title: Pharyngo-jugular fistula after "salvage" total laryngectomy: a case report.
abstract: BACKGROUND
  We present a rare case of pharyngo-jugular fistula in a patient who underwent salvage total laryngectomy after organ-sparing radiochemotherapy.
  
  
  METHODS
  A 77-year-old Caucasian man underwent total laryngectomy and bilateral neck dissection as salvage surgery after the failure of radiochemotherapy at another hospital. Thirty-five days after surgery, he was admitted to our emergency room for fever and massive oral bleeding during meals. Videopanendoscopy showed the presence of a large clot at the base of his tongue, while a neck computed tomography scan showed a pharyngo-jugular fistula with the presence of air in the left internal jugular vein. Cervicotomy was performed: the internal jugular vein was ligated and sectioned, and the pharyngeal defect was repaired with a pectoralis major myocutaneous flap. The postoperative period was uneventful. Twenty-five days post surgery, videofluorography showed the fistula had disappeared. Our patient then began oral feeding without complications and was discharged. At present, 5 years after the operation, our patient is alive and shows no evidence of disease.
  
  
  CONCLUSIONS
  Pharyngo-jugular fistula is an uncommon complication after total laryngectomy, especially in the chemoradiation era, which is potentially fatal if not promptly treated.
authors.affiliation: ENT Department, Martini Hospital, Via Tofane 71, 10141, Turin, Italy. erikacro73@yahoo.com.
authors.forename: Erika
authors.initials: E
authors.lastname: Crosetti
authors.affiliation: ENT Department, S. Luigi Gonzaga Hospital, University of Turin, Regione Gonzole, 10, 10043, Orbassano, Italy. andrea.fulcheri@studenti.unito.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fulcheri
authors.affiliation: ENT Department, S. Luigi Gonzaga Hospital, University of Turin, Regione Gonzole, 10, 10043, Orbassano, Italy. giovannisucco@hotmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Succo
mesh_terms: D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D005402:Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007601:Jugular Veins / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D010608:Pharyngeal Diseases / Q000209:etiology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D016156:Respiratory Tract Fistula / Q000209:etiology* / Q000601:surgery; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000209:etiology* / Q000601:surgery