Normal flora and mucosal immunity of the head and neck.

The study of the human resident flora has grown from Antony van Leeuwenhoek's simple descriptions some 300 years ago to the sophisticated investigations being done today. The acquisition of organisms and the subsequent course of either stable colonization or invasion of the host involve complex host-parasite interactions. From one perspective, clearly host factors are operative that appear to select against certain species while being permissive for others. From another perspective, microbial species that are successful at colonization must overcome certain host factors to maintain a selective advantage and flourish within a particular body habitat. It is intriguing that whereas host mucosal defenses are a significant influence contributing to selection of the resident flora, it is this established flora that provides the host with perhaps its most important local defense system. In the head and neck areas, many of these mucosal surfaces are contiguous and thus for the most part share a common resident flora. These organisms are rarely involved in infection unless some breach of the mucosal surface or some upset in the balance of the normal flora occurs. On these occasions, the host is susceptible to infection from both newly acquired organisms and those previously present, which may now become invasive. In any event, it is clear that improved knowledge of the normal flora of the head and neck is essential for understanding and for effective treatment of infectious processes in this area. It is hoped that a better appreciation of the important role of the normal flora in maintaining the host mucosal defenses will further focus our attention on its preservation.