Our Summary

This research paper is about a complication that can happen after a person has their larynx (voice box) completely removed, called a pharyngocutaneous fistula. This is a serious problem that can seriously slow down a patient’s recovery after surgery. There are different ways to treat this issue, including conservative methods, surgery, negative-pressure wound therapy, and endoscopic techniques, which have been showing promising results lately. However, the best treatment option depends on various factors such as the size and type of fistula, the patient’s overall health, and whether they had chemotherapy or radiotherapy before the surgery. The paper provides an overview of the current ways to treat this complication.

FAQs

  1. What is a pharyngocutaneous fistula and how does it affect a patient’s recovery after a total laryngectomy?
  2. What are some of the treatment options for post laryngectomy pharyngocutaneous fistula?
  3. How does the patient’s overall health condition and preoperative chemoradiotherapy impact the choice of therapy for pharyngocutaneous fistula after total laryngectomy?

Doctor’s Tip

A doctor may advise a patient who has undergone a laryngectomy to avoid smoking and alcohol consumption, as these can increase the risk of developing a pharyngocutaneous fistula. Additionally, they may recommend regular follow-up appointments to monitor for any signs of complications and provide appropriate treatment if needed. It is important for patients to follow their doctor’s instructions and maintain good oral hygiene to prevent infection and promote healing after surgery.

Suitable For

Patients who are typically recommended laryngectomy are those with advanced laryngeal cancer that has not responded to other treatments such as radiation or chemotherapy. Other patients may also be recommended for laryngectomy if they have recurrent or persistent laryngeal cancer, or if they have other conditions that make them poor candidates for other treatments.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with laryngeal cancer and undergoes various tests and evaluations to determine the extent of the cancer.
  2. Patient may undergo chemotherapy and/or radiation therapy to shrink the tumor before surgery.
  3. Patient meets with a multidisciplinary team including surgeons, oncologists, and speech therapists to discuss treatment options and prepare for surgery.
  4. Patient undergoes total laryngectomy surgery to remove the larynx and surrounding tissue.

After laryngectomy:

  1. Patient wakes up with a tracheostomy tube in place to help with breathing and a feeding tube for nutrition.
  2. Patient may experience pain, swelling, and difficulty speaking and swallowing in the immediate postoperative period.
  3. Patient receives speech therapy and rehabilitation to learn how to communicate using alternative methods such as esophageal speech, electrolarynx, or tracheoesophageal puncture.
  4. Patient may develop a pharyngocutaneous fistula, a common complication where there is an abnormal connection between the pharynx and the skin of the neck.
  5. Treatment options for pharyngocutaneous fistula include conservative management with wound care and nutrition support, or surgical intervention such as closure or reconstruction.
  6. Patient undergoes regular follow-up appointments with their healthcare team to monitor for complications and adjust treatment as needed.

What to Ask Your Doctor

  1. What is a pharyngocutaneous fistula and what are the risk factors for developing one after a laryngectomy?
  2. What are the symptoms of a pharyngocutaneous fistula and how is it diagnosed?
  3. What are the treatment options for a pharyngocutaneous fistula and what are the success rates of these treatments?
  4. How long does it typically take for a pharyngocutaneous fistula to heal after treatment?
  5. Are there any potential complications or side effects associated with the treatment of a pharyngocutaneous fistula?
  6. What can I do to help prevent the development of a pharyngocutaneous fistula after my laryngectomy surgery?
  7. Will I need additional follow-up appointments or monitoring after treatment for a pharyngocutaneous fistula?
  8. Are there any lifestyle changes or dietary restrictions I should follow to aid in the healing process of a pharyngocutaneous fistula?
  9. Are there any support groups or resources available for patients who have experienced a pharyngocutaneous fistula after a laryngectomy?
  10. What is the long-term outlook for patients who have had a pharyngocutaneous fistula after a laryngectomy?

Reference

Authors: Xiong YJ, Jin RQ, Liu F, Peng SP. Journal: Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Dec 5;31(23):1858-1862. doi: 10.13201/j.issn.1001-1781.2017.23.020. PMID: 29798405