Closure of Tracheoesophageal Puncture after Total Laryngectomy.

Tracheoesophageal puncture with voice prosthesis placement is used to restore vocal function after total laryngectomy. However, closure of the fistula is sometimes needed. At our department, a simple and effective technique for closure was developed. It does not require interposed tissues or materials. Moreover, our procedure allows for a short rehabilitation time for swallowing and a short hospitalization. We describe advantages, pitfalls, and errors to avoid. This technique should not be performed for patients who are irradiated and those with large fistulas.

The importance of preoperative swallowing therapy in subtotal laryngectomies.

OBJECTIVE: To examine the utility of swallowing therapy (ST) before and after surgery in patients undergoing subtotal laryngectomy. STUDY DESIGN AND SETTING: From 1990 to 2000, 43 patients underwent subtotal laryngectomy. Prior to 1997 patients received ST only after surgery, while from 1997 on, patients scheduled for subtotal laryngectomy also received some sessions of ST before surgery. RESULTS: The average time to swallowing resumption was 27.76 +/- 5.206 days for the 25 patients who received ST only after surgery, and 16.38 +/- 2.953 for those who underwent ST both before and after surgery. CONCLUSION: The difference between the two groups was significant on Student's t test (P < 0.001) and shows that preoperative rehabilitation is of significant help in the early resumption of normal deglutition. SIGNIFICANCE: The authors find that the duration of nasogastric tube feeding is reduced in subjects who underwent ST.

Evidence of p53 immunohistochemical overexpression in ethmoidal mucosa of woodworkers.

A high risk of neoplastic transformation of nasal and paranasal sinuses mucosa is related to the occupational exposure to wood dust, however no conclusive data have been reported up to now about morphological precursors of these tumors, mechanisms of carcinogenesis and role of p53 gene. Immunohistochemical overexpression of protein p53 (DO7 clone) by epithelial cells of ethmoidal mucosa was investigated on 60 woodworkers occupationally exposed for a minimum of 10 years, on 50 functional and/or esthetic nasal surgery patients (control group) and on 15 cases of intestinal-type adenocarcinoma, 10 of these involving subjects who had a longtime exposure to wood dust. In almost all the woodworkers (92%) the normal ciliated epithelium showed tracts of squamous metaplasia. The mean percentage of p53-positive cells in woodworkers and in controls was 28.6 and 7.97%, respectively, in metaplastic epithelium (P<0.001), 11.7 and 2.08% in ciliated epithelium (P<0.001), 12.46 and 1.03% (P<0.001) in the sero-mucous glands of the nasal stroma. Both in tracts of metaplastic epithelium and in those of ciliated epithelium, positive cells were distributed in basal and suprabasal layers. A high number of p53-positive cells was also observed in the normal ciliated epithelium close to the neoplastic cells, of intestinal-type adenocarcinomas affecting subjects with longtime exposure to wood dust. Moreover, a higher number of p53 positive neoplastic cells was showed by the cases occurring in occupationally exposed patients than by the others. The following conclusions can be drawn: (1) in the ethmoidal mucosa, a region at high risk of carcinogenesis in subjects exposed to wood dust, epithelial cells overexpress p53 protein, and this may be linked to the presence of p53 gene mutations; malignant transformation, as at other head and neck sites, may thus occur through this pathway; (2) the presence of p53 overexpression in sero-mucous glands is in keeping with the histogenesis of some tumors from these structures; (3) since tumors of nose and paranasal sinuses, mainly adenocarcinoma, are recognized as occupational neoplasias, immunohistochemical evaluation of p53, perhaps combined with molecular methods, could be the first step to detect subjects at high risk of carcinogenesis among woodworkers.