The allergic nasal mucosa following vidian neurectomy. Electron microsopic study

Adipose Tissue-Derived Mesenchymal Stem Cell Modulates the Immune Response of Allergic Rhinitis in a Rat Model

This study was designed to investigate the potential effects and underlying mechanism of adipose tissue-derived mesenchymal stem cells (MSCs) on allergic inflammation compared to Montelukast as an antileukotriene drug in a rat model of allergic rhinitis (AR). The effect of MSCs was evaluated in albino rats that were randomly divided into four (control, AR, AR + Montelukast, and AR + MSCs) groups. Rats of AR group were sensitized by ovalbumin (OVA) and then challenged with daily nasal drops of OVA diluted in sterile physiological saline (50 μL/nostril, 100 mg/mL, 10% OVA) from day 15 to day 21 of treatment with/without Montelukast (1 h before each challenge) or MSCs I/P injection (1 × 10⁶ MCSs; weekly for three constitutive weeks). Both Montelukast and MSCs treatment started from day 15 of the experiment. At the end of the 5th week, blood samples were collected from all rats for immunological assays, histological, and molecular biology examinations. Both oral Montelukast and intraperitoneal injection of MSCs significantly reduced allergic symptoms and OVA-specific immunoglobulin E (IgE), IgG1, IgG2a and histamine as well as increasing prostaglandin E2 (PGE2). Further analysis revealed that induction of nasal innate cytokines, such as interleukin (IL)-4 and TNF-α; and chemokines, such as CCL11 and vascular cell adhesion molecule-1 (VCAM-1), were suppressed; and transforming growth factor-β (TGF-β) was up-regulated in Montelukast and MSCs-treated groups with superior effect to MSCs, which explained their underlying mechanism. In addition, the adipose tissue-derived MSCs-treated group had more restoring effects on nasal mucosa structure demonstrated by electron microscopical examination.

[About the unresolved problems of terminology and classification of allergic rhinitis and the desirability of distinguishing the mixed form of the disease]

This article deals with the history of the development of terminology and classification of allergic (vasomotor) rhinitis during the last 50 years.

Vidian nerve resection, histamine turnover and mucosal mast cell function in patients with chronic hypertrophic non-allergic rhinitis

Parasympathetic innervation of the respiratory tract of nasal mucosa plays an important role in the pathogenesis of chronic hypertrophic non-allergic rhinitis (C.H.N.A.R.), the vidian nerve providing the main parasympathetic nerve supply to respiratory mucosa. The present study investigates the effect of vidian nerve resection in 22 patient with intractable C.H.N.A.R. on histamine content and formation and on the number of mast cells and their degranulation in the respiratory tract. Samples were taken from respiratory mucosa for histamine and histidine-decarboxylase assay, and for microscopic observations for mast cell density and degranulation index, before and 12-24 months after vidian nerve resection. Neurectomy of the vidian nerve completely cured the clinical symptomatology, evaluated by rhinoreomanometry, and also significantly decreased both the high histamine levels and histidine-decarboxylase activity in patients with C.H.N.A.R. The density and degranulation index of mast cells were also significantly lower after surgery. These data suggest a relationship between cholinergic activity and the secretory response of mast cells and indicates a correlation between the parasympathetic nerve supply and chronic hyperthrophic non-allergic rhinitis. The significant reduction in mast cell density, histamine levels and histidine-decarboxylase activity also lends support to the hypothesis that the parasympathetic nerve supply plays a role in the regulation of mast cell histamine.

Retrograde axonal transport of true blue dye by the peripheral autonomic nerves in canine nasal mucosa

In this study we employed retrograde axonal transport of (E)-2,2'-vinylendi-benzofuran-5-carboxamidin-diaceturate+ ++ or true blue (TB) to study the peripheral autonomic innervation of the canine nasal mucosa. After injection of TB into the nasal mucosa, labeled neurons were found in the ipsilateral sphenopalatine ganglion (SPG) and the superior cervical ganglion (SCG). There were no labeled neurons in the middle cervical or stellate ganglia. This indicated that the origin of the postganglionic sympathetic fibers of the nasal mucosa was only from the ipsilateral SCG. When TB was injected into the nasal mucosa of dogs following a caudal or ethmoidal neurectomy, labeled neurons could still be found in the SPG and SCG. When TB was injected into the nasal mucosa of dogs following ethmoidal and vidian neurectomies or with maxillary neurectomy added, some labeled neurons could still be found in both the ipsilateral SPG and SCG. These results support the concept that another pathway--perhaps perivascular--exists for postganglionic sympathetic fibers other than the vidian and ethmoidal nerves. Labeled neurons were still observed in SPG when TB was applied to the canine nasal mucosa following neurectomy of either the ethmoidal or the caudal nasal nerve. However, retrograde labeled neurons could not be found in SPG following simultaneous neurectomies of the ethmoidal and caudal nasal nerves. These results show that the postganglionic parasympathetic fibers originating in the SPG travel along the ethmoidal and caudal nasal nerves.

Cryosurgery on postganglionic fibers (posterior nasal branches) of the pterygopalatine ganglion for vasomotor rhinitis

Clinical experience with a newly designed device for cryosurgery on autonomic nerves in cases of vasomotor rhinitis is reported. The device consists of a handy spray of liquid nitrogen and a slender probe 2.5 mm in diameter. The posterior nasal branches of the pterygopalatine ganglion were destructed by freezing for 5-8 sec with a jet of supercooled nitrogen gas delivered onto the pterygopalatine foramen under anesthesia with 4% lidocaine. Satisfactory results were obtained by this procedure in 77 of 102 cases of vasomotor rhinitis which had failed to respond to antihistaminics. This original technique of cryosurgery which is not time-consuming and can be performed on an ambulatory basis will prove useful in clinical practice.

Histochemical demonstration of peripheral autonomic innervation in canine nasal mucosa by retrograde axonal transport of horseradish perioxidase

The peripheral autonomic nervous pathways of the nasal mucosa in dogs were investigated by the horseradish peroxidase (HRP) method. HRP was applied to the nasal mucosa, caudal nasal nerve, ethmoidal nerve, vidian nerve and pterygopalatine ganglion in 20 dogs, and retrogradely labelled neurons were observed in the superior cervical ganglion (SCG) and the pterygopalatine ganglion (PPG) by the blue reaction method. It was suggested that the vidian nerve, the maxillary branch of the trigeminal nerve, the caudal nasal nerve, the pterygopalatine nerve and the ethmoidal nerve contained the postganglionic sympathetic fibres which originated in SCG and terminated in the nasal mucosa. Moreover, other sympathetic pathways, such as those around the blood vessels, were also suggested to be a main route. It was suggested that the postganglionic parasympathetic fibers originating in PPG travelled along the caudal nasal nerve and the ethmoidal nerve.

Role of the vidian nerve in nasal allergy

Clinical studies were performed to evaluate the role of the vidian nerve at onset of symptoms in nasal allergy. A localized area of one side of the nasal cavity was stimulated with known allergen and 0.1% histamine chloride in patients with perennial nasal allergy. The effect of unilateral vidian neurectomy and sensory anesthesia on glandular and vascular response was evaluated. With localized nasal stimulation, hyperrhinorrhea was seen in both sides of the nasal cavity before vidian neurectomy. Unilateral vidian neurectomy blocked hyperrhinorrhea only in that nasal cavity in which the nerve was sectioned. However, hyperrhinorrhea from the contralateral side, with an intact vidian nerve, was blocked with sensory anesthesia of the opposite side of the nasal cavity where the stimulation was applied. Nasal hypersecretion in allergic rhinitis was assumed to be mostly due to stimulation of sensory receptors by a chemical mediator and reflexive stimulation of the nasal glands. Vidian neurectomy, however, did not have any apparent influence on the swelling of the nasal mucosa caused by localized stimulation of allergen and histamine.

Vidian neurectomy: neuroanatomical considerations and a report on a new surgical approach

If conventional treatment fails, vidian neurectomy is a viable alternative for therapy of chronic rhinitis with recurrent polyposis of the nose and sinuses. From a neuroanatomical point of view beneficial and adverse effects of this surgical procedure are discussed. According to our own investigations and experiences, vidian neurectomy should be performed together with clearing out of the sinuses in every case. Beginning with this precondition a new surgical approach was developed: the vidian nerve is detected through a transethmoidal route in the pterygoid canal at the bottom of the sphenoid sinus and dissected using the operation microscope.