Chem. Senses 26: 35-39,
2001
© Oxford University Press 2001
Imaging of the Human Vomeronasal Duct
Department of Radiology and 1 Department of Otorhinolaryngology, University of Dresden Medical School, Fetscherstr. 74, 01307 Dresden, Germany
Correspondence to be sent to: Thomas Hummel, Department of Otorhinolaryngology, University of Dresden Medical School, Fetscherstr. 74, 01307 Dresden, Germany. E-mail: thummel{at}rcs.urz.tu-dresden.de
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Abstract |
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The human vomeronasal duct (VND) is described as a tubular or pouch-like mucosal invagination of the anterior nasal septum. This study investigated shape, size and orientation of the VND using magnetic resonance imaging (MRI). Fifteen subjects participated (eight women, seven men; mean age 39 years, age range 18–66 years); they had been pre-selected with regard to the presence of a VND opening of 1 mm. MRI was performed before and after application of diluted gadolinium-diethylene-triamino-penta-acetic actetate (Gd-DTPA) into the left or right VND. A tubular structure was found in 12 subjects with a median length of 7 mm (range 3–22 mm; one VND with a length 47 mm). In three subjects a nearly circular, pouch-like structure was observed. Seven of the tubular VNDs were slightly bent upwards, the other five VNDs ran parallel to the floor of the nasal cavity. There was no significant gender-related difference in the length of VNDs. These data indicate considerable variability of shape, size and orientation of the human VND.
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Introduction |
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TopAbstractIntroductionMaterials and methodsResultsDiscussionReferences |
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The vomeronasal organ (VNO) was first mentioned by Ruysch in 1703 (Ruysch, 1703
) and re-discovered at the beginning of the nineteenth century by Jacobson (Cuvier, 1811); since then, anatomy and function of this chemosensory organ have been thoroughly investigated in different species (Halpern and Frumin, 1979; Wysocki and Meredith, 1991; Trotier and Døving, 1998). Vomeronasal activation has been shown, for example, in hamsters and/or mice to influence aggression, female cyclicity, mating behavior, or onset of puberty [for a review see Wysocki and Meredith (Wysocki and Meredith, 1991)]. In contrast, function of the human VNO is far from clear. Histological studies of the VNO indicate the presence of sensory epithelium in human embryos (Ortmann, 1989). One investigation (Takami et al., 1993) also finds that the adult human vomeronasal epithelium contains cells expressing markers characteristic of neurons (NSE, PGP9.5) [for a discussion see also Witt et al. (Witt et al., 2000)]. Few publications relate to functional aspects (Boehm and Gasser, 1993; Monti-Bloch et al., 1994; Berliner et al., 1996; Lundstrom et al., 2000). It has been reported that application of odorless ‘vomeropherins’ may result in gender-specific behavioral changes, modulation of autonomic nervous system function, or release of gonadotropins (Monti-Bloch et al., 1998).
An opening of the vomeronasal duct (VND) appears not to be detectable in all humans. Its detectability ranges from 25 to >90% (Potiquet, 1891; Johnson et al., 1985; Garcia-Velasco and Mondragon, 1991; Eloit et al., 1998; Gaafar et al., 1998; Knecht et al., 1999). Corresponding to the few and contradictory studies on its presence in humans, there are only few reports regarding the VND’s shape and orientation. Kölliker (Kölliker, 1877) found the length of the vomeronasal duct to range from 2 to 7 mm. Anton (Anton, 1895) described a tubular structure located symmetrically on both sides of the septum with a length of up to 8.4 mm. Mangakis (Mangakis, 1902) observed a VND with a length of 62 mm. Smith et al. (Smith et al., 1998) reported a length between 3.5 and 11.8 mm. And, finally, Eloit et al. (Eloit et al., 1998) found its length to be between 2 and 5 mm. Thus, the present study was undertaken to investigate the shape, size and orientation of the human VND using magnetic resonance imaging (MRI). Due to both high soft-tissue contrast and high in-plane-resolution, this study was expected to yield more detailed and precise information than previously possible.
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Materials and methods |
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Fifteen healthy volunteers participated (eight women, seven men; mean age 39 years, range 18–66 years). All subjects were in excellent health and none of them reported a major nasal trauma or surgery of the nasal septum. The study was conducted according to the Declaration of Helsinki (Sommerset West amendment); it was approved by the University of Dresden Medical Ethics Review Committee. All subjects gave written consent.
The presence of a vomeronasal lumen was verified endoscopically by an experienced otorhinolaryngologist. Criteria for detection were a mucosal invagination on the anterior portion of the septum (up to 2.5 cm above the floor of the nasal cavity, and up to 4.5 cm distant from the naris) that looked different than other humps and invaginations that are occasionally found on the respiratory epithelium. Subjects were pre-selected according to an opening of the lumen of at least 1 mm in diameter. The population presently studied was in part a subset of a population of 173 subjects investigated previously using endoscopical techniques (Knecht et al., 1999). In these subjects a mucosal, ‘VNO-like’ invagination in the anterior portion of the nasal septum was detected in 
60% of the subjects; in 25 % of these subjects the opening was 
1 mm.
The anatomical position of the VND was measured in relation to the columella and the floor of the nasal cavity using custom-built, hook-like rulers with 1 mm graduation marks. Minute amounts (0.2 ml) of diluted contrast agent [CA = gadolinium-diethylene-triamine-penta-acetic-acic (Gd-DTPA), dilution 1:100; Magnevist®, Schering, Germany] were gently placed into the VND opening until CA reflux was visible; CA instillation was done without exerting any pressure. For this maneuver a flexible Teflon catheter was used (outer diameter 0.8 mm). Only one VND was investigated in each subject. The side of investigation was selected according to the VND’s accessibility to endoscope and catheter. To control the possible spill of CA, small pieces of cellulose were placed around the VND opening prior to application. In addition, after CA application the surface of the epithelium was very gently dabbed with cotton swabs. This procedure was performed under endoscopical control in the sitting subjects. MR scans started 3 min after CA application; they lasted 20 min.
MRI was performed with a 1.5 Tesla system (Magnetom Vision®, Siemens, Germany) using a standard quadrature head-coil. We used both T1-weighted turbo spin echo (TSE) sequences (TR = 550 ms, TE = 20 ms, 2 Nex; 512˛ matrix, slice thickness 3–4 mm) and T1-weighted volume-sequences (FLASH-3D, TE = 6 ms, TR = 20 ms, 
= 30°, 5122 matrix) with a voxel size of 1 x 0.59 x 0.59 mm; in one subject a T1-weighted MP-RAGE with isometric voxels (1 x 1 x 1 mm) was used. With these 3D-datasets, multiplanar reconstruction was performed. To identify the presence of fatty tissue within the nasal septum, MRI was also performed before CA application. In addition, the volume of the VND was calculated including occasional bubbles of air inside the VND. Measurements of both length and position of the VNO were performed by two independent observers. In case of differences between these measurements another experienced radiologist was employed.
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Results |
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The VND’s opening was found at a mean distance of 24.6 mm from the columella (range 10–34 mm) and 8.9 mm above the floor of the nasal cavity (range 5–18 mm). None of the subjects reported painful sensations in response to CA application. MRI of the VND was possible in all investigated cases (examples are shown in Figures 1 and 3).
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MRI indicated high variability of both shape and size of the VND. In three subjects pouch-like VNDs were observed (length 4–20 mm, volume 25–126 mm3). CA was found in close contact to the VND’s opening. The remaining 12 subjects had tubular VNDs (median length 7 mm, range 3–47 mm, volume 5–77 mm3; Table 1, Figure 2).
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Three subjects exhibited VNDs which differed significantly from others. Subject A had a large pouch-like VND which extended from the application site into a bulge in the nasal septum without cross-over to the contralateral side. In subject B the VND had a volume of 26 mm3 and a length of 9 mm. After CA application on the left side of the nasal septum, the agent was found to cross over the septum to the right side 6 mm dorsal to the opening (Figure 3). In subject C the VND opening was found 27 mm dorsal to the columella connected to a tubular structure of 9 mm length. From here on no CA was seen for a length of 32 mm until a pouch-like structure (diameter 6 mm) appeared which, again, was filled with CA (volume 76.5 mm3).
VNDs tended to be slightly longer in men (median = 12 mm, mean = 17.4 mm, SD = 14.7) compared to women (median = 5.5 mm, mean = 7.4 mm, SD = 5.2) (t-test, P = 0.10); however, the position of the VND’s opening was almost identical for men and women (Figure 2).
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Discussion |
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The present study produced three major results. It indicated that the VND (i) has a median length of 7 mm; (ii) exhibits large variation in shape; and (iii) may cross over to the contralateral side. To our knowledge, this was the first time that the VND has been investigated using MRI.
Most previous studies indicated that the VND’s length ranges between 2–12 mm (Kölliker 1877; Anton 1895; Stensaas et al., 1991; Moran et al., 1995; Jahnke and Merker 1998). While this corresponds with present observations, we had one subject where the VND was found to have a length of 47 mm. To our knowledge, there is only one anecdotal report from Mangakis (Mangakis, 1902) where a bilateral VND of 62 mm length was found. Similar to findings in the present study, Mangakis also reported that these tubular structures were connected to each other through the septum. Other than all previous findings, however, Mangakis reported that these symmetrical ducts did not end blindly but had a posterior opening. Thus, the present study confirms this previous report as one VND was found to have a length of at least 47 mm. It remains a question, however, as to how this extremely long duct relates to the much shorter mucosal ducts found in the anterior portion of the septum, or whether these long ducts represent a different anatomical entity unrelated to the VND.
As the CA was poured into the VND’s opening without any pressure, the actual length of the VND may have been underestimated. Specifically, the VND’s lumen may not always have been filled completely with CA. On the other hand, regardless of whether the filling was complete or not, the fact that CA was found in the VND points at the possibility that in humans a similar pumping mechanism may exist as it is thought to exist in animals (Meredith and O’Connell, 1979; Eccles, 1982). There, it is possible that the constriction of blood vessels may create a vacuum which draws stimulus-laden air and/or mucus into the VND’s lumen. Whether such pump-like mechanisms exist in humans or not might be explored in cadavers. However, when running such experiments it would be mandatory to use absolutely fresh material in order to avoid potentially disturbing effects of dehydration of the mucosa on the interaction with hydrophilic contrast agents.
In addition to variation in length, the investigated VNDs also exhibited variation in size—which to some extent may be due to septal deviations. Three subjects exhibited pouch-like VNDs, while the other subjects had tubular ones. A similar variability in shape has been reported more than 100 years ago. Anton (Anton, 1895) found one specimen to be pouch-like, with a diameter of 2.2 mm; he described an additional six VNDs which had a tubular shape.
Finally, the present study revealed that VNDs may cross over to the contralateral side. Provided that the human VND subserves chemosensory functions, this may have consequences in terms of septal surgery. It seems possible that the surgeon may unknowingly destroy the VND on one side where no opening can be detected. As a consequence, it must be discussed whether investigations, similar to the one we have performed, should become standard procedure before septal surgery. Alternatively, until the question of the VND’s function in humans has been answered convincingly, the subperiostal approach for nasal septum surgery should be preferred whenever possible.
In conclusion, the present paper indicated large variability in the shape and size of the human VND. In addition, it provided data which are in favor of a careful, subperiostal approach in septal surgery, even when no ipsilateral opening is detectable.
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Acknowledgments |
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We thank Birgit Lehmann for her assistance with data acquisition. We also would like to thank Dr Hans Distel, Institute for Medical Psychology, University of Munich, Germany, for most helpful comments.
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References |
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Accepted July 18, 2000
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