Intraoperative Sneezing Secondary to Indirect Olfactory Nerve Stimulation

Area of Science:

• Neuroscience
• Ophthalmology
• Neurology

Background:

• Sneezing is a complex reflex, traditionally attributed to trigeminal nerve stimulation in the nasal mucosa.
• The efferent pathway involves a coordinated sequence including eye closure, inspiration, and forced expiration.
• Existing knowledge suggests autonomic and psychogenic factors can also trigger sneezes.

Observation:

• A case study involving a patient undergoing awake craniotomy for oligodendroglioma removal is presented.
• During surgical manipulation, sneezing was elicited upon stimulation of the olfactory nerve.
• This occurred while dissecting tumor from the arachnoid surface overlying the olfactory nerve.

Findings:

• The olfactory nerve stimulation during surgery induced a sneezing response.
• This suggests a potential accessory pathway for sneeze induction distinct from the trigeminal nerve.
• The findings challenge the traditional understanding of sneeze pathophysiology.

Implications:

• This discovery may lead to new insights into the neural pathways controlling the sneeze reflex.
• Understanding alternative sneeze triggers could have implications for managing conditions involving involuntary sneezing.
• Further research is warranted to explore the olfactory nerve's role in sneeze generation.