Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: Clinical outcomes and local cytokine changes

Ogawa, Tomoyuki; Takeno, Sachio; Ishino, Takashi; Hirakawa, Katsuhiro

doi:10.1016/j.anl.2007.01.008

Cited by 54 publications

(80 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9 We therefore initially hypothesized that PNN would reduce at least some aspects of the allergic reaction. In our OVA-sensitized allergic rhinitis model, PNN unexpectedly suppressed nasal secretion but no other allergic symptoms and reactions such as sneezing, scratching, eosinophil and mast cell infiltration, mucosal, cytokine expression, and reactivity to histamine.…”

Section: Discussionmentioning

confidence: 99%

Denervation of nasal mucosa induced by posterior nasal neurectomy suppresses nasal secretion, not hypersensitivity, in an allergic rhinitis rat model

Nishijima

Kondo

Toma-Hirano

et al. 2016

Laboratory Investigation

View full text Add to dashboard Cite

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) is thought to induce denervation of the nasal mucosa and relieve the nasal symptoms of allergic rhinitis. However, the underlying mechanisms and therapeutic action of PNN remain unknown. To investigate the impact of PNN-induced denervation of the nasal mucosa on allergic rhinitis, we developed a rat model of PNN and examined the effects of PNN on allergic rhinitis in ovalbumin-sensitized rats. This rat model of PNN was characterized by the depletion of nerve fibers, choline acetyltransferase, and neuropeptides (eg, substance P, calcitonin gene-related peptide, vasoactive intestinal peptide, and neuropeptide Y) in the nasal respiratory mucosa. These animals exhibited nasal gland and goblet cell hypertrophy in the septal mucosa and atrophy of the submucosal gland in the lateral nasal wall, as well as reduced nasal secretion due to deficient acetylcholine synthesis. In an ovalbumin-sensitized model of allergic rhinitis, PNN also induced the depletion of nerve fibers, choline acetyltransferase, and neuropeptides in the nasal mucosa and suppressed nasal secretion. However, PNN did not affect mucosal thickening, eosinophil and mast cell infiltration, interleukin-4 and interferon-γ mRNA expression, and allergic symptoms (ie, sneezing and nasal scratching). These results suggest that the peripheral nerves and corresponding neuropeptides regulate nasal secretion, but not hypersensitivity, in allergic rhinitis, and that allergic rhinitis-related mucosal reactions occur in a highly denervated mucosa after PNN. Posterior nasal neurectomy may be a therapeutic option for the treatment of hyperrhinorrhea, but not allergic rhinitis hypersensitivity. Allergic rhinitis is among the most common diseases; affecting 10-30% of people in industrialized countries. [1][2][3] This condition presents with symptoms that reduce the quality of life such as rhinorrhea, sneezing, nasal obstruction, and nasal itching. 4 Medical allergic rhinitis treatment is approached in a stepwise manner and includes agents such as antihistamines and nasal topical steroids. 1,2,5 However, for patients with allergic rhinitis refractory to medication therapy; surgical interventions such as endoscopic posterior nasal neurectomy (PNN) have been attempted.Endoscopic PNN, which involves the intranasal severing of the posterior nasal nerve, is a common surgical treatment for allergic rhinitis in Asia. 2,6,7 The posterior nasal nerve, which is a peripheral branch of the vidian nerve, innervates the nasal cavity via the pterygopalatine ganglion, which comprises parasympathetic and sympathetic vidian nerve fibers and sensory nerve fibers from the trigeminal nerve. Therefore, PNN is expected to suppress nasal hypersecretion by blocking autonomic vidian nerve fibers, similar to vidian neurectomy (VN), as well as hypersensitivity by simultaneously blocking sensory nerve fibers. 6...

show abstract

Section: Discussionmentioning

confidence: 99%

Denervation of nasal mucosa induced by posterior nasal neurectomy suppresses nasal secretion, not hypersensitivity, in an allergic rhinitis rat model

Nishijima

Kondo

Toma-Hirano

et al. 2016

Laboratory Investigation

View full text Add to dashboard Cite

show abstract

“…Ogawa et al had once employed ELISA to examine local production of cytokines in nasal lavage samples. (Ogawa et al 2007) A comparison of the cytokine levels (IL-5, eotaxin, and normal T cell expressed and secreted proteins, RANTES) before and 6 month after denervation was performed. The mean levels of both IL-5 and eotaxin significantly decreased after surgery (from 1094.8 to 183.8 pg/mg protein, from 540.6 to 165.0 pg/mg protein, respectively), while the mean levels of RANTES did not (from 385.8 to 331.0 pg/mg protein).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Vidian Neurectomy: The Anatomy Consideration and Preoperative Images Analysis

Su¹,

Liu²,

Wang³

2012

Computed Tomography - Clinical Applications

View full text Add to dashboard Cite

IntroductionAlthough surgery is not a primary treatment for manaing rhinitis, it can have some adjuvant benefit in patients with significant nasal congestion or poor pharmacologic response. It is usually performed by surgical approaches to the inferior turbinate, and the more aggressive procedures such as the vidian neurectomy have not been widely applied. Traditional approaches to the vidian canal necessitate larger incisions, including transseptal, transpalatal and transantral methods. These approaches are often not reliable and at the risk of injury to the abutting neurovascular structures. Pioneers in endoscopic surgery are exploring alternatives to these traditional techniques in an attempt to minimize morbidity and the lack of irrelevant incisions. The main difficulties encountered during endoscopic approach are anatomic variations such as canal wall dehiscence, intra-sphenoid septa, pneumatization degree of pterygoid process and the relationship between vidian canal and middle turbinate. Those variations will have effect in determining the surgical success rate and the related complications. Therefore, a powerful tool, in the purpose of identifying the canal location and its surrounding anatomy, is very important to guide the surgeon in preoperative assessment and intraoperative approach. Computed tomography (CT) scanning is superior for the evaluation of the bony confines of the sinonasal tract and skull base. The most minimal recesses of the sinonasal region are easily assessed and it is possible to evaluate the position and configuration of the vidian canal. That valuable information provided by imaging studies enhances the surgical feasibility and offers an alternative for treating the rhinitis. This chapter describes the use of CT images in this capacity. Growing surgical experience and evolving technology will help to advance the feasibility of endoscopic vidian neurectomy and elucidate their indications by using preoperative images.

show abstract

“…Posterior nasal neurectomy (cholinergic nerve) has been shown to remarkably improve subjective nasal symptoms in patients with severe allergic rhinitis as it decreases the IL-5 and mast cells in severe AR [122]. Posterior nasal neurectomy (PNN) is a common surgical treatment for allergic rhinitis in Asia and it is based on the concept that posterior nasal neurectomy may induce denervation of the nasal mucosa and relieve the nasal symptoms of allergic rhinitis.…”

Section: Significance Of Vip In the Allergic Diseasesmentioning

confidence: 99%

Neuroendocrine cells derived chemokine vasoactive intestinal polypeptide (VIP) in allergic diseases

Verma

Manohar

Venkateshaiah

et al. 2017

Cytokine & Growth Factor Reviews

View full text Add to dashboard Cite

Worldwide increase incidences of allergic diseases have heightened the interest of clinicians and researchers to understand the role of neuroendocrine cells in the recruitment and activation of inflammatory cells. Several pieces of evidence revealed the association of neuropeptides in the pathogenesis of allergic diseases. Importantly, one such peptide that is secreted by neuronal cells and immune cells exerts a wide spectrum of immunological functions as cytokine/chemokine is termed as Vasoactive Intestinal Peptide (VIP). VIP mediates immunological function through interaction with specific receptors namely VPAC-1, VPAC-2, CRTH2 and PAC1 that are expressed on several immune cells such as eosinophils, mast cells, neutrophils, and lymphocytes; therefore, provide the basis for the action of VIP on the immune system. Additionally, VIP mediated action varies according to target organ depending upon the presence of specific VIP associated receptor, involved immune cells and the microenvironment of the organ. Herein, we present an integrative review of the current understanding on the role of VIP and associated receptors in allergic diseases, the presence of VIP receptors on various immune cells with particular emphasis on the role of VIP in the pathogenesis of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis. Being crucial signal molecule of the neuroendocrine-immune network, the development of stable VIP analogue and/or antagonist may provide the future therapeutic drug alternative for the better treatment of these allergic diseases. Taken together, our current review summarizes the current understandings of VIP biology and further explore the significance of neuroendocrine cells derived VIP in the recruitment of inflammatory cells in allergic diseases that may be helpful to the investigators for planning the experiments and accordingly predicting new therapeutic strategies for combating allergic diseases. Summarized graphical abstract will help the readers to understand the significance of VIP in allergic diseases.

show abstract

Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: Clinical outcomes and local cytokine changes

Cited by 54 publications

References 18 publications

Denervation of nasal mucosa induced by posterior nasal neurectomy suppresses nasal secretion, not hypersensitivity, in an allergic rhinitis rat model

Denervation of nasal mucosa induced by posterior nasal neurectomy suppresses nasal secretion, not hypersensitivity, in an allergic rhinitis rat model

Endoscopic Vidian Neurectomy: The Anatomy Consideration and Preoperative Images Analysis

Neuroendocrine cells derived chemokine vasoactive intestinal polypeptide (VIP) in allergic diseases

Contact Info

Product

Resources

About