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Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy

Published online by Cambridge University Press:  16 March 2020

M Narayan ,
S Limbachiya ,
D Balasubramanian ,
N Subramaniam ,
K Thankappan  and
S Iyer
M Narayan
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
S Limbachiya
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
D Balasubramanian*
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
N Subramaniam
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
K Thankappan
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
S Iyer
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
*
Author for correspondence: Dr Deepak Balasubramanian, Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India E-mail: [email protected]
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Abstract

Objectives

Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.

Methods

A retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy.

Results

In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.

Conclusion

Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.

Keywords

Diatrizoate MeglumineLaryngectomyFistulaDeglutitionDeglutition Disorders
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 4 , April 2020 , pp. 350 - 353
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Dr D Balasubramanian takes responsibility for the integrity of the content of the paper

References

Chee, N, Siow, JK. Pharyngocutaneous fistula after laryngectomy--incidence, predisposing factors and outcome. Singapore Med J 1999;40:130–2Google ScholarPubMed
Cordeiro, PG, Shah, K, Santamaria, E, Gollub, MJ, Singh, B, Shah, JP. Barium swallows after free jejunal transfer: should they be performed routinely? Plast Reconstr Surg 1999;103:1167–75CrossRefGoogle ScholarPubMed
Friedman, M, Venkatesan, TK, Yakovlev, A, Lim, JW, Tanyeri, HM, Caldarelli, DD. Early detection and treatment of postoperative pharyngocutaneous fistula. Otolaryngol Head Neck Surg 1999;121:378–80CrossRefGoogle ScholarPubMed
Krouse, JH, Metson, R. Barium swallow is a predictor of salivary fistula following laryngectomy. Otolaryngol Head Neck Surg 1992;106:254–7CrossRefGoogle ScholarPubMed
Markou, KD, Vlachtsis, KC, Nikolaou, AC, Petridis, DG, Kouloulas, AI, Daniilidis, IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy: is there a relationship with tumor recurrence? Eur Arch Otorhinolaryngol 2004;261:61–7CrossRefGoogle Scholar
Moses, BL, Eisele, DW, Jones, B. Radiologic assessment of the early postoperative total-laryngectomy patient. Laryngoscope 1993;103:1157–60CrossRefGoogle ScholarPubMed
Papazoglou, G, Terzakis, G, Doundoulakis, G, Dokianakis, G. Pharyngocutaneous fistula after total laryngectomy: incidence, cause, and treatment. Ann Otol Rhinol Laryngol 1994;103:801–5CrossRefGoogle ScholarPubMed
Redaelli de Zinis, LO, Ferrari, L, Tomenzoli, D, Premoli, G, Parrinello, G, Nicolai, P. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck 1999;21:131–83.0.CO;2-F>CrossRefGoogle ScholarPubMed
Seven, H, Calis, AB, Turgut, S. A randomized controlled trial of early oral feeding in laryngectomized patients. Laryngoscope 2003;113:1076–9CrossRefGoogle ScholarPubMed
Virtaniemi, JA, Kumpulainen, EJ, Hirvikoski, PP, Johansson, RT, Kosma, VM. The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae. Head Neck 2001;23:29–333.0.CO;2-P>CrossRefGoogle ScholarPubMed
Swanson, JO, Levine, MS, Redfern, RO, Rubesin, SE. Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. AJR Am J Roentgenol 2003;181:415–20CrossRefGoogle ScholarPubMed
Tanomkiat, W, Galassi, W. Barium sulfate as contrast medium for evaluation of postoperative anastomotic leaks. Acta Radiol 2000;41:482–5CrossRefGoogle ScholarPubMed
Balfe, DM, Koehler, RE, Setzen, M, Weyman, PJ, Baron, RL, Ogura, JH. Barium examination of the esophagus after total laryngectomy. Radiology 1982;143:501–8CrossRefGoogle ScholarPubMed
White, HN, Golden, B, Sweeny, L, Carroll, WR, Magnuson, JS, Rosenthal, EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope 2012;122:1796–9CrossRefGoogle ScholarPubMed