The mole nose instructs the brain

Star-nosed moles normally have 11 mobile appendages, or rays, extending from each side of the nose. In cytochrome oxidase preparations, each ray is visible in primary somatosensory cortex as a dark band separated by light septa. When a single mole was found with 12 rays on each side of the nose, primary somatosensory cortex had 12 bands. We take this as further evidence that morphological features of somatosensory cortex are determined by the periphery.     

Bilateral detection thresholds in dextrals and sinistrals reflect the more sensitive side of the nose, which is not lateralized [published erratum appears in Chem Senses 1998 Dec;23(6):761]

Several fundamental questions remain enigmatic concerning human olfactory sensitivity, including (i) whether detection threshold differences exist between the two sides of the nose (and, if so, whether such differences are influenced by handedness) and (ii) whether bilateral (i.e. binasal) stimulation leads to lower thresholds than unilateral stimulation (and, if so, whether the degree of facilitation is inversely related to general olfactory ability). In this study, and well-validated single staircase procedure was used to establish bilateral and unilateral detection thresholds for the cranial nerve I stimulant phenyl ethyl alcohol in 130 right- and 33 left-handed subjects. No differences in sensitivity between the left and right sides of the nose were observed in either group. Bilateral thresholds were lower, on average, than unilateral thresholds when the latter were categorized in terms of left and right nares. However, the bilateral thresholds did not differ significantly from those of the side of the nose with the lower threshold. Overall smell ability, as measured by the University of Pennsylvania Smell Identification Test, did not interact with any of the test measures. These data imply that (i) the left and right sides of the nose do not systematically differ in detection threshold sensitivity for either dextrals or sinistrals and (ii) if central integration of left:right olfactory threshold sensitivity occurs, its effects do not exceed the function of the better side of the nose.      

Olfactory sensitivity: Is there laterality?

The side of the nose having the greater sensitivity for thedetection of n-butanol was determined for 19 male subjects (nineleft-handed and ten right-handed) using a two-interval forcedchoice paradigm and a flow dilution olfactometer. These determinationsshowed not only that the subjects did have a nostril of greatersensitivity but that left- and right-handed subjects significantlydiffered in the side of that greater sensitivity: Left-handedsubjects were very consistent in showing greater sensitivityin the left side of the nose, whereas right-handed subjectsshowed a weak tendency toward greater sensitivity in the rightside of the nose. A number of physiological and anatomical explanationsare offered to account for these results, but it is felt thatthere is now enough evidence for a relationship between handednessand nasal side sensitivity, for whatever reason, to merit itsfurther consideration. ^*To whom all correspondence should be addressed: Departmentof Physiology, SUNY Upstate Medical Center, 766 Irving Avenue,Syracuse, NY 13210, USA.     

Differing characteristics in 100 consecutive secondary rhinoplasty patients following closed versus open surgical approaches

Open rhinoplasty has unquestionably become more popular during the past two decades because of the putative diagnostic and technical advantages that direct transcolumellar access offers. To test the hypothesis that patients initially treated by the opened or closed approaches differed in the secondary deformities that developed, a retrospective study was conducted of 100 consecutive secondary rhinoplasty patients (66 women and 34 men) operated on by the author before February of 1998. Sixty-four percent had previously undergone closed rhinoplasties and 36 had undergone open rhinoplasties; the incidence of prior open rhinoplasty had increased steadily over the survey years, from 21 percent in 1996 to more than 50 percent in 1998, 1999, and 2000 (p < 0.05). The data generated indicate the following. First, the open rhinoplasty patients had undergone more operations (3.1 versus 1.2) and had more presenting complaints (5.8 versus 2.6) than the closed rhinoplasty patients. Second, although the most common presenting complaint among prior closed rhinoplasty patients was an overresected dorsum (50 percent) or tip (33 percent) or internal valvular obstruction (42 percent), prior open rhinoplasty patients complained more frequently than the closed rhinoplasty patients of these problems and also external valvular obstruction (50 percent, p < 0.0001), short nose (39 percent, p < 0.001), wide columella (36 percent, p < 0.001), narrow nose (31 percent, p < 0.001), columellar scar (25 percent, p < 0.001), and symptomatic columellar struts (19 percent, p < 0.001). Only excessive nasal length was more prevalent among closed rhinoplasty patients (20 percent, p < 0.01). Third, ranking of deformities differed significantly (p < 0.0001) between the two groups, so that complaints related to the nostrils, nasal tip, nasal length, or columella were more common among the open rhinoplasty patients than among those previously treated endonasally. Fourth, the relative frequencies of surgical complaints also differed: whereas patients previously treated endonasally were 6.7 times more likely to complain of long noses, patients previously treated by open rhinoplasty complained more frequently of the following: excessive columellar width (open approach, 36 percent of patients; closed approach, none), hard columellar struts (open approach, 19 percent of patients; closed approach, none), external valvular obstruction (4.5 times as frequent with the open approach as it was with the closed approach), alar/nostril distortion (four times as frequent), and narrow nose (3.9 times). Although the most common complaints among all postrhinoplasty patients remain the overresected dorsum, tip, or (internal valvular) airway obstruction, the author's data suggest that patients previously treated by the open approach are more likely to have postsurgical deformities and complaints referable to those anatomic structures most easily reached by transcolumellar exposure and to techniques that can be performed more readily or aggressively through that access route.     

Lengthening the nose with a tongue-and-groove technique

Lengthening the short nose is often a major task. The ability to maintain proper alignment between the nasal base and dorsum may prove difficult without sacrificing the suppleness of the former. In this article, the authors introduce a technique of nose lengthening that ensures alignment of the tip with the rest of the nose yet avoids tip rigidity, unless a significant increase in tip projection is also planned. Two spreader grafts are placed, one on either side of the septum, and are extended beyond the caudal septal angle proportional to the planned nasal lengthening. A columella strut, with the cephalocaudal dimension equaling the combination of the width of the existing medial crura plus the amount of planned nasal lengthening, is placed between the medial crura in continuity with the caudal septum and is fixed to the medial crura using 5-0 clear nylon or polydioxanone suture. If additional projection beyond what is achievable by mere placement of a columella strut is required, the strut is fixed to the spreader grafts in a more projected position. Otherwise, the columella strut is simply positioned between the extensions of the spreader grafts. It is necessary to mobilize the lower lateral cartilages to prevent excessive columella show. This procedure has been performed on 23 patients over the past 12.5 years, with 20 patients enjoying good-to-excellent results. The advantages of this technique include its predictability and reproducibility, and the ability to elongate the nose with a mobile nasal base that is in line with the rest of the nose. If suture fixation is used to gain more projection, the technique proves dependable but the nose will become more rigid than is optimal. The requirement of three pieces of properly shaped septal cartilage, which might not be available when a secondary rhinoplasty is performed, is the major disadvantage of this operation. Furthermore, the procedure is, to some degree, labor-intensive.     

The principle of upper airway unidirectional flow facilitates breathing in humans

Upper airway unidirectional breathing, nose in and mouth out, is used by panting dogs to facilitate heat removal via water evaporation from the respiratory system. Why some humans instinctively employ the same breathing pattern during respiratory distress is still open to question. We hypothesized that 1) humans unconsciously perform unidirectional breathing because it improves breathing efficiency, 2) such an improvement is achieved by bypassing upper airway dead space, and 3) the magnitude of the improvement is inversely proportional to the tidal volume. Four breathing patterns were performed in random order in 10 healthy volunteers first with normal breathing effort, then with variable tidal volumes: mouth in and mouth out (MMB); nose in and nose out (NNB); nose in and mouth out (NMB); and mouth in and nose out (MNB). We found that unidirectional breathing bypasses anatomical dead space and improves breathing efficiency. At tidal volumes of approximately 380 ml, the functional anatomical dead space during NMB (81 +/- 31 ml) or MNB (101 +/- 20 ml) was significantly lower than that during MMB (148 +/- 15 ml) or NNB (130 +/- 13 ml) (all P < 0.001), and the breathing efficiency obtained with NMB (78 +/- 9%) or MNB (73 +/- 6%) was significantly higher than that with MMB (61 +/- 6%) or NNB (66 +/- 3%) (all P < 0.001). The improvement in breathing efficiency increased as tidal volume decreased. Unidirectional breathing results in a significant reduction in functional anatomical dead space and improvement in breathing efficiency. We suggest this may be the reason that such a breathing pattern is preferred during respiratory distress.     

An assessment of nasal functions in control of breathing

Breathing pattern and steady-state CO2 ventilatory response during mouth breathing were compared with those during nose breathing in nine healthy adults. In addition, the effect of warming and humidification of the inspired air on the ventilatory response was observed during breathing through a mouthpiece. We found the following. 1) Dead space and airway resistance were significantly greater during nose than during mouth breathing. 2) The slope of CO2 ventilatory responses did not differ appreciably during the two types of breathing, but CO2 occlusion pressure response was significantly enhanced during nose breathing. 3) Inhalation of warm and humid air through a mouthpiece significantly depressed CO2 ventilation and occlusion pressure responses. These results fit our observation that end-tidal PCO2 was significantly higher during nose than during mouth breathing. It is suggested that a loss of nasal functions, such as during nasal obstruction, may result in lowering of CO2, fostering apneic spells during sleep.     

Impact of left and right nostril olfactory abilities on binasal olfactory performance

Four models were tested which from theoretical points of viewuse the combined inputs from each side of the nose to predictthe binasal olfactory ability. The best predictor was the modelwhich states that input from the better side accounts for thebinasal ability.     

Morphologic and genetic studies of the nose

The aim of this paper is to find metrical and morphological shape variants of the nose, which are highly determined by heredity. For this, 67 monozygotic and 59 dizygotic twins were measured and the morphological details of the nasal region were recorded and documented by taking photographs in the three standard views of the nose. The study of shape variants in our population was based on 160 control persons, who were not related. Out of this group 61 control pairs were put together by random selection with regard to sex and age. From every examined person data of 9 metrical and 43 well distinguishable morphological variants of the nose were gathered. They had been worked out of numerous observable forms. It could be shown that two measures (breadth of the nose, breadth of the tip of the nose) and eight other morphological features of the nose are of good heredity.     

Metallic taste and retronasal smell

A series of experiments investigated the nature of metallic taste reports and whether they can be attributed to the development of a retronasal smell. Two studies showed that the metallic sensation reports following oral stimulation with solutions of FeSO4 were reduced to baseline when the nose was occluded. No such reduction was seen for CuSO4 or ZnSO4, which were more bitter and astringent, respectively, and less metallic. A discrimination test based on weak but equi-intense levels of FeSO4 and CuSO4 showed that FeSO4 could be discriminated from water with the nose open but not when occluded, but that discrimination of CuSO4 from water was not impaired by nasal occlusion. A discrimination test demonstrated that the headspace over solutions of FeSO4 was not different from water, although some subjects could discriminate FeSO4 solutions from water in the mouth when the nose was occluded, perhaps by tactile or astringent cues. These results confirm that metallic taste reports following oral stimulation with FeSO4 are likely due to development of a retronasal smell, possibly following a lipid oxidation reaction in the mouth. However, metallic taste reports may arise from different mechanisms with copper and zinc salts.     

Adults scan own- and other-race faces differently

It is well established that individuals show an other-race effect (ORE) in face recognition: they recognize own-race faces better than other-race faces. The present study tested the hypothesis that individuals would also scan own- and other-race faces differently. We asked Chinese participants to remember Chinese and Caucasian faces and we tested their memory of the faces over five testing blocks. The participants' eye movements were recorded with the use of an eye tracker. The data were analyzed with an Area of Interest approach using the key AOIs of a face (eyes, nose, and mouth). Also, we used the iMap toolbox to analyze the raw data of participants' fixation on each pixel of the entire face. Results from both types of analyses strongly supported the hypothesis. When viewing target Chinese or Caucasian faces, Chinese participants spent a significantly greater proportion of fixation time on the eyes of other-race Caucasian faces than the eyes of own-race Chinese faces. In contrast, they spent a significantly greater proportion of fixation time on the nose and mouth of Chinese faces than the nose and mouth of Caucasian faces. This pattern of differential fixation, for own- and other-race eyes and nose in particular, was consistent even as participants became increasingly familiar with the target faces of both races. The results could not be explained by the perceptual salience of the Chinese nose or Caucasian eyes because these features were not differentially salient across the races. Our results are discussed in terms of the facial morphological differences between Chinese and Caucasian faces and the enculturation of mutual gaze norms in East Asian cultures.     

Lengthening of the postoperative short nose: combined use of a gull-wing concha composite graft and a rib costochondral dorsal onlay graft

Several causes of short nose are known: congenital anomaly, developmental problem, trauma, and various types of rhinoplasty-the postoperative short nose being one of the most difficult problems to correct in plastic surgery. Contracted skin envelope, tissue deficiency of cartilage and mucosal lining, and poor circulation make postoperative short nose difficult to lengthen and susceptible to recurrence. Thus, for effective lengthening and long-term maintenance of it, specific grafts should be used to supplement the missing lining and cartilage and a mechanical support also is needed to withstand the skin contraction. The nose consists of three structural layers: the outer skin envelope, middle osteocartilaginous framework, and inner mucosal lining. Many methods have been proposed to correct short nose deformity. Those procedures lengthen the nose slightly, but none of them take into account the unique characteristics of postoperative causes and the structural concept of the nose. The procedures have resulted in only limited success. On the basis of the above clinical findings and the structural concept, we developed a surgical technique to correct postoperative short nose according to the structural layers. Our method consists of three main surgical maneuvers: (1) a gull-wing concha chondrocutaneous composite graft to supplement the deficient middle and inner layers, (2) a rib costochondral onlay graft on the dorsum to reinforce the framework, and (3) wide dissection of the outer skin envelope to cover the lengthened framework without tension. We prefer a closed surgical approach rather than an open approach to avoid too much tension on the columellar incision site and to allay patients' fear of an additional scar. From 1988 to 1998, we performed our lengthening technique on six female patients. All six patients demonstrated a significant lengthening and improved appearance postoperatively. After the lengthening procedure, the average nasolabial angle improved from 116 degrees to 104 degrees. The mean follow-up period was 8.7 months, with a range of 3 to 17 months. Sometimes, epidermal sloughing in the vertical strut of the gull-wing     

Group IIIA-metal hydroxides indirectly neutralize the voltage sensor of the voltage-dependent mitochondrial channel, VDAC, by interacting with a dynamic binding site.

The voltage-dependent, anion-selective mitochondrial channel, VDAC, undergoes two different conformational changes from the open to a closed state under positive and negative applied electric fields. Micromolar quantities of aluminum hydroxide and other metal trihydroxides have recently been shown to be able to inhibit this voltage-dependent closure (Dill et al. (1987) J. Membr. Biol. 99, 187-196; Zhang and Colombini (1989) Biochim. Biophys. Acta 991, 68-78). It was suggested that the inhibition results from the neutralization of the positively charged voltage sensors by the metal species. In the present study, the dynamics of the metal-binding site accompanying channel closure was investigated by adding In(OH)3 to only one side of the membrane and examining its effect on the channel's gating processes. Indium added to open channels inhibited channel closure only when the metal-containing side was on the lower potential side of the applied field. If indium was added only to the higher-potential side, the channels closed and tended to remain closed after the field was abolished. The addition of metal hydroxide after closing the channels with a negative potential on the metal side did not result in channel re-opening as would be expected for sensor neutralization. Inhibition occurred immediately, however, if the channels were first allowed to open briefly. The closed-state selectivity seemed to be very similar in the absence or presence of the metal, indicating that the metal-binding sites are not located within the pore of the channel in the closed conformation. The results are consistent with a voltage-dependent translocation across the membrane of each of two metal-binding sites on VDAC. This translocation is tightly coupled with channel opening and closing.     

The Tennison Lip repair revisited

Tennison presented his method for the repair of the single cleft. He was the first to recognize and to preserve the cupid's bow by lowering the peak in the margin of the cleft. He incised the medial side of the cleft and filled the space with a triangular flap from the lateral side. We have modified the Tennison repair based on the vertical height of the normal side, as did Randall and Hagerty. We make the lip 1 mm shorter in the vertical height than the normal side because some of our repairs were too long. Other modifications include a 1-mm offset at the vermilion, and in certain lips that are too long in the newborn, a triangle is excised beneath the alar base to shorten the vertical height. The details for planning the incisions and accomplishing the surgery are given. Certain patients required a V-to-Y procedure to augment a vermilion deficiency, but none of these patients required a secondary procedure. This emphasizes the need for careful planning to get it right at the primary repair. The operation is indicated for the incomplete cleft to the very wide cleft, and in no patient was a lip adhesion required. We no longer operate on the nose at the primary repair.     

Rhinoplasty in the African-American patient

Because of the increasing popularity of rhinoplasty in the African-American patient, we delineate how a rhinoplasty surgeon can perform this challenging technique to obtain uniform and consistent results. First, we address how one can appreciate and analyze the various aesthetic concepts of beauty and the unique anatomic characteristics of the African-American nose. Second, we present a pragmatic, systematic analysis of the African-American nose. Last, we describe the techniques consistently used to modify the African-American nose while achieving or maintaining facial harmony using the open approach to rhinoplasty. Specific case analyses are presented to demonstrate utilization of the technique.     

Nasal reconstruction based on aesthetic subunits in Orientals

Reconstruction based on the aesthetic subunit principle has yielded good aesthetic outcomes in patients with moderate to severe nasal defects caused by trauma or tumor resection. However, the topographic subunits previously proposed are often unsuitable for Orientals. Compared with the nose in white patients, the nose in Orientals is low, lacks nasal muscle, and has a flat glabella; the structural features of the underlying cartilage and bone are not distinctly reflected in outward appearance. The authors devised aesthetic subunits suitable for Orientals, and they used these units to reconstruct various parts of the nose. The major difference between these units and those presented previously is the lack of soft triangles and the addition of the glabella as an independent unit. The authors divided the nose into the following five topographic units: the glabella, the nasal dorsum, the nasal tip, and the two alae. The border of the nasal dorsum unit was extended to above the maxillonasal suture. The basic reconstruction techniques use a V-Y advancement flap from the forehead to reconstruct the glabella, an island flap from the forehead to reconstruct the nasal dorsum and nasal tip, a nasolabial flap to reconstruct an ala, and a malar flap to reconstruct the cheek. A combination of flaps was used when the defect involved more than one unit. This concept was used for nasal reconstruction in 24 patients. In one patient undergoing reconstruction of the nasal dorsum and in one undergoing reconstruction of the nasal tip, the texture of the forearm flap did not match well, which resulted in a slightly unsatisfactory aesthetic outcome. In one patient in whom the glabella, nasal dorsum, and part of the cheek were reconstructed simultaneously, a web was formed at the medial ocular angle, and a secondary operation was subsequently performed using Z-plasty. In one patient undergoing reconstruction with a forehead flap, defatting was required to reduce the bulk of the subcutaneous flap pedicle at the glabella. However, suture lines were placed in the most inconspicuous sites in all patients, and the use of a trapdoor contraction emphasized the three-dimensional appearance of the nose. The use of these aesthetic subunits for reconstruction offers several advantages, particularly in Oriental patients. Because the nasal dorsum is reconstructed together with the side walls, tenting of the nasal dorsum is avoided, which prevents a flat appearance of the nose. A forehead flap is useful in the repair of complex defects. Defects of the alae should be separately reconstructed with a nasolabial flap to enhance the effect of the trapdoor contraction and to highlight the three-dimensional appearance of the nose. Candidates for reconstruction should be selected on the basis of nasal structure. The results suggest that these units can also be used in some white patients.     

Bacterial colonization of patients treated with chronic hemodialysis]

The study was aimed at investigating the predispositions of the patients chronically treated with hemodialysis to nose and skin colonization with potentially pathogenic bacteria. The study involved 41 patients chronically hemodialysed and patients treated at the Department of Renal diseases or out-patient clinic (30 individuals). Smears from the nose and throat were taken from all patients and used for bacteriologic tests. In case of hemodialysed patients material for bacteriologic tests was additionally taken from the skin at the site of arterio-venous fistula and groin. It was found, that patients chronically treated with hemodialyses are more frequently colonized with enteric bacilli and coagulase-positive staphylococci that both hospitalized patients and those treated in out-patient clinic. No relationship between the presence of coagulase-positive staphylococci in the nose and throat and on the skin was seen despite such suggestions of other authors.     

Intranasal localizability of odorants: influence of stimulus volume

When an odorant is presented to one side of the nose and air to the other, the ability to localize which side received the odorant depends upon trigeminal nerve stimulation. It has been shown that performance on this lateralization task increases as stimulus concentration increases. In this study, we determined the influences of stimulus volume and sex on the ability to localize each of 8 odorants presented at neat concentrations: anethole, geraniol, limonene, linalool, menthol, methyl salicylate, phenyl ethanol, and vanillin. At a low stimulus volume (11 mL), only menthol was localized at an above-chance level. At a high stimulus volume (21 mL), above-chance localization occurred for all odorants except vanillin. Women were significantly better than men in localizing menthol. Stimuli rated as most intense were those that were most readily localized. The detection performance measures, as well as rated intensity values, significantly correlated with earlier findings of the trigeminal detectability of odorants presented to anosmic and normosmic subjects. This study suggests that differences in stimulus volume may explain some discrepant findings within the trigeminal chemosensory literature and supports the concept that vanillin may be a "relatively pure" olfactory stimulus.     

A truffle in the mouth is worth two in the bush: odor localization in the human brain

It is widely thought that locating the source of a smell is an ability best left to nonhuman members of the animal kingdom. In this issue of Neuron, two complementary articles highlight the neural mechanisms underlying the localization of an odor, either to the left or right side of the nose (Porter et al.) or to the inside or outside of the mouth (Small et al.). Together, these studies validate the idea that the human brain is equipped with the apparatus necessary to pinpoint the location of an odor source.