Pharyngocutaneous fistula as a complication after total Iaryngectomy
Journal Title: Otolaryngologia Polska - Year 2011, Vol 65, Issue 5
Abstract
SUMMARY Pharyngocutaneous fistula is an important therapeutic problem. It occurs in approximately 20% of cases as a complication after total laryngectomy, per-formed due to the larynx and/or hypopharynx cancer. The process of fistulas' conservative treatment is very long and sometimes reconstructive surgery of the pharynx and esophagus is necessary. Clinically, it is desirable to isolate a group of patients with risk factors of this complication. Numerous pathologies implicated in fistula formation are mentioned in the literature: wound infection, radiotherapy prior to surgery, hypoalbuminaemia, concomitant general diseases, postoperative anemia, location of the cancer in larynx and many others. Objective: This paper analyzes the incidence and etiology of cutaneous fistulas after total laryngectomies as well as overall characterization of risk factors on the basis of the material collected by the Department of Otolaryngology Medical University of Warsaw between the years 2006-2011. Furthermore, an analysis of the literature on cutaneous fistula after total laryngectomy of the last 10 years was performed. Materia! and methods: A retrospective analysis of medical records of patients with laryngeal and hypopharyngeal cancer, treated with total laryngectomy was performed. 12 patients developed cutaneous fistula in the early postop-erative period. Results: The mean time of appearance of fistula after total laryngectomy was 19.3 days. In most cases, conservative management was used to obtain fistulas' closure — after an average of 32.5 days. For two patients operative closure was needed. Microbiological study confirmed the infection in the region of the fistula in 10 patients. There were identified different pathogens, both aerobic and anaerobic bacteria and fungi. 3 patients with a fistula were pre-operatively irradiated. The most common location of the cancer in this group was supraglottic area and piriform recessus (8/12 patients). Conclusions: The pathogenesis of cutaneous fistula as a complication after total laryngectomy seems to be complex. The most significant risk factors for fistula formation are: radiotherapy, supraglottic location of the tumor, extension of the surgery to the pharynx and malnutrition of the patient. Postoperative wound infection favors the formation of fistulas and extends their healing time. It seems reasonable to plan the surgery with the recon-struction of the pharynx for patients with several risk factors of fistulas' onset.
Authors and Affiliations
Anna Rzepakowska, Ewa Osuch-Wójcikiewicz, Aleksandra Ochal-Choińska, Antoni Bruzgielewicz, Piotr Chęciński, Jagna Nyckowska, Paweł Szwedowicz
Keywords
Related Articles
- EP ID EP52352
- DOI -
- Views 98
- Downloads 0
Nowotwory głowy I szyi – 2010, część I
This article reviewed the current state of the art in head and neck oncology. These include very important and stimulating new areas of interest including the marked acceptance of chemoradiation in favor of surgery in pa...
The priest Sebastian Kneipp and his outlook on otorhinolaryngology diseases
SUMMARY The silhouettes of the Priest Sebastian Kneipp, one of the pioneers of world hydrotherapy are presented first of all. Impressions of Polish doctors Józef Surzycki and Władysław Jasiński from this hydrotherapeutic...
Antybiotykoterapia dla laryngologa
W opracowaniu dedykowanym głównie ogólnie praktykującym laryngologom omówiono zasady antybiotykoterapii najczęstszych schorzeń jakimi zajmuje się ta specjalność a mianowicie ostrym zapaleniem migdałków podniebiennych i g...
Hexosoaminidase gene expression in cholesteatoma in adults
Background: Middle ear cholesteatoma is a cyst like structure composed of keratinizing squamous epithelium that contains keratin debris and subepithelial connective tissue. Bone resorption may lead to destruction of ossi...
Adenoma oxyphillicum an extremely rare case of tumour of the larynx end cancer lungs which are going together
There was presented an exstremely rare case of adenoma oxyphillicum of the larynx coexisting with the lung carcinoma. Diagnostical and medical conduct was throughly analyzed. It consisted such matters as detailed graphic...