Bernstein J M
Department of Speech-Language Pathology and Audiology, State College of New York, Buffalo.
Otolaryngol Head Neck Surg. 1991 Oct;105(4):596-607. doi: 10.1177/019459989110500411.
The last decade has seen a marked increase in the number of otolaryngologists-head and neck surgeons who have been trained to perform rhinologic surgery. This includes both rhinoseptoplasty and endoscopic sinus surgery. A better understanding of the pathophysiology of rhinitis and sinusitis has also kept pace with this rapid expansion of surgical intervention. For example, significant advances have taken place in our knowledge of the local immune system in the nose, particularly in regard to mucosal and submucosal mast cells and the development of protective antibodies in the nasal mucosa against viral and bacterial infections. We have far more understanding of the complex innervation of the blood vessels and glands in the nasal mucosa and their receptors, and, most recently, a tremendous increase of scientific data has accumulated on the effect of neuropeptides on the nasal mucous membrane. It is imperative that rhinologic surgeons have an understanding and appreciation of the complex patterns of sensory and autonomic innervation of the nose to better evaluate the medical, allergic, and surgical treatment of acute and chronic rhinitis and sinusitis. This discussion will focus on recent advances in our understanding of the biochemical substances that are released by both the autonomic nervous system and the sensory nervous system in the nasal mucosa. The effect of these mediators on both vascular smooth muscle and the seromucinous glands of the nose will be considered. Finally, the dynamic interaction between the inflammatory mediators released by sensory nerves so-called tachykinins-- and the immune system and mast cell degranulation will be considered.
在过去十年中，接受过鼻科手术培训的耳鼻喉科-头颈外科医生数量显著增加。这包括鼻中隔成形术和鼻内镜鼻窦手术。对鼻炎和鼻窦炎病理生理学的更好理解也与手术干预的迅速扩展同步。例如，我们对鼻腔局部免疫系统的认识有了重大进展，特别是关于黏膜和黏膜下肥大细胞以及鼻黏膜中针对病毒和细菌感染的保护性抗体的产生。我们对鼻黏膜血管和腺体的复杂神经支配及其受体有了更深入的了解，最近，关于神经肽对鼻黏膜影响的科学数据大量积累。鼻科外科医生必须了解和认识鼻子感觉和自主神经支配的复杂模式，以便更好地评估急慢性鼻炎和鼻窦炎的药物、过敏和手术治疗。本次讨论将聚焦于我们对鼻黏膜中自主神经系统和感觉神经系统释放的生化物质的最新认识进展。将考虑这些介质对鼻血管平滑肌和浆液性腺的影响。最后，将考虑感觉神经释放的炎症介质——所谓的速激肽——与免疫系统和肥大细胞脱颗粒之间的动态相互作用。
