| Objective: To study the olfactory function in patients after total laryngectomy. To investigate the morphologic and ultrastructure change of the olfactory mucosa. The residual olfactory function was tested and the factor affected the residual olfactory function were evaluated. The methods to restore the residual olfactory function were considered. Method: The nasal cavity of 40 laryngectomees and 40 normal control subjects was examined with anterior rhinoscope and nasal endoscopy. The ultrastructure of the nasal mucosa in olfactory region was observed with electron-microscopy .The olfactory function of the patients and the control group was tested by using T&T olfactometry, and the residual olfactory function was rehabilitated through nasal airflow-inducing maneuver. Results: 1. In normal control subjects, there was no obstruction, no secretion found in the nasal cavity. The nasal mucosa in respiratory region was smooth,moist, pink in color, and terderness and elastic in touching, the n asal mucosa in olfactory region was brow-yellowish in color and moisture. In patients' group, the nasal cavity widened. The nasal mucosa in respiratory region wassensitive to touching. It was thin, rigid,and white, white-blue or pale in color. There was thin mucus on it. The nasal mucosa in olfactory region, however ,only showed little changes under nasal endoscopy. 2. In control group, typical pseudostratified columnar epithelium, composed of three layers, could be seen under shoot electron-microscopy in olfactory mucosa. The ciliated olfactory cells, microcillar cells, supporting cells and basal cells were arranged normally with no hyperplasia and atrophy .the cilia and microcilia could also be seen. The Bowman' s gland, deep in the lamina propria, had abundant grains. The endothelium of the microvessels below the mucosa was integrity with thin lamina could be seen. There was no apoptosis or necrosis in Pericyte. In patients' group, under electron microscopy, the three layer of olfactory epithelium could be seen, but the connection between the cell was partly interrupted, and the interval between the cell widened. The cell membrance crimpled, chromatin condensed, which showed a picture of apoptosis. Typical apoptosis bodies could be seen sometimes, columnar epithelium tended to the cuboidal epithelium. The number of grain in the Bowman' s gland was decreased. Endodermis of microvessels proliferated and the diameter ofthe vessels decreased. There was apoptosis in pericyte . The proportion of apoptosis cell reached to its highest two years after operation. As the time went on , the propotion of apoptosis cell droped, but the atrophy columnar epithelium increased. 3.A11 laryngectomees complained obviously decline of their olfaction after operation, which disturbed their daily life. And 71% of the patients also reported a deterioration of gestation, which conformed by the result of objective test. 4.Gerder, smoking history, time since operation, voice rehabilitation were all related to residual olfaction, excepted age. S.The method of nasal airflow-inducing maneuver can improve laryngectomees' residual olfactory function. Conclusions: 1.shortage of stimulating by the smell odorants in patients group, the nasal cavity widen. The nasal mucosa is sensitive to touching. It is thin, rigid,and changed in color. There is thin mucus on it. In olfactory epithelium,under electron microscopy, the connection between the cell is partly interrupted, and the interval between the cell widen. The cell membrance crimple, chromatin condense, which show a picture of apoptosis. Typical apoptosis bodies can be seen sometimes, columnar epithelium tend to the cuboidal epithelium. The number of grain in the Bowman' s gland is decreased.Endodermis of microvessels proliferated and the diameter of the vessels decrease. There is apoptosis in pericyte. The ultrastructure change of olfactory epithelium is one reason of losing olfactory. 2.The laryngectomees have some residual olfactory...
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