RESUMO
BACKGROUND: Fistulas, sinus or cysts which trace back to anomalies of the first branchial cleft are seldom compared to lateral neck cysts and fistulas. For their accurate diagnosis and safe treatment special embryological and anatomical knowledge is necessary. MATERIAL AND METHODS: Embryology, anatomy, diagnosis and therapy are described and explained by 2 case studies in context to the current literature. RESULTS AND CONCLUSION: Sonography and contrast-enhanced radiological methods represent the fundamental pillar of the diagnosis. Therapeutically, the complete extirpation is the first choice. Surgeries on children, patients with extended fistulas and special cases of fistula routes require particular carefulness. In certain cases with pronounced findings and low levels of symptoms a "wait-and-see" strategy can be justified. Surgically, protection of the facial nerve and prevention of recurrences are the greatest challenge.
Assuntos
Região Branquial/anormalidades , Adolescente , Adulto , Região Branquial/embriologia , Região Branquial/cirurgia , Branquioma/diagnóstico , Branquioma/embriologia , Branquioma/cirurgia , Criança , Diagnóstico Diferencial , Meato Acústico Externo/cirurgia , Otopatias/diagnóstico , Otopatias/embriologia , Otopatias/cirurgia , Orelha Externa/cirurgia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Fístula/diagnóstico , Fístula/embriologia , Fístula/cirurgia , Humanos , Complicações Intraoperatórias/prevenção & controle , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/prevenção & controle , Orofaringe/patologia , Orofaringe/cirurgia , Otite Externa/etiologia , Otite Externa/cirurgia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/embriologia , Otorrinolaringopatias/cirurgia , Neoplasias Otorrinolaringológicas/diagnóstico , Neoplasias Otorrinolaringológicas/embriologia , Neoplasias Otorrinolaringológicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Nasal polyposis is mostly associated with eosinophilia of mucosal tissue. This points to the implication of CC chemokines in nasal eosinophilia. Recently the CC chemokine eotaxin-2 (CCL24) was identified. This study was initiated to localize the cellular source, analyze expression of mRNA, and quantify protein synthesis of CCL24. METHODS: Specimens of nasal inferior turbinates from controls and polypous tissue from patients suffering from chronic polypous sinusitis were collected. Furthermore, fibroblasts and epithelial cells were cultured. CCL24 protein was analyzed by immunohistochemistry and ELISA, expression of mRNA by SQ-RT-PCR. RESULTS: CCL24 was observed in endothelial and epithelial cells. Specimens from patients expressed significantly (>2fold) more CCL24 mRNA than controls. Fibroblasts and unstimulated cells did not express CCL24 mRNA. Upon stimulation with TNF-alpha, INF-gamma, IL-4, or costimulation with TNF-alpha and INF-gamma CCL24 mRNA was significantly enhanced (3.2-19.6%). In controls, fibroblast, and unstimulated cells CCL24 protein was below detection limit. Most polyps comprised significant amounts of CCL24 (mean 0.24 ng/mg). TNF-alpha, INF-gamma or IL-4 induced CCL24 protein (0.1-0.3 ng/ml) in epithelial cells. Costimulation with TNF-alpha and IL-4 (0.1-30 and 1-30 ng/ml, respectively) synergistically induced synthesis of CCL24 protein (0.18-0.31 ng/ml). CONCLUSION: In nasal polyps endothelial and epithelial cells are obviously the main source of CCL24, which was shown for transcription (mRNA) and production (protein) levels and was associated with diseases. Results gave evidence of CLL24- directed migration of cells from inside (the bloodstream) to the epithelial side (mucosa) in eosinophilic inflammatory diseases, e.g. nasal polyposis.
