-
Otolaryngologic Clinics of North America Apr 2023The Department of Veterans Affairs Laryngeal Cancer Study propelled the combination of chemotherapy and radiation therapy to the forefront of strategies used for the... (Review)
Review
The Department of Veterans Affairs Laryngeal Cancer Study propelled the combination of chemotherapy and radiation therapy to the forefront of strategies used for the management of locally advanced laryngeal cancer. The organ preservation rate was 84%. However, over the past 30 years that these approaches have been in place, there have been concerns regarding long-term survival and high failure rates requiring salvage. Furthermore, salvage laryngectomy, if feasible when considering increased morbidity after CRT, is fraught with a higher risk of wound complications including fistula, longer hospitalization, and reduced quality of life.
Topics: Humans; Laryngeal Neoplasms; Surgical Flaps; Quality of Life; Retrospective Studies; Fistula; Laryngectomy; Salvage Therapy
PubMed: 37030945
DOI: 10.1016/j.otc.2022.12.002 -
American Journal of Otolaryngology 2019Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed...
BACKGROUND
Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula.
METHODS
Case report.
RESULTS
A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability. The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression.
CONCLUSIONS
Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.
Topics: Aged; Animals; Bites and Stings; Dimethylpolysiloxanes; Dogs; Female; Fistula; Humans; Laryngeal Diseases; Laryngoplasty; Postoperative Complications; Prostheses and Implants; Prosthesis-Related Infections; Skin Diseases; Time Factors; Vocal Cord Paralysis
PubMed: 30940403
DOI: 10.1016/j.amjoto.2019.03.018 -
BMJ Case Reports Jan 2022
Topics: Congenital Abnormalities; Esophageal Atresia; Humans; Larynx; Neurosurgical Procedures; Tracheoesophageal Fistula
PubMed: 35039336
DOI: 10.1136/bcr-2021-243515 -
The Journal of Laryngology and Otology Apr 1955
Topics: Fistula; Humans; Laryngeal Diseases; Larynx; Neoplasms; Vocal Cords
PubMed: 14368099
DOI: 10.1017/s0022215100050659 -
Otolaryngology--head and Neck Surgery :... Jan 2023Tracheoesophageal fistula and esophageal atresia (TEA) and laryngeal cleft (LC) can coexist in some patients. The surgery-specific success rate of LC repair in children...
OBJECTIVE
Tracheoesophageal fistula and esophageal atresia (TEA) and laryngeal cleft (LC) can coexist in some patients. The surgery-specific success rate of LC repair in children with associated TEA has not been well described. The aim of the study is to determine if the history of TEA alters the LC repair outcomes.
STUDY DESIGN
Case series with chart review.
SETTING
Single-institution academic medical center.
METHOD
A retrospective review was conducted of patients with LC with and without TEA repair between January 2001 and November 2020. Data collected and analyzed included demographics and clinical characteristics, LC type, and LC with TEA timing of repairs.
RESULTS
An overall 282 patients met the inclusion criteria of LC repair: LC (n = 242, 85.8%) and LC + TEA (n = 40, 14.2%). Revision repair was required in 43 patients (15.2%) with 8 (2.8%) needing a second revision repair. The first LC revision rate in the LC group was 36/242 (14.9%) as compared with 7/40 (17.5%) in the LC + TEA group (P = .67). The second LC revision rate in the LC and LC + TEA groups was 7 (2.9%) and 1 (2.4%), respectively. The median time to revision was 5.1 months (interquartile range, 3.45-10.6) in the LC group as compared with 29.2 months (interquartile range, 4.8-44.2) in the LC + TEA group (P = .06).
CONCLUSION
The incidence of TEA and LC was 14.2% in our study. Based on our findings, history of TEA repair is not associated with a higher revision rate vs LC alone. The history of TEA repair did not alter the outcomes of LC repair.
Topics: Child; Humans; Tracheoesophageal Fistula; Larynx; Esophageal Atresia; Incidence
PubMed: 35536656
DOI: 10.1177/01945998221094210 -
Paediatric Respiratory Reviews Jan 2016
Topics: Congenital Abnormalities; Humans; Laryngomalacia; Larynx; Respiratory System Abnormalities; Tracheoesophageal Fistula; Tracheomalacia
PubMed: 26620224
DOI: 10.1016/j.prrv.2015.09.007 -
Acta Otorrinolaringologica Espanola Feb 2003Laryngeal chondroradionecrosis is a complication following radiotherapy for laryngeal tumours that may appear many years after the treatment. We present the case of a 78...
Laryngeal chondroradionecrosis is a complication following radiotherapy for laryngeal tumours that may appear many years after the treatment. We present the case of a 78 year old man, that come to the Accident and Emergency department with a prelaryngeal mass and hemoptysis. He had been treated 17 years before with radiotherapy for a vocal cond carcinoma. Posteriorly the lesion did a cutaneous fistula with complete laryngeal exposition and torpid evolution. Post-radiotherapy necrosis in the larynx is a serious complication though not a common one. A tumour recurrence needs to be excluded and even in this case a total laryngectomy is mandatory as it will end in total loss of laryngeal function.
Topics: Aged; Antifungal Agents; Candida albicans; Candidiasis; Cartilage Diseases; Exudates and Transudates; Fistula; Humans; Laryngeal Neoplasms; Male; Radiation Injuries; Radiotherapy
PubMed: 12802988
DOI: 10.1016/s0001-6519(03)78394-0 -
Burns : Journal of the International... May 1997A rare case of electrical burn resulting in laryngeal fistula is presented. The fistula manifested about 3 weeks postburn. This was successfully managed by using a...
A rare case of electrical burn resulting in laryngeal fistula is presented. The fistula manifested about 3 weeks postburn. This was successfully managed by using a pectoralis major myocutaneous flap. A 1 year follow-up of the patient is presented.
Topics: Accidents, Home; Adult; Burns, Electric; Fistula; Follow-Up Studies; Humans; Laryngeal Diseases; Larynx; Male; Pectoralis Muscles; Surgical Flaps
PubMed: 9232289
DOI: 10.1016/s0305-4179(96)00125-8 -
The Laryngoscope May 2014Concurrent chemoradiotherapy is the gold-standard nonsurgical organ-preservation treatment for advanced laryngeal carcinoma. Total laryngectomy (TL) is increasingly... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES/HYPOTHESIS
Concurrent chemoradiotherapy is the gold-standard nonsurgical organ-preservation treatment for advanced laryngeal carcinoma. Total laryngectomy (TL) is increasingly reserved for surgical salvage. Salvage surgery is associated with more complications than primary surgery. A systematic review and meta-analysis was undertaken to establish the impact of organ preservation protocols on pharyngo-cutaneous fistula incidence following TL, and to synthesize evidence on the role of "onlay" prophylactic tissue flaps in reducing this complication in salvage TL.
DATA SOURCES
The English language literature (January 1, 2000, to September 1, 2013) was searched, using PUBMED and EMBASE databases, for the terms "laryngectomy" and "fistula." Of 522 studies identified from database searches, 33 were included in the quantitative synthesis.
REVIEW METHODS
Studies reporting fistula incidence following primary TL (PTL), salvage TL (STL), and STL with "onlay" flap-reinforced pharyngeal closure were included. Data were extracted by the first author (M.S.). Meta-analysis of fistula incidence was performed.
RESULTS
PTL fistula incidence is 14.3% (95% CI 11.7-17.0), STL 27.6% (23.4-31.8), and STL with flap-reinforced closure 10.3% (4.6-15.9). Chemoradiotherapy is associated with a pooled fistula incidence of 34.1% (22.6-45.6), compared to 22.8% (18.3-27.4) for radiotherapy alone. Relative risk of fistula is 0.566 (0.374-0.856, P = 0.001) for STL with flap-reinforced closure compared to STL alone. The number needed to treat (NNT) to prevent one fistula is 6.05.
CONCLUSION
Prophylactic flaps used in an "onlay" technique reduce fistula incidence in STL. Chemoradiotherapy increases fistula incidence more than radiotherapy alone. Prophylactic flaps should be offered in salvage cases after failed chemoradiation protocols.
Topics: Combined Modality Therapy; Cutaneous Fistula; Fistula; Humans; Laryngeal Neoplasms; Laryngectomy; Pharyngeal Diseases; Salvage Therapy; Surgical Flaps
PubMed: 24122657
DOI: 10.1002/lary.24448 -
The Laryngoscope Feb 2015Laryngeal cleft (LC) associated with tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) has rarely been described. The purpose of this study is to...
OBJECTIVES/HYPOTHESIS
Laryngeal cleft (LC) associated with tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) has rarely been described. The purpose of this study is to review our experience, clinical features, management, delay in diagnosis, and complications in children with these anomalies.
STUDY DESIGN
Retrospective chart review at pediatric tertiary referral center.
METHODS
Patients diagnosed with LC alone or LC and TEF over a 10-year period were included. Data including demographics, type of TEF and LC, comorbidities, symptoms, management, complications and swallowing outcomes were analyzed.
RESULTS
There were 161 pediatric patients diagnosed with LC alone and 22 with LC and TEF. In patients with LC and TEF, aspiration was the most common presenting symptom (n = 11, 50%). Seventeen patients (77%, mean age 4 years 7 months) underwent endoscopic repair and five patients (23%) with type I clefts did not require surgery. Two patients required revision surgery. For patients with LC alone, the mean age at repair was 3.70 years (4 months-19.9 years) compared to 4.69 years (8 months-17.83 years) for patients with LC and TEF (P = 0.0187). The postoperative swallowing studies from 15 patients showed no aspiration. Mean follow-up was 4 years and 6 months.
CONCLUSION
The diagnosis and management of LC in patients with TEF is often delayed. If a child presents with persistent aspiration after TEF repair, a complete airway endoscopy should be performed to evaluate for vocal fold mobility and cleft. Endoscopic repair is the recommended approach for those patients requiring surgical intervention.
LEVEL OF EVIDENCE
4.
Topics: Adolescent; Child; Child, Preschool; Congenital Abnormalities; Endoscopy; Esophageal Atresia; Female; Humans; Infant; Larynx; Male; Retrospective Studies; Tracheoesophageal Fistula; Young Adult
PubMed: 24964996
DOI: 10.1002/lary.24804