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Osteitis is a misnomer: a histopathology study in primary chronic rhinosinusitis

Authors

  • Kornkiat Snidvongs MD,

    Corresponding author
    1. Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    2. Australian School of Advanced Medicine, Macquarie University, North Ryde, NSW, Australia
    • Correspondence to: Kornkiat Snidvongs, MD, The Australian School of Advanced Medicine, 2 Technology Place, Macquarie University, North Ryde, NSW 2109, Australia; e-mail drkornkiat@yahoo.com

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  • Peter Earls MBBS,

    1. Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia
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  • Dustin Dalgorf MD,

    1. Department of Otolaryngology–Head and Neck, Skull Base Surgery, St Vincent's Hospital, Sydney, Australia
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  • Raymond Sacks MD,

    1. Australian School of Advanced Medicine, Macquarie University, North Ryde, NSW, Australia
    2. Department of Otolaryngology, Concord General Hospital, Sydney, Australia
    3. Sydney Medical School, University of Sydney, Sydney, Australia
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  • Eleanor Pratt BA, BSc,

    1. Sydney School of Public Health, University of Sydney, Sydney, Australia
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  • Richard J. Harvey MD

    1. Australian School of Advanced Medicine, Macquarie University, North Ryde, NSW, Australia
    2. Department of Otolaryngology–Head and Neck, Skull Base Surgery, St Vincent's Hospital, Sydney, Australia
    3. St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
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  • Potential conflict of interest: R.S. is a consultant for Medtronic and Nycomed, speakers’ bureau for Merck Sharp Dolme and Arthrocare. R.J.H. has served on an advisory board for Schering Plough and Glaxo-Smith-Kline, previous consultant with Medtronic, Olympus and Stallergenes, speakers’ bureau for Merck Sharp Dolme and Arthrocare and has received grant support from NeliMed. K.S., P.E., D.D., and E.P. have no financial disclosures.

Abstract

Background

The histological features of osteitis in chronic rhinosinusitis (CRS) in animal studies induced by bacterial inoculation into maxillary sinuses revealed inflammatory involvement of the underlying bone matrix and/or the Haversian system; however, human studies do not mention these findings. The objective of this study was to investigate the inflammatory characterization of osteitis in CRS.

Method

A prospective study of primary CRS patients undergoing sinus surgery was conducted (August 2012 to April 2013). Bone-mucosa samples were taken from a predetermined site that correlated to a computed tomography location. Radiological bone thickness was measured. A blinded histopathological assessment included inflammatory infiltrate of bone, periosteal reaction, presence of osteoblasts or osteoclasts, fibrosis, and the percentage of new woven bone to total bone thickness, together with an overall opinion of whether neo-osteogenesis was present.

Results

Twenty-two primary CRS patients (age 45.8 ± 15.6 years; 59.1% female) were recruited. CRS with polyps accounted for 59.1% of patients. The bony thickness measured radiologically was a median 1.72 (interquartile range [IQR], 2.38; range, 0.3-12.14) mm. No samples (0%) had evidence of inflammatory infiltrate of bone; 90.9% had both osteoblasts present and new woven bone formation. Woven bone was greater with periosteal reaction (80.83% ± 9.25% vs. 47.50% ± 29.37%; p = 0.006), greater with osteoclasts present (80.00% ± 12.58% vs 59.00% ± 28.52%; p = 0.03), and greater when fibrosis was present (69.75% ± 24.14% vs 25.00% ± 7.07%; p = 0.003).

Conclusion

Most primary CRS patients demonstrated evidence of new woven bone formation. True “osteitis” with inflammatory infiltrate of the bone was not observed. “Osteitis” is likely a process of neo-osteogenesis and bone remodeling, rather than bone inflammation in primary CRS.

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