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The Anatomical Record sheds light on the world of the nasopharynx, a most important, yet underappreciated, realm, in a novel Special Issue

2022; Wiley; Volume: 305; Issue: 8 Linguagem: Inglês

10.1002/ar.25013

1932-8494

Jeffrey T. Laitman, Heather F. Smith,

Cleft Lip and Palate Research

New Jersey. In preparing this editorial, we could not help but think about New Jersey. For those of you not up on the United States' states, New Jersey is one of the most important. It lies in the northeast nestled between New York and Pennsylvania, and is the home for major rail and truck routes that carry food, gas, and humans in the super-busy northeast corridor between Washington and New York City. And therein lies the problem: New Jersey is an afterthought, a passageway, lying between the Big Apple, the City of Brotherly Love, and the Capital. As the great comedian Rodney Dangerfield would say, “It don't get any respect!” Examples abound. In most states, great citizens have parks, museums, or stadiums named after them. In New Jersey, they get—wait for it—“Rest Stops” bearing their name and countenance on Interstate Highway 95 (I-95)! We kid you not; on traveling between New York and Philadelphia, one has the option to relieve yourself at “Vince Lombardi,” “Thomas Edison,” “Alexander Hamilton” (he was not even from New Jersey, he was just shot there by Aaron Burr in a duel in Weehawken!) or (JL's kids' favorite) “Molly Pitcher.” New Jersey does not even get its own major TV-station, having to use the bandwidths of those from New York or Philadelphia (as punishment, New Yorkers have to listen to stories about some cat stuck in a tree in Piscataway!). The most famous family from New Jersey is not even real—they are the fictional TV “Sopranos” Mafia crime family. New Jersey has to carry the further ignominy of being the home for the New York Giants football team! To remedy these slights, New Jersey markets itself as “The Garden State” (there might be a few peonies somewhere), but this is sort of like the Vikings naming the frozen rock they found “Greenland” (how'd that work for tourism, Leif?). Poor, unloved, New Jersey! And this brings us to the focus of this Special Issue, the nasopharynx, the New Jersey of human body regions. Like New Jersey, the nasopharynx sits at the nexus of pathways, in this case, those leading to/from the ear, nose, and throat. These are the super-star structures of the head (hence the name of the clinical discipline, otolaryngology, or Ear-Nose-Throat, for those who do not dwell in a hospital or medical school). The New Jersey-esque nasopharynx is crucial for the passage of air to/from our larynx/trachea and lungs (we are air-breathing mammals and nothing is more important for us than air!); as the entry/exit portal to the middle ear to control aeration via the pharyngotympanic (Eustachian) tube; as the home for our protective, nasopharyngeal tonsils; as the receptacle for the epiglottis of the larynx early on in life, as it overlaps the soft palate allowing the airway to be largely continuous from nose to trachea and lungs (an important configuration allowing for an infant's breathing and swallowing coordination). The current Covid pandemic has even put the nasopharynx “on the map,” so to speak, highlighting it as the preferred site (rather than the nose) for performing rapid testing thus enabling millions to hear the word “nasopharynx” for the first time. Despite its recent stardom, not to mention that there is probably not a more crucial area of intersecting functions in the body, the nasopharynx has received relatively little focused attention. Until now. The region, it's walls, tissues, development, physiologic functions, evolutionary morphings, importance in disease and clinical treatment, and history of study from antiquity, have been given center stage in this nasopharyngo-centric Special Issue of The Anatomical Record entitled, “The evolution, development and functional morphology of the nasopharynx and its boundaries.” The Special Issue is guest edited by Anthony S. Pagano, Ph.D., of Hackensack Meridian School of Medicine in New Jersey (how fitting!) and Samuel Márquez, Ph.D., of the State University of New York Downstate Health Sciences University in Brooklyn, New York (Pagano & Márquez, 2022, this volume.) Professors Pagano and Márquez—Anthony and Sam, as they are too well-known to us for formalities—are recognized experts in the world of the upper respiratory tract senso lato. Both have provided novel insights into the biology, development and, especially, evolution of the nose, paranasal sinuses, eustachian tube, middle ear, and nasopharynx itself, leading them to uncover aspects of this underrepresented realm. They have both also grown up publishing their science often in The Anatomical Record, as documented below. As noted, the “nasopharynx” itself has rarely taken center stage in publications in The Anatomical Record. It has, however, often been a part of larger studies, or those on focused investigations of regions frequently reported, such as those on the nose, nasal cavity, eustachian tube, or pharynx. Indeed, a detailed accounting of such would require a dedicated volume unto itself. Some interesting reports to note, however, have come from luminaries in our field and can give evidence of our rich history. These include studies from: A.J. (John) Ladman, brilliant scientist and the revered former Editor of our journal (who served an extraordinary 30 years at the helm – HFS's eyes are open wide just thinking about this; see Haines, 1998) on tubule-acinar glands of the eustachian tube in mice (Ladman & Mitchell, 1955); investigations onto the pharyngeal muscles by John Basmajian, the doyen of electromyography and Past-President of our parent organization, The American Association for Anatomy, on pharyngeal spaces and the constrictors (Basmajian & Dutta, 1961; Dutta & Basmajian, 1960); work by renowned veterinary and canine anatomist KM Dyce on muscles of the pharynx and palate in dogs (Dyce, 1957); or, more recently, by Timothy Smith, our own Anatomical Record Associate Editor and one of the world's leading comparative primate histologists, on many topics, including: distribution of olfactory epithelium in the primate nasal cavity (Smith, Bhatnagar, Tuladhar, & Burrows, 2004), the vomeronasal organ and its connections in the region (Bhatnagar & Smith, 2007), the nasal fossa of lemurs (Smith & Rossie, 2008), the development of the nasal capsule in tamarins (Smith et al., 2008), the distribution of olfactory and non-olfactory surface area in the nasal surface area of Microcebus as a means of interpreting airflow (Smith, Eiting, & Rossie, 2011), and an assessment of the “shrinking” anthropoid nose and its effects of the respiratory tract and skull (Smith, Laitman, & Bhatnagar, 2014); studies by our favorite denizen of the seas and whale expert Joy Reidenberg, including: the position of the larynx in toothed whales, the respiratory tract's function in making “bubble clouds,” or the extensive nasal sac system in whales (Reidenberg & Laitman, 1987, 2007, 2008, respectively); insights into other noted cetacean experts such as those from the laboratory of Helmut Oeschlager on sound production in the harbor porpoise (Huggenberger, Rauschmann, & Oeschlager, 2008); forays into how the region may have functioned as derived from the paleontological record from explorations in dinosaurs by frequent Anatomical Record contributors, Larry Witmer (Witmer & Ridgely, 2008), to those in fossil hominids by Christoph Zollikofer and Weissman (2008); Zollikofer, Ponce de Leon, Schmitz, & Stringer, 2008); novel use of ultrasound to visualize prenatal development of the upper respiratory region by Wolfson and Laitman (1990); to clinical examination of reflux in the pharyngeal and laryngeal areas by Lipan, Reidenberg, and Laitman (2006); plus many, many others. Of particular note are two special issues on topics that relate to, and overlap, the world of the nasopharynx. The first was by the hard-working Samuel Márquez in 2008 and entitled, “The Paranasal Sinuses: The Last Frontier in Craniofacial Biology” (Laitman, 2008; Laitman & Albertine, 2008; Márquez, 2008). This insightful issue explored all facets of the paranasal sinuses (and their extensions; hello occasional drippings into the nasopharynx!) and brought together an extraordinary array of views into the embryology, anatomy, physiology, and evolution of these still enigmatic spaces. The second special issue was in 2014 on “The Vertebrate Nose: Evolution, Structure, and Function” and guest edited by comparative anatomist and canine biologist extraordinare, Blaire Van Valkenburgh, the ubiquitous Tim Smith, and frequent contributor and nose expert Brent Craven (Van Valkenburgh, Smith, & Craven, 2014; Laitman & Albertine, 2014, Laitman, 2014). This issue explored all facets of the nose and its tentacles exploring from the most basic questions of “What is a nose?” to its vertebrate evolution, to many functional and clinical insights. It has become a classic in the field. Lastly, a nod must be given again to the guest editors of this special issue, Anthony Pagano and Sam Márquez. We take great pride in Anthony and Sam as they are literally “home-grown” researchers who have published their best science regularly in The Anatomical Record since they were graduate students. (This was, for full disclosure, not always easy for them. JL was their advisor, and although he enjoyed it very much, Anthony and Sam may have preferred not to be frequently awoken at 2 a.m. with suggestions or revisions. We hear that therapy is going well for them.) (Figure 1). Independently and together, Anthony and Sam have published many papers in The Anatomical Record, including, as examples, and starting with the more senior member of the dynamic duo: Márquez' studies on the climactic effect on the nasal complex (Márquez & Laitman, 2008); explorations of the human ethmoid sinus (Márquez, Tessema, Clement, & Schaefer, 2008); study of the nose and nasal activity of Neanderthals (Márquez, Pagano, Delson, Lawson, & Laitman, 2014); CT study of the nose and paranasal sinuses of Egyptian mummies (Márquez, Lawson, Mowbray, Delman, & Laitman, 2015); exploration of the nasal complex of the moose (Márquez, Pagano, Mongle, Albertine, & Laitman, 2019). Those led by Pagano include: a novel 3D morphometric analysis of nasopharyngeal boundaries in extant hominoids (Pagano & Laitman, 2014); the search for cranial indicators of peak incidence of otitis media (Pagano et al., 2017); reconstruction of the Neanderthal Eustachian tube with insights into disease and extinction (Pagano, Márquez, & Laitman, 2019); identification of critical windows in human middle ear disease (Pagano, Márquez, Smith, & Laitman, 2021); and new findings on how nasopharyngeal morphology can shed light on the perplexing middle phase of the Pleistocene hominin fossil record (Pagano, Smith, Balzeau, Márquez, & Laitman, 2022, this volume.) They may need therapy, but they sure have accomplished a lot! Recently, JL was driving back from Philadelphia after working with renowned paleontologist Peter Dodson of the University of Pennsylvania for a Special Issue of The Anatomical Record honoring Peter for his seminal role in the study of dinosaur anatomy (while JL was brainstorming over coffee at Penn, HFS was really working, scratching for fossil turtles in the heat of the Menefee geologic formation in New Mexico preparing material for future manuscripts in the journal!). There apparently was a major accident on I-95 (turned out it was at Thomas Edison Rest Stop; maybe some light bulbs blew) that closed the highway. As a result, JL was forced to weave his way back through back-roads that led far into the unexplored shires of New Jersey, so far in that one could no longer see the spires of New York City (real New Yorkers always get a little nervous when they cannot see the buildings of Manhattan). Being lost (and hungry after some time), JL stopped to visit Ray Heimbuch, mathematical genius, frequent coauthor, and dear friend from Yale days who lives in some little hamlet tucked away between plant groves and Revolutionary war looking houses. The region was really beautiful; it looked like Burnett's “Secret Garden” from the famed children's story. Trees, flowers, birds-a-singing. “Are we in Pennsylvania?” JL asked. “No, New Jersey,” Ray, snorted, as he shook his head. “I never thought that Jersey actually had such gardens,” an incredulous JL responded. “You never looked. They have always been here,” the adopted son of New Jersey answered with some annoyance. And so it is with the nasopharynx and the intent of this special, Special Issue. Just as there is clearly more to New Jersey than the I-95 corridor, there is much extraordinary functional anatomy, intersecting physiologic functions, and insights into vertebrate embryology and evolution buried within the muscles and walls of the nasopharynx. It is all there, if only one looks from a different perspective and goes beyond the usual suspects to appreciate the nuances that are often overshadowed. The Anatomical Record is proud to offer the fine science in this Special Issue and hope that you, like us, will gain new appreciation for an extraordinary anatomical realm. Just look, and you will see.