Total laryngectomy for cancer of the larynx

Fistulae following laryngectomy in patients treated with irradiation

“…The highest proportion of fistulae in his series was seen when the operation was preceeded by radiotherapy. With a two per cent fistula for- mation following total laryngectomy in previously unirradiated and unoperated patients and 14 per cent for the whole series, the development of fistulae in the present study compares favourably with other reports (Goldman etal, 1972;Joseph and Shumrick, 1973;Cummingse?a/., 1977;Horgan and Dedo, 1979;Lundgren and Olofsson, 1979;Sheehan and Shaw, 1979;Weingard and Spiro, 1983;Farrington et al, 1986;Shemen and Spiro, 1986;Johansen et al, 1988;Kleinsasser, 1988). The present investigation supports the findings of others (Joseph and Shumrick, 1973;Briant, 1975;Cantrell, 1978;Horgan and Dedo, 1979;Johansen et al, 1988;Kleinsasser, 1988) showing that several factors are additive for fistula formation following laryngectomy.…”

“…The reported incidence of fistula formation, which is the most feared nonfatal complication following laryngectomy, ranges from five to 33 per cent (Goldman et al, 1972;Joseph and Shumrick, 1973;Cummings et al, 1977;Horgan and Dedo, 1979;Lundgren and Olofsson, 1979;Sheehan and Shaw, 1979;Weingard and Spiro, 1983;Farrington et al, 1986;Shemen and Spiro, 1986;Johansen et al, 1988;Kleinsasser, 1988). Some authors claim that there is a connection between irradiation and the development of fistulae (Joseph and Shumrick, 1973;Briant, 1975;Johansen et al, 1988;Kleinsasser, 1988) while others doubt such a relationship (Goldman et al, 1972;Cummings et al, 1977;Weingard and Spiro, 1983;Shemen and Spiro, 1986).…”

Postlaryngectomy pharyngocutaneous fistula: Incidence, predisposing factors, and therapy

“…1,2 However, a rate between 13% and 25% has been frequently reported over the last two decades. [3][4][5][6][7]10,11,13,14,17,19,21,22,[28][29][30][31][32][33][34] Only in a few reports was the incidence lower than 10%. 2,8,12,35,36 The observation of 40 fistulas (16%) in our group of 246 patients is consistent with the mean values reported in the literature.…”

“…9,11,13,16,19,28,30,47 The differences appear to be mainly related to previous radiotherapy: spontaneous closure was achieved in 44% to 82% of previously treated patients 13,28,30,37,48 versus 80% to 95% of patients who had not been previously treated. 8,12,16,28,31 Local wound care (including drainage of fluids from the fistulous tract, cleansing with antiseptic and antibiotic solutions, removal of all necrotic tissue, followed by curettage of the fistulous borders and tract and pressure dressing above the flaps) should be associated with introduction of the feeding tube and administration of general antibiotics, if signs of local infection are present.…”