Vasoactive intestinal polypeptide nerves in human upper respiratory tract

Immunoreactive vasoactive intestinal polypeptide (VIP), a recently recognized neuropeptide with a possible transmitter function has been demonstrated in nerves of the human upper respiratory tract. VIP nerves predominate in the inferior turbinate of the nose and in the tracheal wall. They are distributed in the subepithelial connective tissue, around blood vessels and seromucous glands. Scattered VIP nerves are observed also in the tracheal smooth muscle. VIP immunoreactive nerve cell bodies are found only in the tracheal wall, suggesting a local origin of the VIP nerves in this organ. Available information indicates that the VIP-containing nerves constitute a separate component of the autonomic nervous system in addition to the adrenergic and cholinergic ones.

Bilateral nasal vascular responses to unilateral sympathetic stimulation

Unilateral preganglionic cervical sympathetic stimulation in the anaesthetized cat evoked vasoconstriction in both nasal cavities, dependent on stimulation frequency. Vasoconstriction in the contralateral cavity was 15--20% of that of the stimulated side. Similar findings were obtained on unilateral Vidian nerve stimulation. Vasoconstriction evoked in the sympathectomized nasal cavity by stimulating the opposite cervical chain was reduced but not abolished by sectioning the posterior nasal and ethmoidal nerves of the stimulated side. It is suggested that vasoconstrictor fibres reach the opposite cavity either in these nerves or by way of blood vessels, but more likely that sympathetic fibres from these pathways innervate blood vessels which supply both nasal cavities.

[Routes of approach to the vidian nerve (author's transl)]

The authors describe the various routes of approach to the deep recesses of the pterygo-maxillary fossa. A brief historical review indicates the importance of the work of Golding-Wood who started this type of surgery. Description of the personal technique of the authors via a trans-maxillary approach. Review of the endo-nasal approach of Poch-Vinals by cryotherapy and of M. Port mann by electro-coagulation. A parallel is then drawn between the trans-maxillary approach and the endo-nasal approach of Prades by dissection from the spheno-palatine orifice. The respective indications are discussed.

Vidian neurectomy

The author presents his experience with vidian neurectomy. 30 cases have been operated; 18 had bilateral nasal-sinus polyposis and 12 vasomotor rhinitis. The results are presented. The patients with bilateral nasal-sinus-polyposis were operated by bilateral polypectomy cleaning the sinuses according to the Ermiro de Lima technique and unilateral vidian neurectomy was simultaneously performed. On this side the results obtained were excellent in comparation with the other one. The surgical technique is explained and some pathogenetic considerations are discussed.