Miani Cesare, Ortolani Fulvia, Bracale Anna Maria Bergamin, Petrelli Lucia, Staffieri Alberto, Marchini Maurizio
Department of Surgical Sciences, Otolaryngology Section, University of Udine, Piazzale S. M. della Misericordia, 33100 Udine, Italy.
Eur Arch Otorhinolaryngol. 2003 Nov;260(10):529-35. doi: 10.1007/s00405-003-0638-3. Epub 2003 Jun 27.
After total laryngectomy, the patients often report immediate and marked olfactory deficit. The aim of this study was to determine whether hyposmia in laryngectomees reflects olfactory epithelial damage. Ten laryngectomized patients and ten rhinologically normal subjects were subjected to olfactory testing, after which histological examination of biopsied olfactory mucosa was performed. Olfactory testing in laryngectomees revealed a marked reduction in odor perception. Histological examination of olfactory mucosa specimens showed that in laryngectomees some neuroepithelial structural features were comparable with those found in normal subjects. However, additional signs of damage were also observed, consisting mainly of various degrees of epithelial degeneration, above and beyond those that are characteristic of physiological epithelium turnover. These different degenerative features consisted of severe damage to the neuroepithelium, culminating in complete topical loss. Bowman's glands were also observed to be involved in the degenerative process. Laryngectomy-induced hyposmia seems to be correlated with the almost complete loss of nasal airflow due to the disconnection between the upper and lower airways, which prevents odor molecules from reaching the olfactory area, together with degenerative phenomena, which affect the neuroepithelium, and consequent failure in neurosensorial performance.
全喉切除术后，患者常报告即刻出现明显的嗅觉减退。本研究的目的是确定喉切除患者的嗅觉减退是否反映嗅觉上皮损伤。对10例喉切除患者和10例鼻科检查正常的受试者进行嗅觉测试，之后对活检的嗅觉黏膜进行组织学检查。喉切除患者的嗅觉测试显示气味感知明显降低。嗅觉黏膜标本的组织学检查表明，喉切除患者的一些神经上皮结构特征与正常受试者的相似。然而，也观察到了额外的损伤迹象，主要包括不同程度的上皮变性，超出了生理性上皮更新的特征。这些不同的变性特征包括神经上皮的严重损伤，最终导致局部完全丧失。还观察到鲍曼腺也参与了变性过程。喉切除引起的嗅觉减退似乎与上、下气道断开导致鼻腔气流几乎完全丧失有关，这阻止了气味分子到达嗅觉区域，同时还与影响神经上皮的变性现象以及随之而来的神经感觉功能障碍有关。
