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.


Curran and Gullane—CHAPTER 59

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

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Fistulae in Head and Neck Surgery

Clarence T. Sasaki, James Alex, and Sanchayeeta Mitra


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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