Histological changes of the voice tube and possible clinical consequences after voice reconstruction with free ileocolon flap.

Abstract

Free ileocolon flap has become a valid option for restoration of speech after pharyngolaryngectomy. After transfer, deprivation of the trophic intestinal contents and exposure to chronic intermittent airflow could substantially modify the structure of the voice tube, compromising its function. Biopsy specimens from 14 voice tube segments were examined. Sections were evaluated after staining with hematoxylin-eosin, trichromic Masson, and antiproliferating cell nuclear antigen. In all samples, the mucosa displayed diffuse atrophy and decreased proliferation rate, and in some areas only a single layer of goblet cells and enterocytes was present. Erosions, ulcerations, and dysplastic changes were absent and the alterations were limited to the mucosal layer. None of the patients experienced problems related to the modifications of the mucosa. The changes detected in the voice tube mucosa seem to indicate a physiologic adaptation to the new environment as proved by disappearance of the chronic inflammatory infiltrate and absence of erosions when the steady state was reached.