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To the Editor.—The interesting article by Bonneau and Lehman in the Archives (101:408-412, 1975) has prompted me to write. These authors have listed several theories as to the cause of recurrence at the stoma following laryngectomy. I have seen other theories expressed by other writers, but, with one possible exception, I have seen no reference to what looks to me like an obvious reason for this to occur.
Carcinomas of the lung exfoliate malignant cells, which are sought in the mucus for diagnostic purposes. Is it not to be expected that a laryngeal cancer also exfoliates malignant cells? Any malignant cells inhaled by the patient, especially when he is struggling with partial obstruction, and any cells that might reach the lower respiratory tract from manipulation of the lesion during removal or by the use of endotracheal tubes or tracheostomy tubes, on getting down into the tracheobronchial tree will be