Immunocytochemical study of the maxilla and maxillary sinus during human fetal development

Endoscopic sinus surgery for treatment of kartagener syndrome: a case report

BACKGROUND

KARTAGENER SYNDROME (KS) IS A RARE CONGENITAL DISEASE CHARACTERISED BY A CLINICAL TRIAD OF SYMPTOMS: situs inversus, chronic rhinosinusitis, and bronchiectasis. Although congenital ciliary defect is recognised as the main cause of this syndrome, it remains difficult to treat the associated airway infection.

CASE REPORT

A 17-year-old female patient presented with repeated refractory airway infection. She also had bronchiectasis and situs inversus. Electron microscopic evaluation of her nasal mucosa revealed ciliary defect and confirmed the diagnosis of KS. She underwent functional endoscopic sinus surgery (FESS) followed by long-term postoperative debridement of the sinonasal cavity. This treatment reduced chronic rhinosinusitis and protected against subsequent airway infection in a 7-year follow-up.

CONCLUSION

FESS is effective for relieving both chronic rhinosinusitis and lung infection of KS in the long term.

Managing upper respiratory tract complications of primary ciliary dyskinesia in children. Curr Opin Allergy Clin Immunol. 2012;12:32-38. [PMID: 22157161 DOI: 10.1097/aci.0b013e32834eccc6]

PURPOSE OF REVIEW

Primary ciliary dyskinesia (PCD) is a rare and heterogeneous disease that is often misdiagnosed or diagnosed late with more advanced sequelae. PCD primarily effects the respiratory tract, yet most research focuses on the lower respiratory tract manifestations, most of which is derived from research on cystic fibrosis. Little is known about the management of the upper respiratory tract sequelae of PCD. This review summarizes the available evidence for the management of otologic and sinonasal manifestations of PCD.

RECENT FINDINGS

The natural history of otitis media with effusion and hearing loss in PCD appears to fluctuate into adulthood and does not resolve by the age of 9 years, regardless of treatment, as previously assumed. Ventilation tube insertion improves hearing in PCD, but may lead to a higher rate of otorrhoea when compared with the general population. Sinonasal disease in PCD is poorly studied; however, it appears that patients with chronic rhinosinusitis (CRS) may benefit from long-term macrolide therapy and endoscopic sinus surgery (ESS) in recalcitrant disease. Therapies targeted at improving mucociliary clearance have not been tested specifically in PCD. Pharmacogenetic therapy is currently under investigation to target the primary defect in PCD.

SUMMARY

Otologic sequeale in PCD should undergo lifelong evaluation and monitoring and ventilation tube insertion should be considered to avoid complications of chronic hearing loss. Sinonasal disease benefits from macrolide therapy and ESS. Randomized controlled trials of treatment efficacy of the upper respiratory tract manifestations of PCD are lacking.

Microanatomical variation of the nasal capsular cartilage in newborn primates

The breakdown of nasal capsule cartilage precedes secondary pneumatic expansion of the paranasal sinuses. Recent work indicates the nasal capsule of monkeys undergoes different ontogenetic transformations regionally (i.e., ossification, persistence as cartilage, or resorption). This study assesses nasal capsule morphology at the perinatal age in a taxonomically broad sample of non-human primates. Using traditional histochemical methods, osteopontin immunohistochemistry and tartrate-resistant acid phosphatase procedure, the cartilage of the lateral nasal wall (LNC) was studied. At birth, matrix properties differ between portions of the LNC that ultimately form elements of the ethmoid bone and regions of the LNC that have no postnatal (descendant) structure. The extent of cartilage that remains in the paranasal parts of the LNC varies among species. It is fragmented in species with the greatest extent of maxillary and/or frontal pneumatic expansion. Conversely, greater continuity of the LNC is noted in newborns of species that lack maxillary and/or frontal sinuses as adults. Chondroclasts occur adjacent to elements of the ethmoid bone, along the margin of the nasal tectum, and/or along islands of cartilage that bear no signs of ossification. Chondroclasts are prevalent along remnants of the paranasal LNC in tamarin species (Leontopithecus, Saguinus), which have extensive frontal and maxillary bone pneumatization. Taken together, the morphological observations indicate that the localized loss of cartilage might be considered a critical event at the onset of secondary pneumatization, facilitated by rapid recruitment of chondro-/osteoclasts, possibly occurring simultaneously in cartilage and bone.

Secondary pneumatization of the maxillary sinus in callitrichid primates: Insights from immunohistochemistry and bone cell distribution

The paranasal sinuses remain elusive both in terms of function and in the proximate mechanism of their development. The present study sought to describe the maxillary sinuses (MSs) in three species of callitrichid primates at birth, a time when secondary pneumatization occurs rapidly in humans. The MSs were examined in serially sectioned and stained slides from the heads of two Callithrix jacchus, one Leontopithecus rosalia, and two Saguinus geoffroyi. Specimens were examined microscopically regarding the distribution of osteoclasts and osteoblasts along the osseous boundaries of the MS and other parts of the maxillary bone. Selected sections were immunohistochemically evaluated for the distribution of osteopontin (OPN), which facilitates osteoclast binding. Taken together, OPN immunoreactivity and bone cell distribution suggested trends of bone resorption/deposition that were consistent among species for the superior (roof) and inferior (floor) boundaries of the MS. Expansion at the roof and floor of the MS appeared to correspond to overall vertical midfacial growth in callitrichids. Much more variability was noted for the lateral (alveolar) and medial (nasal walls) of the MS. Unlike the other species, the nasal wall of Saguinus was static and mostly composed of inferior portions of the nasal capsule that were undergoing endochondral ossification. The variation seen in the alveolar walls may relate to the presence or absence of adjacent structures, although it was noted that adjacency of deciduous molars influenced medial drift of the alveolar wall in Saguinus but not Leontopithecus. The results of this study are largely consistent with the "structural" or "architectural" hypothesis of sinus formation with respect to vertical MS enlargement, and the variable cellular/OPN distribution found along the nasal and alveolar walls was evocative of Witmer's (J Vert Paleontol 1997;17:1-73) epithelial hypothesis in revealing that most expansion occurred in regions unopposed by adjacent structures.