2.2.2 Contact endoscopy
Contact endoscopy exams (for the evaluation of the nasal and oral
mucosa) were all performed with a contact endoscope (Karl Storz, 7215AA,
0°, 23 cm long, 4 mm in diameter; Tuttlingen, Germany) as an outpatient
procedure. A contact endoscope (CE) was connected to a 150W xenon light
source, a video camera, and an SVHS video recorder (Olympus, nCare
medical recorder). Subsequently, the tip of the endoscope was gently put
in contact with the mucosa (nasal-Locus Kiesselbachii-, or oral) and the
mucosa was examined under 60x- and 150x- magnification, by adjusting the
zoom switch on the endoscope. All findings were recorded digitally. The
digital images were evaluated for blood flow dynamics, overall mucosal
morphology, and density of the sub-epithelial vessels [11-14].
The form of the fungiform papillae was classified to one of four types
in increasing order of damage as following: type 1 , (egg-shaped
or long ellipse type – without surface thickness), type 2(slight thicker surface compared to type 1), type 3 (thick and
irregular surface) and type 4 (remarkably flat and atrophic
surface). Due to their very light staining, fungiform papillae could be
readily distinguished from filiform papillae, which stained dark
[11,12,14].
The classification of the blood vessels’ morphology at the tip of
anterior tongue apex was performed according to a classification by
Negoro et al. [14]. Five types of vessels’ morphology, classified in
increasing order of morphologic alterations were found, namelytype A (clear loop and wooden branch shape), type B(unclear loop and wooden branch shape), type C (elongated blood
vessels), type D (granular shape or dotted shape) andtype E (unclear blood vessels).
Nonetheless, based on previous published experience and studies on
description of the morphology and vascularization of the oral mucosa, a
modification of Negoro’s classification for the outline of the
vascularization of nasal mucosa showed quite reproducible findings and
therefore has been used [14,15]. According to this modified
classification, there are five morphological types of nasal mucosa
vascularization, which have been already described thoroughly above
(Figure 1).
After carefully suctioning of the secretions, the anterior part of the
nasal cavity was stained with methylene blue 1%. Then the mucosa was
gently touched with the tip of the contact endoscope.