title: Treatment of tracheopharyngeal and tracheo-oesophageal fistulas following laryngectomy and fistula classification based on individual silicone casts.
abstract: Persistent tracheopharyngeal (TPF) and tracheo-oesophageal (TEF) fistulas after laryngectomy create a therapeutic challenge. The current classification of TPFs and TEFs is based on clinical experience without detailed anatomical information. In this study, casts of TPFs/TEFs were obtained from 16 patients; these were the first steps in manufacturing customised prostheses. Fistulas were classified according to the shape and dimension of the tracheopharyngeal and tracheo-oesophageal silicone casts and prostheses as well as on epithetic requirements. Four different types of fistulas were classified: Type A, a fistula with a straight axis between the neopharynx and oesophagus; Type B, a fistula with a stenosis of the neopharynx but a straight axis; Type C, the axis between the neopharynx and oesophagus is flexed anteriorly; and Type D, neighbouring structures are absent creating a large defect. This classification system might improve the manufacturing processes of customised prostheses in individual cases with challenging tracheopharyngeal and tracheo-oesophageal fistulas.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University, Halle-Wittenberg, 06120, Halle (Saale), Germany, michael.herzog@uk-halle.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Herzog
authors.forename: Kai J
authors.initials: KJ
authors.lastname: Lorenz
authors.forename: Alexander
authors.initials: A
authors.lastname: Glien
authors.forename: Ingo
authors.initials: I
authors.lastname: Greiner
authors.forename: Stefan
authors.initials: S
authors.lastname: Plontke
authors.forename: Sebastian
authors.initials: S
authors.lastname: Plößl
mesh_terms: D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D007831:Larynx, Artificial; D010608:Pharyngeal Diseases / Q000145:classification / Q000209:etiology / Q000601:surgery*; D011474:Prosthesis Design; D012828:Silicones; D013165:Splints; D014138:Tracheoesophageal Fistula / Q000145:classification / Q000209:etiology / Q000601:surgery*
chemical_list: D012828:Silicones