RADIOLOGIC ASSESSMENT OF THE EARLY POSTOPERATIVE TOTAL-LARYNGECTOMY PATIENT

Pharyngocutaneous fistula is a significant cause of postoperative morb idity following total laryngectomy. The records of 132 patients at the Johns Hopkins Hospital were reviewed retrospectively to determine the role of radiographic contrast studies in the early postoperative peri od after total laryngectomy. Radiographic studies were performed in 41 cases, of which 38 were cinepharyngoesophagograms. Fistulae occurred postoperatively in 28 patients (21%). In patients with no clinical sig ns or symptoms suggestive of an impending fistula (fever, wound erythe ma, wound swelling, or persistent elevated neck drain output), there i s no need to perform a cinepharyngoesophagogram before starting oral a limentation. The presence of soft-tissue air in the neck seen on preli minary scout spot films, suggestive of an impending fistula seen in pa tients who also underwent a neck dissection, did not correlate with a clinical fistula if no extravasation of contrast was observed.