Atrophic Rhinitis: Appraisal of Infection Pressure on Gnotobiotic ...
Role of placental implantation in primary atrophic rhinitis
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Short Report P. K. Singh A trophic rhinitis is a social curse for the patient affected, as the loathsome foetor becomes a social stigma for them. Since the exact etiology of the disease is not known, all efforts have been made to give symptomatic relief. As the medical treatment gives only temporary remission of the symptoms, various techniques have been attempted by surgeons for long term relief of symptoms. Most of the techniques have been directed to narrowing of the nasal cavity, to avoid the direct impact of inspired air on the turbinates & nasal mucosa. In the search of an effective cure for Primary Atrophic Rhinitis sublabial implantation of placental hits have been tried in 25 cases. The improvements noted in these cases both clinically and histopathologically are encouraging. Meterials & Methods 25 cases of Primary atrophic rhinitis were taken up for this study. All the patients were subjected to routine ENT & systemic examinations. Examinations of urine, Blood—including VDRL, Kahn, X—Ray chest & siJIuses were done to exclude Address for Reprints Dr. P. K. Singh R. S. 0. M. G. M. Medical College Hospital, Ja nishedpu r. syphilis, tuberculosis & sinus infections. Those who were free from all these were considered to be suffering from the primary or idiopathic atrophic rhinitis. Biopsy from the inferior turbinate was done to confirm the diagnosis & to compare the histopathological findings., in post operative periods.The age of the patient ranged from 14 years to 41 years. With the maximum incidence between 18 to 30 years 70% of the patients were females and all the patients had bilateral affection. Operative Technique A fresh bit of healthy placenta 3 cm in size was collected in a jar containing normal saline with 2% Chloramphenicol under aseptic condition from Gynae. Department and it was used within 6 hours.Under local infiltration anaesthesia, a sublabial incision extending from the upper medial incisor to second premolar was given down to the bone just below the gingivo labial sulcus. The flap was elevated from the floor &lateral wall of the nose gently & the placental bit was implanted into the pocket—thus created. The incision was closed with interrupted catgut stitches. Another placental bit was implanted on the opposite side also. The post operative care consisted of saline nose douches, antiseptic mouth washes, analgesics & streptopenicillin one vial intra muscular daily for seven days. Post operatively there was swelling of the upper lip & side of the nose which subsided completely within five to seven days. The patients were followed up at regular intervals for one year after surgery 3 patients lost to the follow—up after 3 months but in follow—up period the improvement lasted in only 88% of cases. Observation The following observations were made in these cases 1) The nasal mucosa started becoming moist and pink, within seven days of surgery. The changes were marked first on the floor and lateral wall of the nasal cavity. 2) All the patients were relieved of bad smell and crusting within seven days. 3) Initially seven cases showed improvement as far as anosmia was concerned, but in a follow—up period after 6 months of surgery anosmia again appeared in four cases. 4) Biopsy of the nasal mucosa taken to study the changes before & after the operations showed transformation of squamous ephithelium to columnar & reappearance of glandular tissue. 5) Rejection of graft occurred in one case that too on one side on the 6th day of the operation. Discussion Atrophic rhinitis seems to have multifactorial aetiology. No particular factor can be singled out to be totally responsible for this disease. Various authors have tried to blame one or the other factor responsible for this condition. Indian Journal of O[olarvntgologv and Head and Neck Surgei7, Volu,ne 2, No. 3, September 199$ — 169
Transcript of Role of placental implantation in primary atrophic rhinitis
Short Report
P. K. Singh
Atrophic rhinitis is a social curse forthe patient affected, as theloathsome foetor becomes a social
stigma for them. Since the exact etiologyof the disease is not known, all efforts havebeen made to give symptomatic relief. Asthe medical treatment gives only temporaryremission of the symptoms, varioustechniques have been attempted bysurgeons for long term relief of symptoms.Most of the techniques have been directedto narrowing of the nasal cavity, to avoidthe direct impact of inspired air on theturbinates & nasal mucosa. In the searchof an effective cure for Primary AtrophicRhinitis sublabial implantation of placentalhits have been tried in 25 cases. Theimprovements noted in these cases bothclinically and histopathologically areencouraging.
Meterials & Methods
25 cases of Primary atrophic rhinitis weretaken up for this study. All the patients weresubjected to routine ENT & systemicexaminations. Examinations of urine,Blood—including VDRL, Kahn, X—Raychest & siJIuses were done to exclude
Address for Reprints
Dr. P. K. SinghR. S. 0.M. G. M. Medical College Hospital,Ja nishedpu r.
syphilis, tuberculosis & sinus infections.Those who were free from all these wereconsidered to be suffering from the primaryor idiopathic atrophic rhinitis. Biopsy fromthe inferior turbinate was done to confirmthe diagnosis & to compare thehistopathological findings., in postoperative periods.The age of the patientranged from 14 years to 41 years. With themaximum incidence between 18 to 30 years70% of the patients were females and allthe patients had bilateral affection.
Operative Technique
A fresh bit of healthy placenta 3 cm in
size was collected in a jar containing normalsaline with 2% Chloramphenicol underaseptic condition from Gynae. Departmentand it was used within 6 hours.Under localinfiltration anaesthesia, a sublabial incisionextending from the upper medial incisor tosecond premolar was given down to thebone just below the gingivo labial sulcus.The flap was elevated from the floor&lateral wall of the nose gently & theplacental bit was implanted into thepocket—thus created. The incision wasclosed with interrupted catgut stitches.Another placental bit was implanted on theopposite side also.The post operative care consisted of salinenose douches, antiseptic mouth washes,analgesics & streptopenicillin one vial intramuscular daily for seven days.Post operatively there was swelling of theupper lip & side of the nose which subsided
completely within five to seven days. Thepatients were followed up at regularintervals for one year after surgery 3patients lost to the follow—up after 3 monthsbut in follow—up period the improvementlasted in only 88% of cases.
Observation
The following observations were made inthese cases1) The nasal mucosa started becomingmoist and pink, within seven days ofsurgery. The changes were marked first onthe floor and lateral wall of the nasal cavity.2) All the patients were relieved of badsmell and crusting within seven days.3) Initially seven cases showedimprovement as far as anosmia wasconcerned, but in a follow—up period after6 months of surgery anosmia againappeared in four cases.4) Biopsy of the nasal mucosa taken tostudy the changes before & after theoperations showed transformation ofsquamous ephithelium to columnar &reappearance of glandular tissue.5) Rejection of graft occurred in one casethat too on one side on the 6th day of theoperation.
Discussion
Atrophic rhinitis seems to havemultifactorial aetiology. No particularfactor can be singled out to be totallyresponsible for this disease. Various authorshave tried to blame one or the other factorresponsible for this condition.
Indian Journal of O[olarvntgologv and Head and Neck Surgei7, Volu,ne 2, No. 3, September 199$ — 169
Role of Placental Implantation in Primary Atrophic Rhin ills— Sing/r
The very first observation made in thisstudy that the atrophic rhinitis usually startsaround puberty and it is more common infemales, favours the endocrine dysfunction,to have some definite role in theetio—pathogenesis of the disease, and basedon these factors the sublabial implantationof placental bit was tried.Placenta is a homo—graft and isimmunologically competent. It isabundantly rich in steroids and proteinhormones like chorionic gonadotrophines.oestrogens, progesterone, cortisone.hydrocortisone & A. C. T. II.The exact mechanism is not clear, but ithas been believed that placental hormoneswhich stimulate the pituitary and suprarenalcortex & thus regulate metabolism.Moreover it has been proved that localinjections of placental extracts improvesblood circulations (Sinha et al) besides this
mode of action maybe based on the Filtov'sInternationally reputed theory "That animaland vegetable tissues when removed fromthe parent body and exposed to a conditionunfavourable but not mortal to theirexistence undergo biological readjustmentleading to the development of substancesto ensure their vitality called biologicalstimulators'. Such tissues or their vitalitycalled biological stimulators. Such tissuesor their extracts when implanted or injectedinto the body stimulate metabolic orregenerative processes following recovery,more or less graft also narrow the nasalpassage to avoid the direct impact ofinspired air on the nasal mucosa andturhinates.Whatever might be the mode of action butit is certain that the cases showedremarkable improvement, symptomatically,clinically and histopathologically. The rate
of rejection of the graft is negligible Theoperation is safe, simple and can beperformed under local anaesthesia. Besidesthis Placenta is easily available at no cost
References
1. Filtov V. P. (195b) • Tissue Theiapy.Foreign language. publishing house.Moscow.
2. Ramanjaneyulu. I'. (1976) . AhophicRhinitis— A new treatment. IndtunJournal of Otolarvn,goloey 28 : 168.
3. Sinha S. N. et at, (1978) : lntranasalinjection of placental Extinct inatrophic rhinitis. Indium .lonrnul ofOlolarvn ologv, 30 (1) : 20 — 22
4. Tailor M & Young A (1961)Histopathological & Ilistoctinicalstudies in Atiophic Rh iii tis. Journal ofLnryngolo,gv & Olologv 75 : 574.
170 — Indian Journal of Otolcuyagolo&,y and 1/cad and Neck Surgery, Volume 2, No. 3, September 1993
