The Study Of Gustation In Patients After Total Laryngectmy

Objective: To test the function of the residusal taste in patients after total laryngectomy. To study the reasons of taste descendant and the factors that affected the residual taste function after operation. To discuss the measures of improving gustation in patients after total laryngectomy. Method: The group of using new operation-style include 40 laryngectomees remaining lingual surface parenchyma of epiglottis and voice rehabilitation. The group of using routine operation-style and voice rehabilitation is composed of 40 people who are laryngectomees. The control group include 40 normal people . The TR-06 electrogustometer made by Japan RION company is used to test the function of gustation in both the groups of new and routine operation-style, as well as 40 normal people.Besides, afer getting the mucosa of ligual root, epiglottis and aryepiglottis fold , we study taste bud by histology and ultra-structure pathology .Meanwhile, new operation-style and CNOAM(closing-mouth and nasal out-word airflow maneuver) are applied to enhance the function of gustation in patients after total laryngectomy. Results:l.It is proved by histology that there are some sums of taste buds in laryngeal, most of which are pinch in epiglottis lingual surface and aryepiglotticfold. 30-60 taste cells constitute a global/pyriform taste bud, which is 20-40Mm in diameter, 40-60Hm in length. Taste cell is slim /columinform, 5-7Mm in diameter, extend from taste bud' s bottom to stratosphere and enter into taste pore district. 2. Taste cells include light cell, dark cell, intermediate cell,basal cell in laryngeal by ultra-structure pathology study. Basal cell lie in the taste bud' s bottom, which constitute heperplasia colony of taste cell. Light cell, dark cell, intermediate cell are differentiated from basal cell. Dark cells lie in the taste bud' s edge. Their distinctive features include plasm is dark, the presence of dense granules in apical cytoplasm, and deeply indented, irregularly shaped nuclei. Light cell lie in the taste bud' s midst. Their distinctive features include plasm is light, excessive poly-ribosome and rough endoplasmic reticulum in the nucleolus. Intermediate cell have features of both dark cell and light cell. 3. All laryngectomees complained hypogeusia after operation, which disturbed their daily life and food takeing and choosing. And 90% of the patients also reported a deterioration of olfaction. These conformed by the result of objective test. 4.Gerder, smoking history, time since operation, radiation were all related to residual gustation. 5. The newoperation-style can improve gustation of laryngectomees.The closing-mouth and nasal out-word airflow maneuver can improve both the patients' olfaction and gustation of laryngectomees. Conclusion: 1. Histology and ultra-structure pathology study confirm that taste buds exist in laryngeal, most of which are pinch in epiglottis lingual surface and aryepiglottic fold, which have no difference with the taste buds of mouth and pharynx in structure. 2. The primary reasons of laryngectomees hypogeusia are as follows:?Part of taste buds on laryngeal were ablated. Taste bud' s number is in inverse propotion with threshold. (2) Dystrophia can also result in vitamin absence and serum hemoZinc decrease, which are in inverse propotion with threshold. (3)The patients after total laryngectomy can arouse bite and sup reduce, structure change. All of them result in the inner disturbance of water and electrolyte. Moreover taste bud' s excitability is sensitive to the change of hydronium chroma(Na+, K+, Ca2+, Mg2+, Cl" etc). ?All laryngectomees complained hyposmia after operation. The relation of taste and olfaction is osculative. Hyposmia can result in hypogeusia and the mechanism is unclear. 3. The residual gustation in female is better than in male, non-smoking better than smoker. And the residual gustation tend todrop dowm as the time goes on. Radiation has great influence on residual gustation .primary because receptors on the taste cell surface or hydronium channel was damaged. 4. The new operation-style is a simple, convinent and effective method .which can improve patients' residual gustation. 5.The closing-mouth and nasal out-word airflow maneuver can improve both olfaction and gustation of the laryngectomees.