Pharyngocutaneous fistula after total laryngectomy remains a hardly inevitable complication. The predisposing factors are not clearly identified, but prior radiotherapy seems to increase the risk of fistulae. The purpose of this retrospective study was to determine the value of the pectoralis myofascial flap in pharyngeal reconstruction in post-radiotherapy total laryngectomy in order to decrease the risk of fistula formation. The charts of 60 consecutive patients who had undergone total laryngectomy or pharyngolaryngectomy after radiotherapy were analyzed. Twenty-one variables were recorded for each patient. The overall rate of fistula formation was 38% (23% when a pectoralis myofascial flap was used to cover the pharynx and 50% when no flap was used, P = 0.06). The flap-related complications were exceptional. In the subgroup of patients with diabetes mellitus, a history of vascular disease or a poor nutritional status, the use of a flap reduced the fistula formation from 73 to 13% (P = 0.018). The pectoralis myofascial flap covering the pharyngeal sutures in postradiotherapy laryngectomy is particularly useful in a selected group of patients (with diabetes mellitus, history of vascular disease or poor nutritional status).

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The present data emphasize the existence of distinct subgroups of cholesteatomas identifiable at both cell kinetic and differentiation levels. Some of the biological variables used here to identify distinct biological subgroups of cholesteatomas in turn enabled some biological variables to be identified, so making it possible to classify the cholesteatomas in terms of recurrence versus nonrecurrence.

We report a case of primary tracheal schwannoma causing symptoms of airway obstruction in a 51-year-old woman. There was no history of pulmonary disease. The patient had been coughing and suffering from progressive dyspnea for over 1 year. Medical treatment with bronchodilatators had no effect. Computerized tomography and bronchoscopy demonstrated a polypoid mass located inside the trachea's cervical segment, obstructing 50% of the lumen. A biopsy was not attempted because of the tumor's vascularity to avoid bleeding. Tracheal resection with primary anastomosis was performed. The diagnosis was confirmed with histological analysis. It revealed a benign neurogenic tumor of Schwann's cell origin. Schwannoma of the trachea is extremely rare. Only 23 cases have been reported previously. Most of them occur in adults (19/23, 82.6%) and are located in the lower trachea. They usually have a long natural history, causing symptoms only after they have attained a large size. The treatment of choice is surgical removal.

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