Assessment and incidence of salivary leak following laryngectomy

Authors

  • Hilliary N. White MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Blake Golden MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Larissa Sweeny MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • William R. Carroll MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Jeffery S. Magnuson MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Eben L. Rosenthal MD

    Corresponding author
    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
    • Julius N. Hicks Professor of Surgery, University of Alabama School of Medicine, Department of Surgery, Division of Otolaryngology, 563 Boshell Building, 1808 7th Avenue South, Birmingham AL 35233
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  • Poster presentation at the Triological Society Combined Sections Meeting, Miami Beach, Florida, U.S.A., January 26–28, 2012.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To determine the incidence and risk factors of pharyngocutaneous fistula formation in patients undergoing either primary or salvage laryngectomies and evaluate the role of barium esophagram in these patients.

Study Design:

Retrospective cohort study.

Methods:

Medical records of 259 patients who underwent total laryngectomy between 2003 and 2009 at our institution were reviewed. Risk factors for fistula formation were analyzed, including primary treatment modality, comorbidities, and operative details, which included use of a free flap for closure, concurrent neck dissections, margin status, and preoperative tracheostomy. The length of time until leak, postoperative swallow study results, and fistula management strategies were also assessed.

Results:

Fifty-five patients developed a pharyngocutaneous fistula (overall incidence, 21%) in a median time of 12 days (range, 4–105 days). Twenty of these patients underwent laryngectomy as their initial treatment modality, and 35 had failed previous radiotherapy. Fistula formation was significantly higher in salvage surgery patients (P = .03), particularly those with hypothyroidism (P < .0002). A barium swallow performed at approximately 1 week after laryngectomy demonstrated a sensitivity of 26% with a specificity of 94%. Sixty-two percent of the fistulas healed with conservative measures only.

Conclusions:

Our data confirmed that previous radiotherapy and hypothyroidism, particularly in salvage laryngectomy patients, are important significant predictors of postoperative pharyngocutaneous fistula. The use of a postoperative barium swallow in these patients may be useful but was not found to be highly sensitive in predicting who will develop a clinically evident leak and should be used with caution.

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