Long-term effect of posterior nasal neurectomy for perennial allergic rhinitis.

BACKGROUND: Surgical treatment is recommended for patients with severe allergic rhinitis (AR) refractory to medical treatment. Endoscopic posterior nasal neurectomy (PNN) is primarily performed to improve rhinorrhea in severe perennial AR, however studies on its long-term prognosis are lacking. AIMS/OBJECTIVES: This study aimed to investigate the long-term prognosis of PNN. MATERIALS AND METHODS: A questionnaire survey was administered to 17 patients (12 men and 5 women) at least 1 year after PNN. Nasal symptoms and medications, as well as patient satisfaction with surgery at the time of survey, were scored. Furthermore, scores were compared between patients with postoperative periods of >5 years and <5 years. RESULTS: Nasal symptoms and medication scores significantly improved after surgery. There was no significant difference between patients with a postoperative period of >5 years and <5 years in both preoperative and postoperative nasal symptoms and medication scores. No correlation was found between patient satisfaction with surgery and postoperative period. CONCLUSIONS AND SIGNIFICANCE: PNN improved nasal symptoms and medication scores in patients with severe perennial AR. Furthermore, the study results suggest that the long-term effect of PNN for perennial AR lasts for >5 years. J. Med. Invest. 71 : 62-65, February, 2024.

Underwater posterior nasal neurectomy compared to resection of peripheral branches of posterior nerve in severe allergic rhinitis.

BACKGROUND: Several surgical procedures for posterior nasal neurectomy have been reported, but no conclusion has been reached about which procedure is best. OBJECTIVES: The aim is to evaluate the improvement in symptom medication scores for resection of the posterior nasal nerve trunk in an underwater environment, with submucous inferior turbinectomy, without injuring the sphenopalatine artery (SPA) in severe allergic rhinitis. MATERIAL AND METHODS: Improvements in symptom medication scores were retrospectively compared between 27 consecutive cases who underwent resection of the posterior nasal nerve trunk with turbinoplasty in an underwater environment without injuring the SPA (Underwater group) and, as a historical control, 16 consecutive cases who underwent resection of peripheral branches of the posterior nasal nerve with turbinoplasty (Control group). RESULTS: The improvements in symptom medication scores in the Underwater group were significantly better than in the Control group (3.07 vs. 1.96, p = 0.02). CONCLUSIONS AND SIGNIFICANCE: By using underwater posterior nasal neurectomy, we can easily and safely resect the posterior nasal nerve trunk under a clear surgical view without injuring the SPA. This technique with submucous inferior turbinectomy may, more than resection of peripheral branches of the posterior nasal nerve, be able to reduce the medication score and symptom medication score.

Adverse Events Associated With ClariFix Posterior Nasal Nerve Cryoablation: A MAUDE Database Analysis.

Posterior nasal nerve (PNN) cryoablation is a novel surgical technique used to address chronic rhinitis. The purpose of this study is to review the medical device reports (MDRs) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events related to the use of ClariFix, a device designed for office-based cryosurgical ablation of the PNN. A total of 12 adverse events associated with ClariFix from January 2017 to August 2020 were identified and analyzed. The most common adverse events associated with ClariFix PNN cryoablation include epistaxis and nasal swelling. Further studies are needed to clarify whether PNN cryoablation is associated with epistaxis in certain populations.

Long-term effectiveness, safety, and quality of life outcomes following endoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis.

OBJECTIVE: In recent decades, posterior nasal neurectomy (PNN) with submucosal inferior turbinectomy (ST) has been increasingly used for the treatment of intractable severe rhinitis; however, to the best of our knowledge, there have been few studies regarding its long-term therapeutic effects or its influence on patient quality of life (QOL). Therefore, this study examined the long-term therapeutic effects in patients who underwent PNN with ST, as well as their QOL and medication use after surgery. METHODS: This retrospective cohort study initially included 16 consecutive patients who underwent PNN with ST from January 2010 to December 2011. Ten of the 16 patients participated in a paper-based survey questionnaire between June 2018 and November 2018; the responses of these 10 patients were used for analysis in this study. To clarify the effects of surgical treatment on symptoms, QOL, and medication status, data recorded before and 3 months after surgery were compared with data recorded at 8 years after surgery using the Japan Rhinoconjunctivitis Quality of Life Questionnaire No. 1 and Classification of the Severity of Allergic Rhinitis Symptoms I and II. RESULTS: Nasal symptoms including runny nose and nasal congestion, medication score, respective total symptoms medication scores (i.e., combined average total symptoms score and medication score), and the scores of troubles with daily life and total QOL were significantly improved at 3 months and 8 years after surgery, compared with before surgery; scores were not significantly worsened at 8 years after surgery, compared with 3 months after surgery. In addition, there were no adverse events requiring treatment after surgery. CONCLUSION: Our findings suggest that PNN with ST is effective and safe for long-term treatment of severe chronic rhinitis symptoms, as well as reduction of medication use and improvement of QOL.

An isomorphic three-dimensional cortical model of the pig rostrum.

Physiological studies of the last century mapped a somatosensory cortical gyrus representing the pig's rostrum. Here, we describe the extraordinary correspondence of this gyrus to the rostrum. The pig rostrum is packed with microvibrissae (~470 per hemi-rostrum) and innervated by a prominent infraorbital nerve, containing about 80,000 axons. The pig's rostrum has three major skin-folds. The nostrils have a rectangular medial wall and a funnel-like lateral opening, nasal channels run obliquely from lateral (surface) to medial (inside). The rostrum gyrus mimics rostrum geometry in great detail. The putative representation of skin folds coincides with blood sinus and folds of the rostrum gyrus. The putative nostril representation is an oblique sulcus running from lateral (surface) to medial (inside). As observed in rodents, Layer 4 is thin in the nostril sulcus. The side of the nostril sulcus representing the medial wall of the nostril is rectangular, whereas the side of the nostril sulcus representing the lateral wall is funnel-like. Proportions and geometry of the rostrum and the rostrum gyrus are similar, albeit with a collapsed nostril and a larger interindividual variability in the gyrus. The pig's cortical rostrum gyrus receives dense thalamic innervation, has a thin Layer 1 and contains roughly 8 million neurons. With all that, the rostrum gyrus looks like a model of the pig rostrum at a scale of ~1:2. Our findings are reminiscent of the raccoon cortex with its forepaw-like somatosensory forepaw-representation. Representing highly relevant afferents in three-dimensional body-part-models might facilitate isomorphic cortical computations in large-brained tactile specialists.

Whisking Asymmetry Signals Motor Preparation and the Behavioral State of Mice.

A central function of the brain is to plan, predict, and imagine the effect of movement in a dynamically changing environment. Here we show that in mice head-fixed in a plus-maze, floating on air, and trained to pick lanes based on visual stimuli, the asymmetric movement, and position of whiskers on the two sides of the face signals whether the animal is moving, turning, expecting reward, or licking. We show that (1) whisking asymmetry is coordinated with behavioral state, and that behavioral state can be decoded and predicted based on asymmetry, (2) even in the absence of tactile input, whisker positioning and asymmetry nevertheless relate to behavioral state, and (3) movement of the nose correlates with asymmetry, indicating that facial expression of the mouse is itself correlated with behavioral state. These results indicate that the movement of whiskers, a behavior that is not instructed or necessary in the task, can inform an observer about what a mouse is doing in the maze. Thus, the position of these mobile tactile sensors reflects a behavioral and movement-preparation state of the mouse.SIGNIFICANCE STATEMENT Behavior is a sequence of movements, where each movement can be related to or can trigger a set of other actions. Here we show that, in mice, the movement of whiskers (tactile sensors used to extract information about texture and location of objects) is coordinated with and predicts the behavioral state of mice: that is, what mice are doing, where they are in space, and where they are in the sequence of behaviors.

Understanding the Anatomy of the Transverse Nasalis Aponeurotic Fibers and Its Importance in Asian Rhinoplasty.

BACKGROUND: A complete release of the transverse nasalis aponeurotic fibers (TNAFs) during Asian rhinoplasty is critical for accurate positioning of the nasal implant and lengthening of the short nose. The objectives of this article are to clarify the anatomy of the TNAFs using cadaveric dissections and to present the clinical results after complete TNAF release in Asian rhinoplasty. METHODS: An anatomical dissection was performed in 8 cadavers to study the TNAFs, specifically the origin, insertion, and boundary of the TNAFs and the effect of the TNAF release on nasal length. Between January 2012 and December 2014, 2314 open implant augmentation rhinoplasties (1777 primary and 537 secondary) were performed by the senior author (J.J.). The records of these patients were retrospectively reviewed for results of TNAF release. A separately designed prospective clinical study was performed to document the nasal envelope extension after TNAF release in 52 consecutive patients. RESULTS: In the cadaver study, the anatomy and the boundaries of the TNAFs were clearly visualized and documented. With accurate release of the TNAFs, the ideal pocket for nasal implant can be defined, and the effect of the release of the TNAFs recorded. Release of the TNAFs also allows extension of the nasal envelope. However, measurements of the nasal envelope were not studied in the cadaver because the skin was degloved.From the clinical study with a follow-up ranging from 6 months to 1.5 years, the overall complication of open rhinoplasty using silicone implants incorporating TNAF release was 6%. In this group, 3.4% of patients required revision rhinoplasty. Releasing the TNAFs ensures an accurate implant pocket reducing the risk of implant deviation and implant visibility and increases the nasal length by 2.1 mm. CONCLUSIONS: Complete release of the TNAFs is especially important in Asian rhinoplasty to facilitate accurate pocket dissection, allowing the extension of the nasal envelope in order to correct short nose or secondary contracted nose.

Digital technology for performing a nasopalatine and greater palatine nerve block with a modified implant surgical guide: A technique article.

This article describes a computer-aided design and computer-aided manufacturing (CAD-CAM) technique to perform a precise nerve block of the nasopalatine and greater palatine nerves by using an implant surgical guide. The technique uses additional guide anchor pins planned and positioned for specific anatomic landmarks during guided implant surgical guide planning. A relief modification virtually designed on the intaglio surface of the surgical guide allows for palatal soft tissue distension following administration of local anesthetic. This information is then transferred to the guide manufacturer to order the modified guided implant surgical guide. The purpose of this procedure is to provide precise delivery of local anesthetic and to prevent any discrepancy in surgical guide seating following injection.

Parkinson disease in eldery patients: lessons from odour detection thresholds on olfacto-trigeminal interaction.

BACKGROUND: Human nasal chemosensation is mediated by two separate, though interacting sensory pathways: the trigeminal and olfactory systems. Trigeminal sensitivity and olfacto-trigeminal interactions have not yet been well studied in idiopathic Parkinsons disease (IPD). OBJECTIVES: The aim of this study was to assess odour detection thresholds in elderly IPD patients, and compare them to the odour detection thresholds of healthy controls. Finally, we investigated potential interactions between trigeminal and olfactory sensitivity. METHODS: 89 IPD patients aged over 65 and 89 matched healthy participants were enrolled in the study. Odour detection thresholds to 3 stimuli differentially activating olfactory and trigeminal afferents (Phenyl-ethyl alcohol, n-Butanol and Pyridine) were assessed, using an ascending staircase, binary forced-choice procedure. RESULTS AND CONCLUSION: Detection threshold scores were able to discriminate between elderly IPD and controls. Pyridine was less effective than the two other odorants, suggesting that trigeminal pathway is less impaired than the olfactory system. We found that the detection thresholds were significantly different between IPD patients with good autonomy, and patients with impaired autonomy.

Efficacy of external nasal nerve block following nasal surgery : A randomized, controlled trial.

BACKGROUND: Pain is the major determinant factor which affects the quality of recovery and postoperative agitation following nasal surgery with the patient under general anesthesia. Our objectives were to test the hypothesis that an external nasal nerve block will decrease pain intensity, decrease drug consumption, decrease the incidence of postoperative emergence agitation and improve quality of recovery. MATERIAL AND METHODS: In this study 100 adult patients who were scheduled for elective external nasal surgery with the patient under general anesthesia and nasal packing on each side, received external nasal nerve blocks postoperatively for 24 h with saline (group I) or 2% xylocaine (group II) with 1:200,000 epinephrine. Postoperative pain was measured at the postanesthesia care unit (PACU) utilizing a visual analog scale (VAS). Narcotics consumption was also measured. Emergence agitation and quality of recovery were also assessed. RESULTS: Pain scores were statistically significant between both groups. Requirements of equivalent morphine doses in the PACU were lower in group II (block) than group I (control) with a significant P value <0.001. Group II (block) patients required significantly less intraoperative fentanyl than group I (control) patients (p = 0.001). Group II (block) showed higher scores in pain dimension of QoR-40 in comparison with group I (P <0.001). The incidence of emergence agitation was lower in group II (block) than in group I (control, 24% vs. 48%, P = 0.012). CONCLUSION: External nasal nerve block is an effective technique for reducing postoperative pain, drug consumption and quality of recovery. It also reduces emergence agitation. The effects are mainly due to profound analgesia and effective pain control that lead to decreased drug usage and reduced discomfort.

Guanylyl cyclase-G is an alarm pheromone receptor in mice.

Many animals respond to threats by releasing alarm pheromones (APs) that warn conspecifics. In mice, detection of the AP 2-sec-butyl-4,5-dihydrothiazole (SBT) is mediated by chemosensory neurons residing in the Grueneberg ganglion (GG) of the anterior nasal region. Although the molecular mechanisms underlying activation of GG neurons by SBT and other substances are still unclear, recent studies have reported an involvement of the transmembrane guanylyl cyclase (GC) subtype GC-G in chemosensory signaling in the GG Here, we show that SBT directly binds with high affinity to the extracellular domain of GC-G and elicits an enhanced enzymatic activity of this protein. In line with this finding, heterologous expression of GC-G renders cells responsive to SBT while activation by SBT was strongly attenuated in GG neurons from GC-G-deficient mice. Consistently, SBT-induced fear-associated behaviors, SBT-evoked elevated blood pressure, and increased serum levels of the stress hormone corticosterone were clearly reduced in GC-G-knockout animals compared to wild-type mice. These observations suggest that GC-G serves as an unusual receptor in GG neurons mediating the detection of the volatile AP substance SBT.

Oculonasal Synkinesis: Video Report and Surgical Solution of a Rare Phenomenon.

BACKGROUND: Synkinesis represents involuntary muscular movements that occur in association with voluntary contraction of other muscle groups. Oculonasal synkinesis is a rare phenomenon. OBJECTIVES: In a series of videos, the authors present clinical findings and surgical correction of oculonasal synkinesis. METHODS: Two women who underwent surgical procedures to correct oculonasal synkinesis were evaluated in a prospective study. One patient presented with bilateral synkinesis after 2 previous rhinoplasties. She underwent open rhinoplasty in our office. The other patient had unilateral synkinesis of the left side and received endonasal rhinoplasty. RESULTS: The patients' mean age was 27.5 years, and follow-up was conducted for 6 months. Both patients experienced complete, stable resolution of synkinesis after surgical correction. No complications were recorded. CONCLUSIONS: Patients with oculonasal synkinesis may not notice it preoperatively and may regard these muscle movements as an unfavorable result of rhinoplasty. Therefore, careful preoperative evaluation is crucial.

Anatomical study of the internal nasal branch of the infraorbital nerve: Application to Minimizing Nerve Damage With Surgery In and Around the Nose.

The internal nasal branch of the infraorbital nerve (ION) runs down the nose and around the ala to be distributed to the nasal septum and vestibule. The aim of this study was to measure the internal nasal branch around the ala of the nose and discuss its possible relevance in clinical/surgical practice. Twelve sides from seven specimens derived from fresh frozen and embalmed Caucasian cadaveric heads were dissected. The specimens included three males and four females. The ages of the cadavers at death ranged from 65 to 84 years. The diameter of the internal nasal branch, horizontal distance from the lateral contour of the ala (Point A) to the branch (distance H) and vertical distance from the bottom part of the ala (Point B) to the branch (distance V) were recorded. Distance H ranged from -1.6 to 1.5 mm on right sides and -1.0 to 1.5 mm on left sides. The diameter of the nerves at Point A ranged from 1.3 to 1.8 mm on right sides and 1.3 to 1.6 mm on left sides. Distance V ranged from -1.5 to 1.0 mm on right sides and -2.3 to 1.1 mm on left sides. The diameter of the nerves at Point B ranged from 0.7 to 1.3 mm on right sides and 0.8 to 1.2 mm on left sides. The results of this study are the first to detail the topography of the internal nasal branch of the ION. Clin. Anat. 30:817-820, 2017. © 2017Wiley Periodicals, Inc.

Prolonged denervation induces remodeling of nasal mucosa in rat model of posterior nasal neurectomy.

BACKGROUND: The posterior nasal nerve is the dominant source of the parasympathetic, sympathetic, and sensory fibers that innervate the nasal respiratory mucosa. Therefore, a posterior nasal neurectomy (PNN) induces denervation of the nasal mucosa and relieves the nasal symptoms of intractable rhinitis. PNN depletes nerve fibers, choline acetyltransferase, and neuropeptides in nasal respiratory mucosa, and reduces nasal secretion. However, the histological and symptomatic changes over an extended period after PNN remain unknown. METHODS: Using a rat model of PNN via the transorbital approach, we investigated chronological changes of nasal morphology, innervation, and secretion over a 48-week postoperative period after PNN. RESULTS: The respiratory nasal mucosa exhibited squamous metaplasia, lymphocyte and plasma cell infiltration, basement membrane thickening, loss of cilia, and hyperplasia of the mucus gland in thickened epithelium with increased connective tissue from 24 weeks after PNN. These changes resemble the characteristics of remodeling in chronic rhinosinusitis. DNA microarray and quantitative polymerase chain reaction analysis revealed that mucin 5ac, interleukin 13, and brain-derived neurotrophic factor messenger RNA (mRNA) were upregulated in PNN-treated mucosa compared to untreated mucosa. During this period, nerve fibers including sensory, sympathetic, and parasympathetic fibers gradually reinnervated the mucosa from 12 weeks after PNN. However, nasal secretion was decreased even at 48 weeks after PNN probably due to the prolonged absence of choline acetyltransferase. CONCLUSION: Prolonged denervation induces remodeling of the nasal mucosa. Although the depleted nerves were partially reinnervated a few months after PNN, nasal secretion was still suppressed, partly due to a sustained deficiency of acetylcholine synthesis.

The Effect of Stimulus Duration on the Nostril Localization of Eucalyptol.

The trigeminal system is a chemosensory system participating in the perception of most odorants, which allows for the perception of diverse sensations including the freshness of eucalyptus or the spiciness of pepper. The lateralization task, that is, the identification of the stimulated nostril in a monorhinal stimulation paradigm is only possible following trigeminal stimulation and allows therefore for the assessment of the trigeminal sensitivity also in a clinical setting. In this study, we aimed to determine the effects of the duration of stimuli on the lateralization task. To this end, we asked 32 young and healthy subjects perform the lateralization task while being exposed to eucalyptol stimuli ranging between 100 and 1250 ms. We found that participants performed on average at chance for stimuli shorter than 500 ms, and observed increasing accuracy for stimuli with longer durations. In conclusion, these data suggest that 500 ms represents a threshold for the lateralization of eucalyptol stimuli. Therefore, when trigeminal sensitivity is tested in a clinical setting, eucalyptol stimuli should have a duration of at least 500 ms.

Trigeminal sensitivity in chronic rhinosinusitis: topographical differences and the effect of surgery.

INTRODUCTION: Little is known on endonasal trigeminal sensitivity in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The aim of our study was to investigate changes in trigeminal sensitivity in patients with CRSwNP and the effect of functional endoscopic sinus surgery (FESS) on trigeminal perception. METHODS: A prospective study was performed to investigate the trigeminal sensitivity at three different locations within the nose (anterior septum, anterior lateral wall, middle turbinate) using electrical stimuli. Therefore 45 CRSwNP patients were compared to 30 healthy subjects. Further, the effect of FESS was investigated in 31 patients before and 3 months after surgery. RESULTS: CRSwNP patients had a significantly higher trigeminal threshold at all tested locations than healthy subjects. The lowest trigeminal detection threshold could be shown at the entrance of the nose in healthy subjects and in patients with CRSwNP. Three months after FESS a significant improvement of trigeminal detection threshold was observed at the anterior nasal septum. CONCLUSION: Protective function of the trigeminal system is preserved in CRSwNP patients. FESS seems to show beneficial effects on restoring sentinel function at the entrance of the nose.

Circuits in the Ventral Medulla That Phase-Lock Motoneurons for Coordinated Sniffing and Whisking.

The exploratory behavior of rodents is characterized by stereotypical movements of the vibrissae, nose, and head, which are phase locked with rapid respiration, that is, sniffing. Here we review the brainstem circuitry that coordinates these actions and propose that respiration may act as a master clock for binding orofacial inputs across different sensory modalities.