The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae
BACKGROUND: The pharyngocutaneous fistula is troublesome complication after total laryngectomy. Despite a large number of studies, there is still disagreement on factors predisposing to this complication. METHODS: A retrospective analysis of pharyngocutaneous fistulas in 133 patients in whom total laryngectomy was performed. RESULTS: Fistulas were found in 15% of the patients. Spontaneous closure was noted in 80%. Simultaneous laryngectomy and partial pharyngectomy or neck dissection increased the risk of fistula formation. Preoperative irradiation, short interval between radiotherapy and operation, and cobalt/roentgen radiation instead of photons predispose to this complication. The fistulas appeared earlier, and the sizes of fistulas were significantly larger in patients with previous irradiation than those in patients with no preoperative irradiation. CONCLUSIONS: Postoperative pharyngocutaneous fistulas significantly increase patients' morbidity and hospital stay. Good surgical technique and postoperative treatment should be paid attention to patients with an increased risk of pharyngocutaneous fistula formation. Copyright 2000 John Wiley & Sons, Inc. Head Neck 23: 29-33, 2001.
Virtaniemi
JA
Department of Otorhinolaryngology, University of Kuopio and Kuopio University Hospital, P.O. Box 1777, FIN-70211, Kuopio, Finland.
Kumpulainen
EJ
Hirvikoski
PP
Johansson
RT
Kosma
VM