Ultrasonographic swallowing examination for early detection of neopharyngeal fistula after salvage total laryngectomy: A preliminary study

Abstract

Background The current study investigated the feasibility of ultrasonographic swallowing examination (USSE) for the evaluation of neopharynx and early detection of neopharyngeal fistula after salvage total laryngectomy. Methods A prospective case series‐based study involving 16 patients who underwent salvage total laryngectomy was conducted. USSE was performed on postoperative days 5‐7, and oral diet initiation was determined based on the USSE results. Results Fistula of the neopharynx was detected in four patients (25%) via USSE, as was the specific site of the fistula. In these patients, oral diet was delayed and immediate interventions including ultrasound‐guided fluid aspiration and compression dressing were applied, and all fistulas were subsequently closed. In the remaining 12 patients with no neopharyngeal fistula on USSE, an oral diet was started immediately and no fistula occurred. Conclusions USSE is a promising method for neopharynx evaluation and early detection of neopharyngeal fistula after salvage total laryngectomy.

Swallowing disorders during and after the treatment of larynx cancer

“…Immediately after the intervention, additional conditions occur that complicate the physiology of swallowing. The study showed that 27% of total laryngectomized patients experience additional complications after surgical treatment, namely 1) edema of the pharyngeal mucosa, which usually resolves spontaneously within a few months of surgery; 2) fistulas whose incidence varies from 4 to 75% of laryngectomized patients; 3) functional barriers to bolus transit such as stenosis, strictures, obstruction, the presence of pseudoepiglottis or areas of excess tissue "pockets" where food and fluid accumulate, 4) return of nasal contents reported in 9% of patients after laryngectomy and explained is velopharyngeal incompetence; 5) poor motility of the esophagus; 6) reflux; 7) changes in language mobility in the region of the base (26,27).…”