Disabilities resulting from healed salivary fistula.

Abstract

Pharyngocutaneous salivary fistulae sometimes prolong the recovery period after laryngectomy, but usually heal within 2 or 3 weeks and are not ordinarily considered a cause of permanent postoperative symptoms. However, the present study indicates that many permanent disorders of the swallowing mechanism are due to the manner in which the structure and function of the pharynx and hypopharynx are altered by the way in which such fistulae heal. Moreover, these symptoms may occur in laryngectomized patients in whom complete salivary fistulae did not develop during convalescence but who, in contrast, developed an incomplete fistula or sinus tract from the pharyngeal lumen. These conclusions have been reached after a 2½-year study of 43 patients subjected to laryngectomy, using cinefluorographic visualization of the activity of the larynx coated with propyliodone (Dionosil) and the pharynx outlined with barium. Twenty-six of these patients have been examined postoperatively with barium swallows at repeated intervals, including