title: Tracheocutaneous fistula in patients undergoing supracricoid partial laryngectomy: the role of chronic aspiration.
abstract: The aim of the present retrospective controlled study was to analyse and compare risk factors for tracheocutaneous fistula in patients who received tracheostomy after supracricoid partial laryngectomy with those who received tracheostomy for other causes. We enrolled 39 patients with tracheocutaneous fistulas who were divided into two groups. The first received temporary tracheostomy for supracricoid partial laryngectomies (n = 21), while the control group consisted of patients who received temporary tracheostomy for other causes (n = 18). Risk factors believed to play a role in the pathogenesis of tracheocutaneous fistula were examined including advanced age, cardiopathy, local infections, radiotherapy, elevated body mass index, malnutrition, decannulation time and aspiration grade. The Leipzig and Pearson scale score was significantly higher in the supracricoid partial laryngectomy group (p = 0.006 and 0.031 for univariate and multivariate analyses, respectively). The penetration/aspiration scale score was significantly higher in the supracricoid partial laryngectomy group as determined by univariate analysis (p = 0.014). The decannulation time was significantly lower in the supracricoid partial laryngectomy group (p = 0.004 and 0.0004 for univariate and multivariate analyses, respectively). The number of surgical closures for tracheocutaneous fistula was significantly higher in the supracricoid partial laryngectomy group by univariate analysis (p = 0.027). These results suggest that chronic aspiration and related cough may be important pathogenic factors for tracheocutaneous fistula and could be responsible for the significantly higher rates of closure failure in patients after supracricoid partial laryngectomy.
authors.affiliation: Department of Sensory Organs, ENT Section, Sapienza' University of Rome, Italy - Department of Surgical Sciences, 'Sapienza' University of Rome, Italy;
authors.forename: A
authors.initials: A
authors.lastname: DE Virgilio
authors.affiliation: The Speech and Swallowing Rehabilitation Service, "Santa Lucia" Foundation, Roma, Italy;
authors.forename: M
authors.initials: M
authors.lastname: Simonelli
authors.affiliation: Department of Sensory Organs, ENT Section, Sapienza' University of Rome, Italy - Department of Surgical Sciences, 'Sapienza' University of Rome, Italy;
authors.forename: A
authors.initials: A
authors.lastname: Greco
authors.affiliation: Department of Surgical Biotechnologies and Science, ENT Section, Sapienza Università di Roma, Italy;
authors.forename: A
authors.initials: A
authors.lastname: Gallo
authors.affiliation: Department of Sensory Organs, ENT Section, Sapienza' University of Rome, Italy - Department of Surgical Sciences, 'Sapienza' University of Rome, Italy;
authors.forename: A
authors.initials: A
authors.lastname: Moretta
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan - School of Speech Language Pathology & Audiology, Chung Shan Medical University, Taichung, Taiwan - Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: C C
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Surgical Biotechnologies and Science, ENT Section, Sapienza Università di Roma, Italy;
authors.forename: S
authors.initials: S
authors.lastname: Martellucci
authors.affiliation: The Speech and Swallowing Rehabilitation Service, "Santa Lucia" Foundation, Roma, Italy;
authors.forename: P
authors.initials: P
authors.lastname: Calcagno
authors.affiliation: Department of Sensory Organs, ENT Section, Sapienza' University of Rome, Italy - Department of Surgical Sciences, 'Sapienza' University of Rome, Italy;
authors.forename: M
authors.initials: M
authors.lastname: DE Vincentiis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003413:Cricoid Cartilage; D017577:Cutaneous Fistula / Q000209:etiology*; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D053120:Respiratory Aspiration / Q000150:complications*; D016156:Respiratory Tract Fistula / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014133:Tracheal Diseases / Q000209:etiology*; D014139:Tracheostomy / Q000009:adverse effects*
keywords: Aspiration; Risk factors; Supracricoid partial laryngectomy; Tracheocutaneous fistula; Tracheostomy