Anatomical and immunohistochemical considerations on the microinnervation of trachea in humans

The anatomy of the tracheal microinnervation is understudied in humans; the purpose of our study was to fill this gap by working on human adult tracheas, to compare the results with those obtained from animal studies, and to checking whether or not these studies are suitable to be translated from comparative to the human anatomy. The study was designed as a qualitative one. The present work was performed on human adult tracheas dissected out in 15 human adult cadavers. Microdissections were performed in eight tracheas and revealed the outer peritracheal plexus, segmentally supplied and distributed to trachea and esophagus, with longitudinal intersegmentary anastomoses but also with bilateral interrecurrential anastomoses previously undescribed in anatomy. Seven different tracheas were transversally cut and paraffin embedded. Histological stains (HE, toluidine blue, luxol fast blue, Giemsa on tissues and trichrome Gieson) and immunohistochemistry using primary antibodies for nNOS, neurofilament, SMA and the cocktail of citokeratines CK AE1-AE3+8/18 were done. According to the histological individual variation, the neural layers of the posterior wall of the human trachea could be considered as it follows: (a) an outer neural layer, ganglionated, associated with the connective covering layers, adventitia and the posterior fibroelastic membrane (external elastic lamina); (b) a submucosal ganglionated neural layer, mainly with juxtaglandular microganglia that may expand, as glands do, through the outer covering layers; (c) intrinsic nerves of the transverse trachealis muscle; (d) the neural layer intrinsic to the longitudinal elastic band (internal elastic lamina) and supplied from the inner submucosa; (e) the neural plexus of the lamina propria, with scarcely distributed neurons. We also bring here the first evidences for the in vivo nNOS phenotype of mast cells that were identified, but not exclusively, within the trachealis muscle.