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Cutaneous innervation of the human face as assessed by skin biopsy
Author(s) -
Nolano Maria,
Provitera Vincenzo,
Caporaso Giuseppe,
Stancanelli Annamaria,
Leandri Massimo,
Biasiotta Antonella,
Cruccu Giorgio,
Santoro Lucio,
Truini Andrea
Publication year - 2013
Publication title -
journal of anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.932
H-Index - 118
eISSN - 1469-7580
pISSN - 0021-8782
DOI - 10.1111/joa.12001
Subject(s) - sudomotor , microneurography , anatomy , calcitonin gene related peptide , skin biopsy , substance p , colocalization , pathology , medicine , biopsy , facial muscles , catecholaminergic , biology , neuropeptide , neuroscience , catecholamine , baroreflex , heart rate , receptor , blood pressure
The morphology of cutaneous sensory and autonomic innervation in human trigeminal territory is still unknown. The aim of this study is to describe facial cutaneous innervation using skin biopsy. This new tool could be useful in understanding the mechanisms underlying several facial pain conditions. In 30 healthy subjects, we quantified epidermal nerve fibers ( ENF s) and dermal myelinated fibers ( MF s) in V1, V2 and V3, using indirect immunofluorescence and confocal microscopy applied to 2‐mm punch skin biopsies from areas adjacent to the eyebrow, upper and lower lip. Using selective markers, we also evaluated the distribution of peptidergic, cholinergic and noradrenergic fibers. Facial skin appeared abundantly innervated and rich in annexes. The ENF density decreased and the MF density increased, moving from the supraorbital to the perioral skin. Noradrenergic sudomotor fibers were particularly and constantly expressed compared with other body sites. Distribution of vasoactive intestinal peptide‐immunoreactive ( VIP ‐ir) fibers appeared peculiar for their constant presence in the subepidermal neural plexus – in close contact, but without colocalization with calcitonin gene related peptide ( CGRP ) and substance P ( S ub‐ P )‐ir fibers. Finally, in perioral skin samples, we observed striated muscle fibers with their motor nerves and motor endplates. Our work provides the first morphological study of human facial cutaneous innervation, highlighting some unique features of this territory. Quantification of unmyelinated and myelinated fibers on 2‐mm punch biopsies appeared to be feasible and reliable. Facial skin biopsy may be a new approach with which to study and to better characterize facial pain syndromes.