Efficient cleansing of the upper and lower respiratory surfaces by the mucociliary apparatus is essential to health. Failure of the cleansing allows contaminants prolonged residence on the mucosal respiratory surfaces and thus penetration into the mucosa and possibly inauguration of disease. For some years, genetic ultrastructural ciliary alterations have been recognized, with symptoms dating from early life. It is only in recent years, however, that evidence has shown that ultrastructural ciliary alterations can be acquired later in life and that these alterations in turn lead to a deterioration of efficient ciliary cleansing. A discussion of the intrastructure of the normal mammalian cilium will be given, as well as a listing of the genetic ciliary diseases and their characteristic morphologic alterations. A more complete review will be made in regard to acquired ciliary defects, their cause, the ultrastructural changes, and the relation to clinical disease.
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