Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula.

OBJECTIVE: To determine the rate of pharyngocutaneous fistula after salvage laryngectomy and assess if pectoralis myofascial flap reinforcement over primary pharyngeal closure prevents pharyngocutaneous fistula. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-care public hospital. SUBJECTS AND METHODS: This study included 43 patients undergoing total laryngectomy between 2003 and 2008. Pectoralis myofascial flap reinforcement of the pharyngeal closure during salvage laryngectomy was performed on patients after June 2006. The main outcome measure was pharyngocutaneous fistula after primary laryngectomy, salvage laryngectomy, and salvage laryngectomy with pectoralis flap reinforcement. RESULTS: Of the 43 patients, 26 were treated with primary total laryngectomy while 17 received salvage laryngectomy. Seven of 26 patients (27%) undergoing primary total laryngectomy developed pharyngocutaneous fistula. All patients in this group were closed primarily with no flap reinforcement. For salvage laryngectomy, four of seven patients (57%) with primary pharyngeal closure developed pharyngocutaneous fistula; however, none of 10 patients (0%) undergoing salvage laryngectomy with pectoralis myofascial flap reinforcement developed fistula (P<0.02; 0%-23%; 95% CI). CONCLUSIONS: With pectoralis myofascial flap reinforcement, pharyngocutaneous fistula rate after salvage laryngectomy dropped to 0 percent in this study (0%-23%; 95% CI). This is a simple, reliable technique that prevents postoperative pharyngocutaneous fistula and its associated morbidity after salvage laryngectomy.

Sculptra (injectable poly-L-lactic acid).

As contemporary antiviral therapy provides patients who have HIV effective long-term management of their disease, the prevalence of facial HIV-associated lipoatrophy is increasing. Sculptra (Dermik Laboratories, Berwyn, Pennsylvania) (injectable poly-L-lactic acid) is US Food and Drug Administration approved for the treatment of HIV-associated lipoatrophy and has been shown to increase skin thickness for up to 2 years. The number of treatment sessions depends on the volume of deficiency to be treated. As is true for any cosmetic treatment, expectations must be carefully managed, especially considering the frequent need for multiple Sculptra treatments. The few adverse events resulting from poly-L-lactic acid injections consist mainly of subcutaneous nodule formation and local bruising.

Identification of thyroid hormone receptors in the human larynx.

PURPOSE: Thyroid hormone is essential for normal development, growth, and function of the majority of tissues. Among the many clinical signs associated with hypothyroidism, alterations in the voice may occur even in cases of mild thyroid failure, suggesting that the larynx is a target tissue for thyroid hormone. The objective of our study is to further understand the effects of thyroid hormone on the larynx by first identifying the presence and locations of its receptors. METHODS: Two human cadaveric larynges (one male and one female) were harvested, formalin-fixed, and paraffin-embedded. Sections were immunostained with antibodies reactive with the two identified thyroid hormone receptors, TR-alpha and TR-beta. The slides were examined under light microscopy. RESULTS: Both male and female specimens revealed consistent patterns of staining for thyroid hormone receptors. The staining pattern for TR-alpha included the fibrous connective tissue of the lamina propria, the cartilage, and the glandular elements. The staining pattern for TR-beta included the fibrous connective tissue of the lamina propria only. No receptors were identified in the respiratory mucosa or muscle. CONCLUSIONS: Thyroid hormone receptors are present in both the male and the female human larynx. These findings imply a role for thyroid hormone within the human larynx, through both TR-alpha and TR-beta.