Pharyngocutaneous or salivary fistula is a feared complication following laryngectomy, causing significant morbidity, prolonged hospital inpatient stay / cost and mortality. Previous radiotherapy / chemoradiotherapy is a well recognised risk factor and leads many surgeons to recommend onlay pectoralis major flaps for such cases. This paper explores further risk factors through the systematic review of data from 63 studies.

The results confirmed previous radiotherapy / chemoradiotherapy as significant risk factors. Further patients factors included: chronic obstructive pulmonary disease (COPD), previous haemoglobin <12.5g/dL and blood transfusion requirement.

Tumour factors included: supraglottic origin of tumour, hypopharyngeal involvement and advanced primary tumours (T3 and T4). Surgical factors included: positive surgical margins, concurrent neck dissection with laryngectomy, irrespective of type of neck dissection (i.e. selective or radical), and the use of catgut for pharyngeal closure compared to Vicryl. The commonly performed second layer closure was not found to be a significant factor in fistula formation. This paper informs the head and neck surgeon of further factors that can be addressed to reduce the risk of pharyngocutaneous fistula following laryngectomy. 

Pharyngocutaneous fistula after total laryngectomy: Systematic review of risk factors.
Dedivitis RA, Aires FT, Cernea CR, Brandão LG.
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Jonathan Hughes

Locum Consultant, Oxford University Hospitals Trust, UK.

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