The vomeronasal (Jacobson's) organ.

A 66-year-old woman presented with a chief complaint of nasal congestion in the setting of chronic sinusitis. Anterior rhinoscopy revealed a septal deviation and mildly hypertrophied inferior turbinates. Nasal endoscopy detected a small "punched-out" lesion in the anterior cartilaginous nasal septum on the left side (figure 1). The patient was treated with cephalexin, but 3 weeks later the lesion remained unchanged.

[FIGURE 1 OMITTED]

The human vomeronasal organ (VNO) has long been a source of curious interest in the scientific literature. (1) Its discovery has long been attributed to the great Dutch anatomist Frederic Ruysch, who first illustrated the organ in the early 18th century. (2) The first detailed histologic accounts of the human VNO were published in 1877 by the Swiss anatomist Rudolph Albert von Kolliker. (3) Interestingly, Ludwig Levin Jacobson, for whom the organ is named, described its existence only in animals (in 1811); he reported that the VNO did not exist in humans. (1) Various others have published reports of the existence of the VNO in a variety of different animals as well as in human embryos, but its existence in adult humans was not widely accepted until relatively recently. (1)

In 1985, Johnson et al examined 100 human adults and found an opening of the VNO on the anteroinferior part of the nasal septum in 39. (4) Nine of these subjects had bilateral pits. On postmortem examination of 27 septal specimens, a VNO was found in 19 (70%).

In 1998, Gaafar et al examined the nasal septa of 200 adults. (5) The frequency of occurrence varied according to the method of examination. On anterior rhinoscopy, large pits were visible in 32 of these subjects (16%), while nasal endoscopy found them in 152 (76%).

Grossly, the VNO appears as a shallow circular pit or depression on the anterior cartilaginous nasal septum. Its shape can be oval, circular, or irregular. (4) It can be unilateral (figure 1) or bilateral (figure 2). One recent study showed that bilaterality was more common in males than in females. (6) The size of the VNO ranges from 0.2 to 2 mm. (4) It is situated in the anterior one-third of the nasal septum at a distance of 1.5 to 2 cm dorsal to the columella and 0.5 to 1 cm above the nasal floor. (5) The VNO can resemble a small ulcer or a punched-out lesion, and therefore it should not be confused with a septal ulceration. (7)

[FIGURE 2 OMITTED]

Although long believed to be a vestigial olfactory organ of no clinical significance, recent studies have raised questions about its possible role in pheromone communication among humans. (8,9) However, evidence of such a role has not been supported by any clinical investigation.

References

(1.) Bhatnagar KP, Smith TD. The human vomeronasal organ. V. An interpretation of its discovery by Ruysch, Jacobson, or Kolliker, with an English translation of Kolliker (1877). Anatomical Record (Part B: New Anatomist) 2003;270B:4-15.

(2.) Ruysch F. Thesaurus Anatomicus Tertius. Amsterdam: Joannen Wolters, 1703:48-49; Plate IV, fig. 5.

(3.) Kolliker A. Uber die Jacobson'schen Organe des Menschen. Leipzig: Wilhelm Engelmann, 1877.

(4.) Johnson A, Josephson R, Hawke M. Clinical and histological evidence for the presence of the vomeronasal (Jacobson's) organ in adult humans. J Otolaryngol 1985;14:71-9.

(5.) Gaafar HA, Tantawy AA, Melis AA, et al. The vomeronasal (Jacobson's) organ in adult humans: Frequency of occurrence and enzymatic study. Acta Otolaryngol 1998;118:409-12.

(6.) Besli R, Saylam C, Veral A. et al. The existence of the vomeronasal organ in human beings. J Craniofac Surg 2004;15:730-5.

(7.) Hawke M, Bingham B, Stammberger H, Benjamin B. Diagnostic Handbook of Otorhinolaryngology. London: Martin Dunitz, 1997.

(8.) Meredith M. Human vomeronasal organ function: A critical review of best and worst cases. Chem Senses 2001;26:433-45.

(9.) Jahnke V, Merker HJ. Electron microscopic and functional aspects of the human vomeronasal organ. Am J Rhinol 2000;14:63-7.

From the Section of Otolaryngology, Yale-New Haven Hospital (Dr. Coelho and Dr. Yanagisawa); the Section of Otolaryngology, Hospital of St. Raphael (Dr. Yanagisawa); and the Section of Otolaryngology, Yale University School of Medicine (Dr. Coelho and Dr. Yanagisawa), New Haven, Conn.