Conclusion

In summary, fistula formation after head and neck surgery is common, with uncertainty regarding predisposing factors. Because of the retrospective nature of previous studies, this controversy is bound to continue. This chapter attempts to address factors important in the prevention of this problem and to detail how best to manage a fistula once it develops. It is important to realize that clinically the fistula may range from a tiny opening to a wide-open pharyngeal cavity in size; this can represent a considerable challenge to the surgeon. In most cases, conservative treatment is appropriate initially. Successful closure of the larger fistula is possible in most instances, although considerable technical skill and planning are necessary to achieve this goal.

REFERENCES

Curran and Gullane—CHAPTER 59

1. Dedo DD, Alonso WA, Ogura JH. Incidence and predispos ing factors and outcome of pharyngocutaneous fistulas. Ann OtolRhino Laryngol 1975;84:833-838

Lavell RJ, Maw AR. The etiology of post-laryngectomy pharyngocutaneous fistulae. J Laryngol Otol 1972,86: 785-793

3. Havas TE, Gullane PJ. Prevention of complications in head and neck surgery. A self-instructional package. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Alexandria, VA; 1987

4. Giordano AM, Adams GL. Pharyngocutaneous fistula after laryngeal surgery. Otolaryngol Head Neck Surg 1984;92: 19-23

5. Gullane PJ, Jabbour JN, Conley JJ, et al. Correlation of pharyngeal fistulization with pre-operative radiotherapy, reduced serum albumin and dietary obstruction. Otolaryngol Head Neck Surg 1979;87:311-317

6. Hooley R, Levin H, Flores TC, et al. Predicting post-operative head and neck complications using nutritional assessment: the prognostic nutritional index. Arch Otolaryngol 1983;107: 725-729

7. Parikh SR, Irish JC, Curran AJ, et al. Pharyngocutaneous fis-tulae in laryngectomy patients: the Toronto Hospital experience. Otolaryngol 1998;27:3:136-140

8. MacGregor IA, McDonald DG. Mandibular osteotomy in the surgical approach to the oral cavity. Head Neck Surg 1983,5: 457-462

9. Spir RH, Gerold F0, Shah JP, et al. Mandibulotomy approach to oropharyngeal tumours. Am J Surg 1985;150:466-469

10. Davidson J, Freeman J, Gullane P, et al. Mandibulotomy and radical radiotherapy: compatible or not? J Otolaryngol 1988; 17:279-281

11. McCann K, Irish J, Gullane P, et al. Complications associated with rigid fixation of the mandibulotomies. J Otolaryngol 1994;23(3):210-215

12. Kassel RN, Havas TE, Gullane PJ. The use of topical tetracycline in the management of persistent chylous fistula. J Otolaryngol 1987:16:174-178

13. Crumley RL, Smith JD. Postoperative chylous fistula prevention and management. Laryngoscope 1976,86:804-813

14. Kent RB, Pinson TW. Thorascopic ligation of the thoracic duct. Surg Endosc 1993;7:52-55

Fistulae in Head and Neck Surgery

Clarence T. Sasaki, James Alex, and Sanchayeeta Mitra

CHAPTER 60

A head and neck fistula typically refers to an unplanned postoperative communication between the upper aerodigestive tract and skin. Although this term may also refer to other types of fistulae, such as a tracheal fistula or chylous fistula, this chapter focuses primarily on pharyngocutaneous fistulae. Postoperative fistula formation remains a challenging problem that can be managed only with understanding of causative factors, diagnosis, methods of prevention, and treatment options.

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