Chylous fistula is a serious complication of neck surgery. The aim of this study was to analyse the incidence, treatment and evolution of chylous fistula in neck dissection. We conducted a retrospective study of 304 patients, 295 (97.03%) men and nine (2.97%) women. Ages ranged from 24 to 80 years (mean = 59.28 years, SD = 6.02) and they had all undergone neck dissection. Chylous fistula occurred in four cases (1.31%). Incidence was 1.83% in laryngeal cancer and 2.7% in oral cavity and oropharyngeal cancer. No statistically significant correlation was found between tumoral stage and fistula occurrence. Radiotherapy prior to surgery was a risk factor although the association was not statistically significant. The incidence rates for radical and functional neck dissection were 3.3% and 0.46%, respectively, statistically significant (P = 0.042). The fistulas were located on the left side in all cases. One of the four patients required surgical intervention and another one died. The occurrence of chylous fistula increased significantly the length of hospital stay (P = 0.01). Chylous fistulas appear on the left side, radiotherapy prior to surgery is a risk factor and there is not correlation with tumoral stage. Chylous fistulas are significantly more common in radical than in functional dissections and increase significantly the length of hospital stay.

Fistulas in head and neck cancer patients are a common and challenging issue. Despite their commonality, there is little consensus regarding optimal treatment strategies or in preventative measures that might be taken preoperatively. A general knowledge and understanding of what factors correlate with fistula formation can assist a surgeon in optimizing a patient for surgery, thus decreasing prevalence. In addition, surgical techniques can aid in both the prevention and treatment of fistulas once they form. This review details risk factors for fistula formation, the use of vascularized tissue as a preventative measure, conservative and nonconservative treatment of fistulas, and possible strategies to decrease the likelihood of their formation.