ABSTRACT
Pharyngo-cutaneous fistula [PCF] is a Common and serious complication following total laryngectomy for laryngeal cancer. Despite its relative frequency, there is still uncertainty about its incidence and predisposing factors. This study was designed to determine the incidence, possible predisposing factors and management of this complication. The records of 150 consecutive patients who underwent total laryngectomy for squamous cell carcinoma of the larynx were reviewed and analyzed. We evaluated the overall Incidence of PCF, factors potentially predisposing to fistula formation [T-stage of the tumor, extent of surgery, concurrent neck dissection, preoperative tracheotomy, preoperative, radiotherapy, postoperative hemoglobin level lower than 12 g dl, type of pharyngeal closure, type of suture material and onset of oral feeding] and the potential management. PCF developed in 32% of patients with a mean time of 9 days following surgery. There was statistically significant association between tumor stage, extent of surgical resection and type of pharyngeal closure and PCF formation. The other contributing factors- such as preoperative radiotherapy, preoperative tracheotomy, concurrent neck dissection and low postoperative hemoglobin level failed to show statistically significant effect. Spontaneous closure with wound care was achieved in 79% of cases. 4 patients [8.3%] required surgical closure by direct suture of the pharyngeal mucosa, while deltopectoral flaps were used in 3 cases [6.2%] pectoral is major myocutaneous flaps in 2 cases [4.1%] and free jejunal interposition flap in 1 case [2%]. Advanced T-stage of the tumor, extended laryngectomy and type of pharyngeal closure were found to have significant role in PCF formation but no statistical significant difference could be demonstrated for other investigated parameters. Our experience confirmed that most fistulas can be successfully managed with conservative treatment except in some cases where surgical suture is appropriate when conservative treatment has failed