presence of calcium ions. Plexin is expressed in the receptors and neurons of particular sensory systems. These findings indicate that plexin is a novel calcium-dependent cell adhesion molecule and suggest its involvement in specific neuronal cell interaction and/or contact.

"Capsaicin-sensitive" sensory neurons in cluster headache: pathophysiological aspects and therapeutic indication.

Capsaicin, when repeatedly applied to the nasal mucosa of cluster headache patients, has been shown to prevent the occurrence of pain attacks. In order to investigate the mechanism of the drug's action, we evaluated the effect of repeated nasal application of capsaicin on the contents of sensory fibres immunoreactive to substance P and CGRP in the rat nasal mucosa. Further, considering the possible involvement of the cerebral circulation, we verified the effect of a single application of capsaicin on the blood flow velocity of the internal carotid and middle cerebral arteries (of both sides) and the basilar artery, in a group of healthy humans. The measurements were taken using Doppler devices. In order to verify the reproducibility of therapeutic effect of capsaicin, we carried out a 2-year follow-up study on patients affected by cluster headache (17 by episodic form, 8 by chronic form) who responded positively to the first treatment with capsaicin. During this period they were treated again with capsaicin in case of re-occurrence of symptoms. Capsaicin depletes the fibers immunoreactive to substance P and CGRP in the rat nasal mucosa. In the healthy controls, a single application induced vasodilation in the internal carotid, whereas middle cerebral arteries and basilar artery were narrowed. The results of the follow-up study, demonstrates that in 65% of the patients, the beneficial effect of capsaicin was again present when the treatment was repeated. In the chronic patients the therapeutic effect was always transitory (lasting, at maximum one month).(ABSTRACT TRUNCATED AT 250 WORDS)

Manipulation of the fractured nose under local anaesthesia.

Simple fractures of the nasal pyramid without significant septal deformity may be reduced as effectively under local as under general anaesthesia. Currently, the former may involve regional nerve blockade by intranasal infiltration and is often unpleasant. We have attempted to find a more acceptable method. Fifty consecutive, adult patients with clinically displaced nasal fractures were randomized to receive either blocks of the infraorbital, infratrochlear and external nasal nerves by intranasal infiltration or generalized infiltration of the nasal dorsum by an external route. All patients received intranasal cocaine. Following manipulation, each patient recorded their overall discomfort level and subjective nasal airway patency. The surgeon recorded the cosmetic result. Analysis revealed the internal route to be significantly more painful (P less than 0.001) and with no advantage to the patient with respect to post-operative airway patency or cosmesis. We recommend the technically easier external method for this procedure.

A physiological stimulus to upper airway receptors in humans.

The regular involuntary inspiratory muscle contractions that occur in normal conscious men during breath holding were quantified by means of the waves of intrathoracic pressure that they produced. A stream of cool air circulated through the nose and mouth reproducibly inhibited the contractions. The degree of inhibition increased with increasing nasal flow in the range of normal resting respiratory flow and with lower temperature of circulating gas. The effect depended on the phase of respiration in which flow occurred and was abolished by local anesthesia of the nose and pharynx. The results demonstrate that the upper airway contains flow-sensitive receptors, the discharge of which can have a marked influence on respiration.

Bilateral transnasal cauterization of the vidian nerve in vasomotor rhinitis.

A brief report of twenty cases of bilateral cauterization of the Vidian Nerve Canals in intractable non-atopic chronic Vasomotor Rhinitis by a Trans-Nasal approach not previously described is given. The authors find this approach to be a much safer and simpler procedure than either the Trans-Septal or the Trans-Antral routes. The advantages of this approach to the Vidian Nerve Canal over the Trans-Septal and Trans-Antral routes are discussed.