Our Summary

This research paper is about a medical condition called pharyngocutaneous fistula, which can cause serious health problems after a patient has had their larynx (voice box) removed. The researchers looked into whether using a salivary bypass tube during the removal of the larynx could reduce the chance of this condition occurring.

To do this, they searched through medical databases to find relevant studies. They found three studies that showed using the salivary bypass tube did indeed reduce the chance of pharyngocutaneous fistula occurring. However, they also found six studies with widely varied results.

When it came to the rate of stricture (a narrowing or tightening of an opening or tube in the body), the largest study they found did not show any improvement with the use of the salivary bypass tube.

The researchers concluded that there is some evidence that salivary bypass tubes might reduce the chance of pharyngocutaneous fistula in patients who are at high risk. However, they say that more large-scale studies are needed to confirm these findings.

FAQs

  1. What is the purpose of using salivary bypass tubes during a laryngectomy?
  2. What were the findings of the case-control trials regarding the use of salivary bypass tubes in reducing pharyngocutaneous fistula rates?
  3. What further research is needed to confirm the effectiveness of salivary bypass tubes in laryngectomy procedures?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laryngectomy is to consider the use of salivary bypass tubes to potentially reduce the risk of developing pharyngocutaneous fistula. It is important to discuss this option with your healthcare provider to determine if it is appropriate for your individual situation.

Suitable For

Patients who are at high risk for developing pharyngocutaneous fistula following laryngectomy are typically recommended to undergo the use of salivary bypass tubes. High-risk patient groups may include those with a history of radiation therapy, poor nutritional status, diabetes, and previous neck surgery. These patients may benefit from the use of salivary bypass tubes to reduce the incidence of fistulae and neopharyngeal strictures. However, further research, such as robust randomised controlled trials or large multicentre cohort studies, is needed to better understand the effectiveness of this intervention.

Timeline

Before laryngectomy:

  • Patient undergoes thorough evaluation by a healthcare team including otolaryngologists, speech therapists, and nutritionists
  • Patient may undergo preoperative tests such as imaging studies and blood work
  • Patient may receive counseling on the procedure and potential complications
  • Patient may undergo preoperative counseling on speech and swallowing rehabilitation post-surgery

After laryngectomy:

  • Patient undergoes surgery to remove the larynx
  • Patient may have a temporary tracheostomy tube placed to help with breathing
  • Patient may receive postoperative care in the intensive care unit
  • Patient undergoes speech and swallowing therapy to learn new ways of speaking and eating
  • Patient may experience complications such as pharyngocutaneous fistula, which can be treated with interventions such as salivary bypass tubes
  • Patient may require long-term follow-up care for monitoring and management of complications.

What to Ask Your Doctor

  1. What is a laryngectomy and why is it being recommended for me?
  2. What are the potential risks and complications associated with a laryngectomy?
  3. What is a pharyngocutaneous fistula and how common is it after a laryngectomy?
  4. How does the use of salivary bypass tubes during laryngectomy help reduce the risk of pharyngocutaneous fistula?
  5. Are there any alternative treatments or interventions that can help prevent pharyngocutaneous fistula?
  6. What is the likelihood of developing a neopharyngeal stricture after a laryngectomy?
  7. Are there any specific precautions or care instructions I should follow after the surgery to reduce the risk of complications?
  8. How long will I need to have the salivary bypass tube in place and what can I expect during this time?
  9. What are the potential long-term effects or complications associated with having a salivary bypass tube?
  10. Are there any specific signs or symptoms I should watch for that may indicate a complication related to the laryngectomy or the use of a salivary bypass tube?

Reference

Authors: Kamhieh Y, Fox H, Hallett E, Berry S. Journal: J Laryngol Otol. 2018 May;132(5):380-384. doi: 10.1017/S0022215118000154. Epub 2018 Feb 15. PMID: 29444718