The techniques of nonmuscular closure of hypopharyngeal defect following total laryngectomy: the assessment of complication and pharyngoesophageal segment

1997 ◽  
Vol 111 (11) ◽  
pp. 1060-1063 ◽  
Author(s):  
Ching-Ping Wang ◽  
Tzu-Chan Tseng ◽  
Rheun-Chuan Lee ◽  
Shyue-Yih Chang
Keyword(s):  
Total Laryngectomy ◽  
Fistula Formation ◽  
Voice Rehabilitation ◽  
Pharyngocutaneous Fistula ◽  
Swallowing Function ◽  
Pharyngeal Muscle ◽  
Constrictor Muscle ◽  
Pharyngoesophageal Segment ◽  
Pharyngeal Muscles ◽  
Closure Group

AbstractThe usual method of reconstructing a hypopharyngeal defect during total laryngectomy includes pharyngeal muscle layer closure, which may result in high pharyngoesophageal pressure. We hypothesize that nonclosure of the pharyngeal muscle can reduce the pressure of the pharyngoesophageal segment which can reduce the chances of the formation of pharyngocutaneous fistulae. A technique of nonmuscular closure of a hypopharyngeal defect is presented. The differences in the rate of fistula formation and swallowing function between patients with usual and nonmuscular closure were also studied. Sixty consecutive laryngectomees were enrolled in this study. Thirty patients received usual closure after total laryngectomy, whereas the other 30 patients underwent non closure of their pharyngeal muscles. One patient (3.3 per cent) in the nonmuscular closure group and three patients (10 per cent) in the usual closure group developed a pharyngocutaneous fistula. The pharyngoesophageal pressures of the nonmuscular closure group were significantly lower than those of the usual closure group. We conclude that the technique of nonclosure of the pharyngeal constrictor muscle after total laryngectomy is relatively more simple and is not associated with a higher rate of fistula formation. Furthermore, nonclosure of the pharyngeal constrictor muscle is preferable to muscular closure because it reduces the spasm of the pharyngoesophageal segment which limits voice rehabilitation.

scholarly journals Early versus delayed oral feeding post total laryngectomy and relation to trachea-oesophageal fistula formation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H A Elibiary ◽  
T A Aboelezz ◽  
O M Mady ◽  
A O T Keshk
Keyword(s):  
Hospital Stay ◽  
Total Laryngectomy ◽  
Malignant Tumors ◽  
Group Versus ◽  
Oral Feeding ◽  
Fistula Formation ◽  
Voice Rehabilitation ◽  
Pharyngocutaneous Fistula ◽  
Early Oral Feeding ◽  
Feeding Group

Abstract Background total laryngectomy is the most common procedure in treatment of advanced laryngeal malignant tumors. Total laryngectomy although an important and reliable method of management, still carries a lot of short term and long term complications. One of the common complications is the pharyngocutaneous fistula. Being a major risk factor of longer hospital stay, morbidity and wound infection. Pharyngocutaneous fistula is studied carefully concerning causes, risk factors and management. Oral feeding and voice rehabilitation are two valuable outcomes for the patient. Both could be disturbed by occurrence of pharyngocutaneous fistula. Oral feeding usually starts by the seventh to tenth day postoperative to allow adequate time for pharyngeal closure as believed by many surgeons for decades. Recent studies including our study discuss the possibility of early oral feeding versus conventional delayed feeding and its advantages regarding hospital stay and incidence of fistula. Aim The aim of this study is to points out the rate of pharyngocutaneous fistulae incidence after total laryngectomy in two different groups of patients depending on timing of post-operative oral feeding. Oral feeding usually starts after 7-10 days of surgery to allow for complete healing and closure of pharyngeal repair. Methodology A meta-analysis study is done to assess the feasibility and the possibility of early oral feeding after total laryngectomy versus delayed oral feeding. The outcome is the occurrence of pharyngocutaneous fistula in each group. Results In all included studies the incidence of pharyngocutaneous fistula was 168/1374 (12.23%) in early feeding group versus 69/570 (12.11%) in the delayed feeding group. The statistical difference was insignificant P > 0.05 Conclusion Early oral feeding after total laryngectomy during the first 72 hours post-operative is a safe clinical practice and results in shorter hospital stay.

Voice Rehabilitation after Total Laryngectomy and Tracheoesophageal Puncture Using Nonmuscle Closure

1993 ◽  
Vol 102 (10) ◽  
pp. 792-796 ◽  
Author(s):  
Ross A. Clevens ◽  
Duane O. Hartshorn ◽  
Ramon M. Esclamado ◽  
Jan S. Lewin
Keyword(s):  
Total Laryngectomy ◽  
Voice Rehabilitation ◽  
Rehabilitation Outcomes ◽  
Pharyngoesophageal Segment ◽  
Pharyngeal Plexus ◽  
Neck Recurrence ◽  
Tracheoesophageal Puncture ◽  
Early Primary ◽  
Successful Production

The successful production of voice with a tracheoesophageal puncture (TEP) and voice prosthesis requires a compliant pharyngoesophageal segment. Speech failure is commonly attributed to spasm of the pharyngoesophageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the safety and efficacy of TL and TEP with nonclosure of the pharyngeal musculature to prevent pharyngoesophageal spasm as an alternative to 3-layer closure with pharyngeal plexus neurectomy and/or pharyngeal constrictor myotomy. Twenty-one consecutive patients were enrolled by a single surgeon. The mean duration of follow-up was 19.5 ± 7.9 months. Surgical complications and voice rehabilitation outcomes were examined. An overall complication rate of 28.5% was observed. Fluency was achieved in 75% of patients within a mean of 4.3 ± 5.1 months. Speech failure was attributable to early primary site and neck recurrence (5%), hypoglossal nerve palsy (5%), hypopharyngeal stricture and recurrence (5%), dementia (5%), and intransigent alcohol abuse (5%). Pharyngeosophageal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively safe. Furthermore, it is preferable over 3-layer closure because it avoids pharyngeosophageal spasm, a factor limiting voice rehabilitation.

Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomy

2000 ◽  
Vol 114 (10) ◽  
pp. 768-771 ◽  
Author(s):  
A. Ö. İkiz ◽  
M. Uça ◽  
E. A. Güneri ◽  
T. K. Erdağ ◽  
S. Sütay
Keyword(s):  
Neck Dissection ◽  
Nasogastric Tube ◽  
Total Laryngectomy ◽  
Positive Association ◽  
Fistula Formation ◽  
Pharyngocutaneous Fistula ◽  
Technical Error ◽  
Significant Positive Association ◽  
Positive Surgical Margins ◽  
Tumour Differentiation

Ninety-two total laryngectomy cases were investigated with reference to post-laryngectomy fistula formation. Fistula was observed in eight cases (8.69 per cent). There were no statistically significant differences between the fistula group and the non-fistula group with regard to pre-operative tracheotomy, tumour differentiation, positive surgical margins, concurrent neck dissection, previous radiotherapy, T stage of the tumour, presence of extended hypopharyngeal mucosal excision, and placement of nasogastric tube. The only statistically significant positive association was found with primary pharyngeal myotomy. Myotomy was performed in six of the fistula patients and in two cases a technical error was observed. In these cases myotomy was performed adjacent to the edge of hypopharyngeal mucosa resulting in a weakened area of pharyngeal closure, possibly contributing to the fistula. This should be kept in mind and avoided at all costs during the performance of myotomy. Since it was not possible to find out any specific causal relationship with myotomy in four other cases, further studies are needed to establish the association of myotomy with pharyngocutaneous fistula.

scholarly journals Outcomes following pharyngeal reconstruction in total laryngectomy – Institutional experience and review of literature

2018 ◽  
Vol 51 (02) ◽  
pp. 190-195 ◽  
Author(s):  
Deepak Balasubramanian ◽  
Narayana Subramaniam ◽  
Priyank Rathod ◽  
Samskruthi Murthy ◽  
Mohit Sharma ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Univariate Analysis ◽  
Anterolateral Thigh Flap ◽  
Tumour Resection ◽  
Pharyngocutaneous Fistula ◽  
Swallowing Function ◽  
Swallowing Dysfunction ◽  
Institutional Experience ◽  
Free Jejunal Flap ◽  
Pharyngeal Reconstruction

ABSTRACT Background: Pharyngeal reconstruction is a challenging aspect of reconstruction after resections for head-and-neck cancer. The goals of reconstruction are to restore the continuity of the pharyngeal passage to enable oral alimentation and rehabilitation of speech wherever possible. This study was performed to determine the outcomes following pharyngeal reconstruction in total laryngectomy (TL) using different reconstructive options and to determine the predictors of pharyngocutaneous fistula (PCF) and swallowing dysfunction. Materials and Methods: Retrospective analysis of patient data between 2003 and 2010 of patients undergoing TL with partial or total pharyngectomy. Demographic and treatment details were collected and analysed. Univariate analysis was performed to determine predictors of PCF and swallowing dysfunction. Results: Fifty-seven patients underwent pharyngeal reconstruction following TL, 31 of whom had received prior treatment. Following tumour resection, 31 patients had circumferential defects and 26 patients had partial pharyngeal defects. The flaps used include pectoralis major myocutaneous flap (n = 29), anterolateral thigh flap (n = 8), gastric pull-up (n = 13) and free jejunal flap (n = 7). PCF was seen in 20 patients, of which 15 (75%) were managed conservatively and 5 required another surgery. At last follow-up, 99 patients (68%) were on full oral alimentation. Tracheo-oesophageal puncture and prosthesis insertion was done in 20 patients, of whom 17 (85%) developed satisfactory speech. Partial pharyngeal defects were associated with a higher risk of PCF on univariate analysis (P = 0.006) but were not significant on multivariate analysis. Post-operative swallowing dysfunction was significantly higher with hypopharyngeal involvement by tumour (P = 0.003). Conclusion: Pharyngeal reconstruction in TL is feasible with good results. Majority of the patients swallow and regain acceptable swallowing function within 3 months.

Post-laryngectomy pharyngocutaneous fistula – a still unresolved problem

1995 ◽  
Vol 109 (3) ◽  
pp. 221-224 ◽  
Author(s):  
Milo Fradi ◽  
Ludwig Podoshin ◽  
Jaacov Ben David
Keyword(s):  
Nasogastric Tube ◽  
Late Stage ◽  
Total Laryngectomy ◽  
Surgical Repair ◽  
Spontaneous Closure ◽  
Fistula Formation ◽  
Pharyngocutaneous Fistula ◽  
Infection Age ◽  
Neck Irradiation ◽  
Specific Factors

AbstractFifty-six total laryngectomy cases are presented with special reference to post-operative fistula formation. All these patients were operated upon at the Department of Otorhinolaryngology at the Bnai Zion Medical Centre by one surgeon over a 16-year period, from 1976–1992. The incidence of fistula was 12.5 percent. This paper could not verify reports that any specific factors were significantly related to fistula formation, although there was a preponderance of fistulas in patients presenting with late stage tumours. No relationship was found with rate of infection, age, or between previous neck irradiation (ranging from 5500 to 7000 cGy) and fistula formation in the patient population.If a fistula occurs, the administration of oral solid food keeping the nasogastric tube in place for administration of fluids may lead to spontaneous closure of the fistula, with no need for secondary surgical repair.

scholarly journals Inflammatory indices predict pharyngocutaneous fistula formation after total laryngectomy

2021 ◽  
Vol 17 (2) ◽  
pp. 98-103
Author(s):  
Levent Yucel ◽  
◽  
Sibel Yildirim ◽  
Hasay Guliyev ◽  
Hazan Basak ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Fistula Formation ◽  
Pharyngocutaneous Fistula

scholarly journals Voice rehabilitation, alaryngeal communication and swallowing function after total laryngectomy

2012 ◽  
Vol 22 (3) ◽  
pp. 303-310
Author(s):  
Shigenori Kanazawa ◽  
Kunitoshi Yoshino ◽  
Takashi Fujii ◽  
Hirokazu Uemura ◽  
Tomoyuki Kurita ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Voice Rehabilitation ◽  
Swallowing Function

Tissue transfer to post-chemoradiation salvage laryngectomy defects to prevent pharyngocutaneous fistula: single-centre experience

2014 ◽  
Vol 128 (4) ◽  
pp. 365-367 ◽  
Author(s):  
J Powell ◽  
U R Ullal ◽  
O Ahmed ◽  
M Ragbir ◽  
V Paleri
Keyword(s):  
Total Laryngectomy ◽  
Primary Closure ◽  
Pharyngocutaneous Fistula ◽  
Retrospective Assessment ◽  
Tissue Transfer ◽  
Single Centre Experience ◽  
Tissue Flap ◽  
Soft Tissue Flap ◽  
Closure Group ◽  
Salvage Laryngectomy

AbstractBackground:In recent practice, we have used tissue transfer (pedicled or free flap) to augment the pharyngeal circumference of the neopharynx following salvage total laryngectomy, even in patients who have sufficient pharyngeal mucosa for primary closure. In this study, the rates of pharyngocutaneous fistula were compared in soft tissue flap reconstructed patients versus patients who underwent primary closure.Method:A retrospective assessment was carried out of all patients who had undergone a salvage total laryngectomy between 2000 and 2010. The presence or absence of a pharyngocutaneous fistula was compared in those who received reconstruction closure versus those who received primary closure.Results:The reconstruction closure group (n = 7) had no incidence of pharyngocutaneous fistula, whereas the primary closure group (n = 38) had 10 fistulas, giving pharyngocutaneous fistula rates of 0 per cent versus 26 per cent, respectively.Conclusion:The findings revealed a lower rate of pharyngocutaneous fistula with tissue transfer compared with primary closure of the neopharynx.

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