Ao. Ikiz et al., Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomy, J LARYNG OT, 114(10), 2000, pp. 768-771
Ninety-two total laryngectomy cases were investigated with reference to pos
t-laryngectomy fistula formation. Fistula was observed in eight cases (8.69
per cent). There were no statistically significant differences between the
fistula group and the non-fistula group with regard to pre-operative trach
eotomy, tumour differentiation, positive surgical margins, concurrent neck
dissection, previous radiotherapy, T stage of the tumour, presence of exten
ded hypopharyngeal mucosal excision, and placement of nasogastric tube. The
only statistically significant positive association was found with primary
pharyngeal myotomy. Myotomy was performed in six of the fistula patients a
nd in two cases a technical error was observed. In these cases myotomy was
performed adjacent to the edge of hypopharyngeal mucosa resulting in a weak
ened area of pharyngeal closure, possibly contributing to the fistula. This
should be kept in mind and avoided at all costs during the performance of
myotomy. Since it was not possible to find out any specific causal relation
ship with myotomy in four other cases, further studies are needed to establ
ish the association of myotomy with pharyngocutaneous fistula.