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.