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Laryngoscope Investigative... Dec 2022This article aims to propose a new surgical method for the treatment of pyriform fistula, especially for the complex pyriform fistula.
OBJECTIVE
This article aims to propose a new surgical method for the treatment of pyriform fistula, especially for the complex pyriform fistula.
METHODS
A total of 36 patients with pyriform fistula underwent the procedure between August 2017 to October 2020. Surgery was performed by the senior authors using the same technique at the same clinical center for all patients. The median follow-up time was 33 months. Meantime, we collected information on patients with pyriform fistula using traditional surgical methods in our hospital from April 2015 to November 2018 for comparison.
RESULTS
The surgery was successfully completed in 36 patients. In all, 32 patients had a history of multiple incisions and drainage, 16 patients had a history of surgical resections, and two patients had a history of cauterization of the internal fistula. Compared with traditional surgical methods, our new surgical method greatly shortens the length of the surgical incision (4.3 vs. 5.5, < 0.0001), reduces the operation time (8.1 vs. 27.1, < 0.0001), and reduces the blood loss (103.2 vs. 196.8, < 0.0001). None of the 36 patients in this study had complications such as pharyngeal fistula, recurrent laryngeal nerve paralysis, or hypothyroidism. The mean follow-up duration after the excision of the lesion was 34.1 months. To date, no patients have relapsed.
CONCLUSION
Our experience showed that this surgical technique could be used to completely remove the fistula, and it was easier to perform than the conventional strategies. These treatment options result in less trauma and reliable results, especially for complex pyriform fistulas.
LEVEL OF EVIDENCE
IV.
PubMed: 36544960
DOI: 10.1002/lio2.971 -
Indian Journal of Otolaryngology and... Mar 2017Neck trauma is a very important surgical emergency faced by ENT surgeons in day to day practice. They are potentially life threatening conditions due to the presence of...
Neck trauma is a very important surgical emergency faced by ENT surgeons in day to day practice. They are potentially life threatening conditions due to the presence of many vital structures in this area. Timely presentation to the referral centre and proper multidisciplinary approach towards management plays a pivotal role in the healing pattern of the wound and prevention of serious complication like shock, sepsis, laryngeal stenosis or fistula formation. A retrospective study was done in ENT Department, NSCB Medical College, Jabalpur, Madhya Pradesh, India during the period of 2014-2016. 17 patients were included in the study. All the records regarding symptoms at presentation, type and mode of injury, level of injury were analyzed. Management plan undertaken were thoroughly studied and post operative complications like hoarseness, stenosis or fistula formation were noted carefully. 14 out of 17 patients were male, all 17 patients belonged to lower socioeconomic status. Most common age group presenting with neck trauma was between 22 and 40 years. 7 case were homicidal, 5 cases were suicidal and 4 were of accidental injury. Most cases reached hospital within 2-6 h of injury except 3 cases which took more than 8 h. Bleeding from wound site was most common symptom at presentation. Most injuries in 13 out of 17 cases were at thyroid cartilage level. Penetrating neck trauma was most common followed by blunt neck trauma. Most cases required emergency tracheostomy along with primary laryngotracheal repair. Most common post operative complication seen was wound dehiscence, subglottic stenosis and fistula formation. Neck trauma and cut throat injuries are potentially life threatening emergency that require multidisciplinary approach. Timely intervention can be crucial in preventing fatal complications and reducing morbidity period of the patient.
PubMed: 28239579
DOI: 10.1007/s12070-016-1048-3 -
Indian Journal of Otolaryngology and... Oct 2019Complications following the total laryngectomy with or without partial pharyngectomy with neck dissection for laryngeal and pyriform fossa malignancies like aspiration,...
Complications following the total laryngectomy with or without partial pharyngectomy with neck dissection for laryngeal and pyriform fossa malignancies like aspiration, pharyngocutaneous fistula wound infection, flap necrosis, haematoma, chyle fistula and carotid blowout can cause serious implication on the final outcome of the treatment, which leads to increased postoperative morbidity, hospital stay and hospital cost. A prospective study in the Department of Otolaryngology and Head-Neck Surgery, JSS Hospital, Mysore, from November 2014 to July 2016. 30 patients undergoing Total laryngectomy with or without partial pharyngectomy for laryngeal and pyriform fossa were included in this study. The presentation, diagnosis, and management of the complications that were occurred, were discussed. The age of the patients vary between 32 and 76. Also, male preponderance was seen with approximately M:F ratio 3:1. Out of these 30 patients, 6 patients developed complications. The most common complication was pharyngocutaneous fistula (2 patients, 6%), which was developed after the 7th day. It was managed conservatively in both patients, wound infection was a second complication (2, 6%). Other complications were drain failure (1, 3%) and chylous fistula (1, 3%). The Most common complications after total laryngectomy with or without partial pharyngectomy with neck dissection in our study were wound infection and pharyngocutaneous fistula. Assessment of risk factors, early recognition of complications per operative protocols with improvised techniques are necessary to reduce incidence of complication after total laryngectomy with or without partial pharyngectomy with neck dissection.
PubMed: 31742008
DOI: 10.1007/s12070-018-1366-8 -
JAMA Otolaryngology-- Head & Neck... Jan 2023Controversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy...
IMPORTANCE
Controversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy.
OBJECTIVE
To explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with recurrent, clinically node-negative larynx or hypopharynx tumors after definitive nonsurgical treatment who were treated with a salvage total laryngectomy were included. Data were analyzed from October 2021 through September 2022.
EXPOSURES
Elective neck dissection.
MAIN OUTCOMES AND MEASURES
Presence and location of occult nodal metastasis in electively dissected necks, along with differences in fistula rates and overall and disease-free survival between patients receiving elective neck dissection vs observation.
RESULTS
Among 107 patients receiving clinically node-negative salvage total laryngectomy (median [IQR] age, 65.0 [57.8-71.3] years; 91 [85.0%] men), 81 patients underwent elective neck dissection (75.7%) and 26 patients underwent observation (24.3%). Among patients with elective neck dissection, 13 patients had occult nodal positivity (16.0%). Recurrent supraglottic (4 of 20 patients [20.0%]) or advanced T classification (ie, T3-T4; 12 of 61 patients [19.7%]) had an occult nodal positivity rate of 20% or more, and positive nodes were most likely to occur in levels II and III (II: 6 of 67 patients [9.0%]; III: 6 of 65 patients [9.2%]; VI: 3 of 44 patients [6.8%]; IV: 3 of 62 patients [4.8%]; V: 0 of 4 patients; I: 0 of 18 patients). There was a large difference in fistula rate between elective neck dissection (12 patients [14.8%]) and observed (8 patients [30.8%]) groups (difference, 16.0 percentage points; 95% CI, -3.4 to 35.3 percentage points), while the difference in fistula rate was negligible between 50 patients undergoing regional or free flap reconstruction (10 patients [20.0%]) vs 57 patients undergoing primary closure (10 patients [17.5%]) (difference, 2.5 percentage points; 95% CI, -12.4 to 17.3 percentage points). Undergoing elective neck dissection was not associated with a clinically meaningful improvement in overall or disease-free survival compared with observation. Recurrent hypopharynx subsite was associated with an increased risk of death (hazard ratio, 4.28; 95% CI, 1.81 to 10.09) and distant recurrence (hazard ratio, 7.94; 95% CI, 2.07 to 30.48) compared with glottic subsite.
CONCLUSIONS AND RELEVANCE
In this cohort study, patients with recurrent supraglottic or advanced T classification tumors had an increased occult nodal positivity rate, elective neck dissection was not associated with survival, and patients with recurrent hypopharynx subsite were more likely to have a distant recurrence and die of their disease. These findings suggest that underlying disease pathology rather than surgical management may be associated with survival outcomes in this population.
Topics: Male; Humans; Aged; Female; Cohort Studies; Laryngectomy; Laryngeal Neoplasms; Salvage Therapy; Neoplasm Recurrence, Local; Elective Surgical Procedures; Hypopharyngeal Neoplasms; Retrospective Studies
PubMed: 36394866
DOI: 10.1001/jamaoto.2022.3597 -
Acta Otorhinolaryngologica Italica :... Dec 2015The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A... (Review)
Review
The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared with a control group of 86 patients without fistula, randomly selected from a pool of 352 total laryngectomies, performed between January 1999 to October 2014. The overall incidence of PCF in the series was 24.4%; we recorded rates of 19.0%, 28.6% and 30.3% following primary total laryngectomy (PTL), salvage laryngectomy post-radiotherapy (RT-STL) and salvage laryngectomy postchemoradiotherapy (CRT-STL), respectively. Multivariate analysis revealed that the relative risk of fistula was respectively 2.47, 3.09 and 7.69 for hypoalbuminaemia ≤3.5 g/dL, RT-STL and CRT-STL. An early onset of PCF within 10 postoperative days was recorded in case of salvage total laryngectomy. The management of PCF significantly differed between PTL, RT-STL and CTRT-STL, with exclusive conservative treatment for PTL (93.55%), while in the CRT-STL group surgical closure with regional flaps (58.82%) prevailed. Conservative management, adjuvant hyperbaric oxygen therapy and surgical closure were equally distributed in the RT-STL group. Thorough knowledge of patient-related risk factors and its prognostic value, allows the surgeon to better evaluate preventive strategies with the aim of minimising fistula formation, hospitalisation times and related costs.
Topics: Cutaneous Fistula; Humans; Laryngeal Neoplasms; Laryngectomy; Pharyngeal Diseases; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors
PubMed: 26900245
DOI: 10.14639/0392-100X-626 -
Journal of Clinical Medicine Mar 2024: The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in...
: The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in patients who underwent total laryngectomy (TL) for laryngeal cancer and were subsequently rehabilitated to phonatory function with tracheoesophageal speech (TES). : To evaluate the long-term outcomes and complications of TEP, the following data were collected: mean time of prosthesis replacement, mean time of onset of complications, type of complications, and type of failure. : Complications occurred in 18 out of 46 patients (39.2%) with primary TEP and in 10 out of 30 patients (33.4%) with secondary TEP, out of a total of 76 enrolled patients. Common complications included prosthesis leakage, fistula leakage, granulation, and prosthesis extrusion. Prosthesis replacement due to fistula leakage or prosthesis extrusion was observed exclusively in the group of patients with primary TEP. Among the 28 patients (35.7%) who experienced complications, rehabilitation with TEP failed in 10 cases, primarily due to abandonment and spontaneous fistula closure. : TEP, both primary and secondary, represents a valid option for vocal rehabilitation in patients undergoing TL. However, identifying prognostic factors that could influence the success of TEP would be beneficial to allow a targeted rehabilitation process.
PubMed: 38610678
DOI: 10.3390/jcm13071912 -
Frontiers in Surgery 2017Total laryngectomy after (chemo)radiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic...
BACKGROUND
Total laryngectomy after (chemo)radiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic total laryngectomy prompted us to develop similar minimally invasive open approaches for functional total laryngectomy.
METHODS
A retrospective study of consecutive unselected patients with a dysfunctional larynx after (chemo)radiation that underwent open maximal mucosal-sparing functional total laryngectomy (MMSTL) between 2014 and 2016 is presented. The surgical technique is described, and the complications and functional outcome are reviewed.
RESULTS
The cohorts included 10 patients who underwent open MMSTL. No pedicled flap was used. Only one postoperative fistula was noted (10%). All patients resumed oral diet and experienced a functional tracheo-esophageal voice.
CONCLUSION
MMSTL could be used to perform functional total laryngectomy without a robot and with minimal incidence of complications.
PubMed: 29075632
DOI: 10.3389/fsurg.2017.00060 -
Respiratory Care Jun 2014Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation... (Review)
Review
Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation on airway injury by describing the acute and long-term sequelae of each of the most commonly injured anatomic sites along the respiratory tract, including the nasal cavity, oral cavity, oropharynx, larynx, and trachea. Injuries covered include nasoseptal injury, tongue injury, dental injury, mucosal lacerations, vocal cord immobility, and laryngotracheal stenosis, as well as tracheomalacia, tracheoinnominate, and tracheoesophageal fistulas. We discuss the proposed mechanisms of tissue damage that relate to each and present their most common clinical manifestations, along with their respective diagnostic and management options. This article also includes a review of complications of airway management pertaining to video laryngoscopy and supraglottic airway devices. Finally, potential strategies to prevent intubation-associated injuries are outlined.
Topics: Airway Management; Humans; Respiratory System; Risk Factors
PubMed: 24891204
DOI: 10.4187/respcare.02884 -
HNO Aug 2021Recurrent and residual laryngeal cancer after organ-preserving radio- or radiochemotherapy is associated with a poor prognosis. Salvage surgery is the most important...
BACKGROUND
Recurrent and residual laryngeal cancer after organ-preserving radio- or radiochemotherapy is associated with a poor prognosis. Salvage surgery is the most important therapeutic option in these cases.
OBJECTIVE
The study assessed rates of recurrence and residual tumor as well as survival and complication rates after salvage laryngectomy at the authors' academic cancer center.
MATERIALS AND METHODS
A retrospective examination of all patients receiving laryngectomy between 2001 and 2019 due to tumor residuals or recurrence after primary radio- and radiochemotherapy was conducted.
RESULTS
A total of 33 salvage procedures were performed. Defect reconstruction was performed by free flap surgery in 30.3% (n = 10) and regional flap surgery in 15.2% (n = 5) . One patient received regional flap surgery and free flap surgery simultaneously. Overall survival after 1, 2, and 5 years was 68.7, 47.9, and 24.2%, and disease-free survival was 81.6, 47.8, and 24.2%, respectively, with 48.5% (n = 16) postoperative tumor recurrences overall. Disease-free survival was significantly shorter for tumor extension into or onto the hypopharynx (p = 0.041). Postoperatively, 72.7% of patients developed a pharyngocutaneous fistula, of which 24.2% required surgical treatment. The hospital stay was 28.0 ± 16.1 days.
CONCLUSION
Salvage laryngectomy is associated with a high rate of treatable complications and high morbidity. Nevertheless, considering the advanced tumor stages treated, it allows for respectable oncological results.
Topics: Chemoradiotherapy; Free Tissue Flaps; Humans; Laryngectomy; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 34019140
DOI: 10.1007/s00106-021-01030-3 -
The Laryngoscope Dec 2014To review the fistula rate in irradiated patients undergoing salvage laryngectomy, compare the effect of closure type on fistula rate, and examine possible perioperative...
OBJECTIVES/HYPOTHESIS
To review the fistula rate in irradiated patients undergoing salvage laryngectomy, compare the effect of closure type on fistula rate, and examine possible perioperative risk factors that might contribute to an increased fistula rate.
STUDY DESIGN
Case series with chart review.
METHODS
We conducted a retrospective review of the University of Pittsburgh head and neck tumor registry and identified 73 patients from 1998 to 2011 who had received prior radiation before total laryngectomy or salvage laryngectomy and who had either primary closure, pectoralis major myofascial (PMMF) flap onlay, or pectoralis major myocutaneous (PMMC) flap.
RESULTS
Fistula was more common in patients who underwent initial primary closure (45%) than in patients who had immediate PMMF onlay (10.5%). The fistula rate for patients who underwent immediate PMMC flap was 28.6%, intermediate to primary closure and PMMF flap. Several factors were evaluated for relationship to fistula, but no significant associations were identified. However, patients with fistula tended to have longer inpatient stays and may have been more likely to have a history of cardiovascular or hypoxic disease.
CONCLUSION
Pharyngocutaneous fistula is a well-established complication of total laryngectomy and is especially a concern in patients with a previous history of radiation. Our retrospective review demonstrates that PMMF onlay flap appears to be more effective in reducing the rate of fistula compared to primary closure in these patients. Myocutaneous augmentation flaps, in contrast, have a fairly high fistula rate and may be better replaced with alternative closures such as free flaps.
LEVEL OF EVIDENCE
4.
Topics: Aged; Aged, 80 and over; Cutaneous Fistula; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Laryngectomy; Male; Middle Aged; Myocutaneous Flap; Pectoralis Muscles; Pharynx; Postoperative Complications; Plastic Surgery Procedures; Respiratory Tract Fistula; Retrospective Studies; Salvage Therapy; Treatment Outcome
PubMed: 25132580
DOI: 10.1002/lary.24796