Clarence T Sasaki

Fistulae in Head and Neck Surgery

Richard Gallagher and Paul A. Levine

CHAPTER 58

One of the most frustrating complications of surgery of the upper aerodigestive tract is the development of a salivary fistula, which results in a prolonged hospitalization and morbidity. The patient's recovery, rehabilitation of swallowing, speech, and adjuvant treatment are delayed, and the fistulae may predispose to serious complications, such as great vessel rupture or mediastinitis.

A fistula may develop as a consequence of any operation where the mucosa of the upper aerodigestive tract is approached by a neck incision and is entered, whether planned or iatrogenic. Saliva leaks through the line of mucosal closure and appears at an external skin incision line. The challenge for the surgeon then becomes thoughtful management of the problem to achieve wound healing, while avoiding significant complications. This chapter presents our thoughts and philosophy regarding the prevention and management of salivary fistulae.

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