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.

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.

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.

Pharyngocutaneous Fistula after Laryngeal Surgery: The Role of the Barium Swallow

1984 ◽  
Vol 92 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Anthony M. Giordano ◽  
Jamie Cohen ◽  
George L. Adams
Keyword(s):  
Nasogastric Tube ◽  
Fistula Formation ◽  
Barium Swallow ◽  
Pharyngocutaneous Fistula ◽  
Wide Field ◽  
University Of Minnesota ◽  
Laryngeal Surgery ◽  
The University ◽  
Length Of Hospitalization

Pharyngocutaneous fistula is one of the major complications following laryngeal surgery. Prior to 1979, patients undergoing laryngectomy at the University of Minnesota were not fed until 9 or 10 days postoperatively if unirradiated and 12 to 14 days If irradiated. Most fistulas were apparent by 14 days postoperatively, but occasionally a patient would develop a fistula as late as a month postoperatively. Starting in 1979, in an attempt to decrease the length of hospitalization as well as prevent fistula formation, routine barium-swallow videoesophagograms were obtained 7 days postoperatively in all laryngectomy patients. If the results were considered normal, the nasogastric tube was removed and oral feedings were started. Of a total of 45 patients undergoing wide-field laryngectomy, there were three clinical fistulas and three radiologic fistulas. Following this protocol, we shortened the average postoperative hospitalization by 2 days without an increase in the rate of fistulization.

scholarly journals Preemptive Utilization of Anterior Belly of the Digastric Muscle Flaps in Transoral Robotic Radical Tonsillectomy

OTO Open ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. 2473974X2110351
Author(s):  
Olivia Daigle ◽  
James Reed Gardner ◽  
Deanne King ◽  
Mauricio Alejandro Moreno ◽  
Jumin Sunde ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Care Center ◽  
Tertiary Care ◽  
Muscle Flap ◽  
Fistula Formation ◽  
Pharyngocutaneous Fistula ◽  
Digastric Muscle ◽  
Muscle Flaps ◽  
Reconstructive Option ◽  
Anterior Belly

Objective To demonstrate the use of an anterior belly of the digastric muscle flap (ABDMF) during transoral robotic radical tonsillectomy (TORRT) with concomitant neck dissection with the intent of preventing the formation of postoperative pharyngocutaneous fistulas. Study Design Retrospective study. Setting Single academic tertiary care center. Methods In this study, all patients were included who underwent TORRT plus limited pharyngectomy with concomitant neck dissection and ABDMF for the treatment of oropharyngeal squamous cell carcinoma between September 2012 and September 2020. The rate of fistula formation was assessed in patients with preemptive utilization of ABDMF. Results A total of 43 patients underwent TORRT with neck dissection and ABDMF. No patients developed a fistula in the postoperative period or associated morbidity with the use of this flap. Conclusion Preemptive use of ABDMF in TORRT with concomitant neck dissection represents a reconstructive option that may help prevent the formation of pharyngocutaneous fistula by reinforcing the posteroinferior boundary of the parapharyngeal space.

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 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.

Radiotherapy and complications of laryngectomy

1993 ◽  
Vol 107 (2) ◽  
pp. 130-132 ◽  
Author(s):  
A. W. McCombe ◽  
A. S. Jones
Keyword(s):  
Median Duration ◽  
Surgical Repair ◽  
Positive Association ◽  
Radical Radiotherapy ◽  
Significant Positive Association ◽  
Surgical Closure ◽  
Radiotherapy Group ◽  
Hospital Deaths ◽  
Pharyngocutaneous Fistulae ◽  
Tumour Differentiation

In an effort to establish factors responsible for our post laryngectomy fistulae we reviewed 357 patients who underwent total laryngectomy between 1965 and 1990, for laryngeal carcinoma. Pharyngocutaneous fistulae occurred in 84 cases (23 percent). There was no difference between the fistula group and the non-fistula group with regard to age, sex, general condition, or tumour differentiation. The only significant, positive association was with previous radical radiotherapy (10 fistulae out of 167 primary laryngectomies (4 percent) versus 74 fistulae out of 190 salvage laryngectomies (39 percent)). The median time to occurrence of a fistula was day seven in both groups. However, in the non-radiotherapy group the median duration of the fistula was 28 days; the majority healing spontaneously, with only one patient requiring surgical closure. There were no ‘hospital’ deaths. In the radiotherapy group the median duration of fistulae was 112 days with 30 patients requiring a total of 66 procedures to achieve closure of the fistula. There were six ‘hospital’ deaths in this group.We conclude that previous radical radiotherapy strongly predisposes towards the occurrence of a postlaryngectomy fistula. Fistulae in this group tend to be longer lasting and are more likely to require surgical repair.

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