Chronic kidney disease-mineral bone disorder (CKD-MBD) is a syndrome encompassing skeletal and extra skeletal changes associated with chronic kidney disease. It progresses silently until an advanced clinical stage when complications impact on the quality of life and survival rates of patients. The maxillofacial manifestations are unique and may play an important role in the early identification of changes which could influence the management of these patients. The goal of this review is to highlight the maxillofacial features, pathology, and principles of management of CKD-MBD.
Metabolic bone diseases often are asymptomatic and progress sub clinically. Many patients present at a late stage with catastrophic skeletal and extra skeletal complications. In this article, we provide an overview of normal bone remodeling and a synopsis of recent developments in the following conditions: osteoporosis, rickets/osteomalacia, endocrine-induced bone disease, chronic kidney disease-mineral bone disorder and Paget's disease of bone. Our discussion will emphasize the clinical and microscopic manifestations of these diseases in the jaws.
Airway surface liquid forms part of the innate defence mechanism of the respiratory system, including the nasal and paranasal sinuses. Successful mucociliary clearance, which lies at the centre of this defence mechanism, involves the synchronized function of two structures, namely, the periciliary liquid layer and the mucus layer. The two structures have collectively been termed the 'two phase airway surface liquid' system. This system is kept hydrated through regulation of sodium and chloride transport. A well hydrated airway surface liquid that allows the periciliary liquid layer to extend over the height of the outstretched cilia keeping mucus away from the epithelia is considered to be essential for effective mucus clearance and sinonasal health. This mechanism assists in trapping and eliminating foreign particles and, together with antimicrobial peptides, maintains a sterile environment in the nasal and paranasal sinuses, which are continually exposed to microorganisms in the external environment. In diseases such as rhinosinusitis, the mucociliary clearance capacity is diminished; the first line of defence is disrupted allowing for bacterial invasion and infection. This manuscript explores the prospect of an alternative approach for the prophylaxis and primary management of rhinosinusitis based on the maintenance of a well hydrated airway surface liquid.
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