Surgical emphysema as an early sign for pharyngocutaneous fistula following total laryngectomy: a case report

Ahmed Amin Nassar,Hazem Othman Ibrahim

doi:10.1186/s43163-021-00081-1

Ahmed Amin Nassar, Hazem Othman Ibrahim

Open Access

https://doi.org/10.1186/s43163-021-00081-1

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Journal: The Egyptian Journal of Otolaryngology	Publication Date: Feb 15, 2021
Citations: 1	License type: open-access

Affiliation: Cairo University

Abstract

BackgroundPharyngocutaneous fistula is the most common and troublesome complication after total laryngectomy. Many factors may be used in laryngectomy patients for the early diagnosis of pharyngocutaneous fistulae such as skin flap edema, neck erythema, salivary leak, postoperative barium swallow, and wound amylase level. Its diagnosis is mainly standing on a clinical basis.Case presentationThis report described two cases of laryngeal carcinoma, which presented with a history of persistent hoarseness of voice and mild stridor and were diagnosed with a battery of clinical investigations and managed successfully with total laryngectomy and lateral neck dissection. Both patients suffered from postoperative surgical emphysema before developing pharyngocutaneous fistula.ConclusionSurgical emphysema can precede the occurrence of pharyngocutaneous fistula after total laryngectomy. Further studies are needed to confirm this finding.

Highlights

Pharyngocutaneous fistula is the most common and troublesome complication after total laryngectomy
Sex, TNM staging, prior radiotherapy, type of pharyngeal repair (T closure or horizontal closure), the technique of closure, suture material, preoperative tracheostomy, and postoperative margin status are all considered factors that may affect the incidence of pharyngocutaneous fistula [6, 7]
There are not much data about how to prevent the pharyngocutaneous fistula after total laryngectomy, it is generally agreed that most fistulas respond well to

Summary

Introduction

Pharyngocutaneous fistula is the most common and troublesome complication after total laryngectomy. We describe two cases underwent total laryngectomy complicated with postoperative surgical emphysema before the pharyngocutaneous fistula. Various studies have been performed to predict the occurrence of pharyngocutaneous fistulas as early as possible. Our diagnosis of the fistula is based on clinical or radiological findings such as skin flap edema, neck erythema, salivary leak, and the presence of sinus tract on barium swallow.

Results

Conclusion