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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана
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undertunneling is strictly limited to the lateral wall of the
premaxilla and not continued laterally on the nasal floor.
Fig. 1.76Incisive nerve (coronal section at the middle of the nasal cavity, MC staining).
Incisive nerve (1); vomer (2); bony palate (3); sphenoidal process of the cartilaginous
septum (4).
Fig. 1.77Incisive canals. Incisive nerves (1); vomer (2); bony palate (3).
Vomeronasal Organ
The vomeronasal organ (organ of Jacobson) is a
rudimentary chemosensory organ found in most mammals
and the majority of humans. It is located at the base of the
anterior cartilaginous septum in the lamina propria of the
mucosa adjacent to the perichondrium. The organ is able to
perceive chemical signals with a sexual or territorial
significance, called pheromones. It starts as a mucosal
depression at the ventral part of the septal base (▶ Fig.
1.78). Its posterior part deepens, and the lips of the pit fold
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over to form a tunnel that runs within the perichondrium in
a dorsal direction (▶ Fig. 1.79). It then forms a small duct of
variable length (2 to 10 mm), which terminates in a small
pouch (▶ Fig. 1.80). Both duct and pouch are lined with a
high columnar cell epithelium. In contrast to most
mammals, the vomeronasal organ in man is situated in the
lamina propria adjacent to the perichondrium, not in the
cartilage or bone.
Fig. 1.78Vomeronasal organ (coronal section just posterior to the premaxilla, MC
staining). Bilateral mucosal pit or opening (1); cartilaginous septum (considerably
dislocated in this case) (2); premaxilla (3). Note the septal turbinates and turbinate-like
tissue inside the bony pyramid and at the nasal floor.
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Fig. 1.79High magnification detail of ▶ Fig. 1.78. Opening with posterior lip (1);
beginning of the duct (2).
Fig. 1.80High magnification detail of ▶ Fig. 1.78. Vomeronasal organ (coronal section,
MC staining). Vomeronasal organ lined with a high columnar epithelium lying within the
perichondrium of the septal cartilage (3).
Septal Pathology
Septal Deviation and Basal Crest
A high deviation of the perpendicular plate and
cartilaginous septum to one side, and a basal crest to the
other side, is a common type of pathology. A classic
example is shown in ▶ Fig. 1.81 and ▶ Fig. 1.82. The
perpendicular plate and the cranial part of the
cartilaginous septum are deviated to the right, whereas the
septal base is dislocated to the left. The anterior nasal
spine is somewhat asymmetric, the left wing being larger
than the right. There is extensive scarring at the
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chondrospinal junction. Several pieces of cartilage are
present. It is unclear whether they represent (dislocated)
paraseptal cartilages, or new posttraumatic cartilaginous
growth.
Fig. 1.81Deviation of the anterior septum with a basal crest to the opposite side
(coronal section at the level of the anterior nasal spine, MC staining). Cartilaginous
septum (1); perpendicular plate (2); dislocated septal base (3); anterior nasal spine (4);
chondrospinal junction with scar tissue and multiple pieces of cartilage (5). Note the
septal turbinates and the turbinate-like tissue on the inside of the nasal bones.
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Fig. 1.82High magnification of detail of ▶ Fig. 1.81. Dislocated septal base (3);
premaxilla (4); chondrospinal junction with scar tissue and several (dislocated) pieces of
cartilage (5).
Vomeral Crest
Vomeral crests generally occur at the more posterior parts
of the anterior septum. They usually consist of a bony
(vomeral) and a cartilaginous part. The latter derives from
the base of the cartilaginous septum and/or a dislocated
sphenoidal process, as shown in ▶ Fig. 1.83 and ▶ Fig. 1.84.
They often end in a spur.
Fig. 1.83Vomeral crest (coronal section at the level of the sphenoidal process of the
cartilaginous septum, MC staining). Vomer (1); superimposed dislocated sphenoidal
process (2).
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