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Shires CB, Latour M, Sebelik M, Dewan K. The use of Montgomery salivary bypass tubes and pharyngocutaneous fistula following salvage laryngectomy. World J Otorhinolaryngol Head Neck Surg 2024; 10:43-48. [PMID: 38560030 PMCID: PMC10979037 DOI: 10.1002/wjo2.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 04/04/2024] Open
Abstract
Objectives Pharyngocutaneous fistula (PCF) is the most common complication to follow total laryngectomy (TL) and is associated with increases in length of hospital stay and with a need for revision surgery or readmission, as well as with delays in return to oral diet. Patients who require salvage TL (STL) or primary (chemo)radiation therapy are at higher risk for developing PCF. Due to the quality-of-life burden of PCF on patients, limiting this occurrence is crucial. Methods We conducted a retrospective cohort study of patients undergoing STL with placement of Montgomery salivary bypass tube (MSBT)™ for at least 2 weeks duration between 2013 and 2017 at a single institution. Our patients all underwent free flap reconstruction. Our primary outcome of interest was development of PCF. Secondary outcomes included demographics, previous treatment, base of tongue (BOT) involvement, extent of defect, concurrent neck dissection (ND), and margin status. Univariate χ 2 analysis was used to evaluate factors associated with PCF. Results Forty-four patients underwent STL with Montgomery tube placement and free flap reconstruction. Eight developed PCF (18.2%). The average age was 61.6 years; 36 patients were male (81.8%), whereas eight patients were female (18.2%). There was no association between PCF and previous chemoradiation versus radiation (15.8% vs. 33.3%, P < 0.30), BOT involvement versus not (11.1 vs. 22.2%, P < 0.38), circumferential versus partial defect (18.8% vs. 17.9%, P < 0.94), ND versus none (10% vs. 25%, P < 0.20), or margin status. Conclusion PCF complicated 18.2% of STL cases at our institution and was not associated with differences in primary treatment modality, presence of concomitant ND, extent of pharyngeal defect, BOT involvement, or positive frozen or permanent surgical margin.
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Affiliation(s)
| | - Mackenzie Latour
- Department of Otolaryngology–Head and Neck SurgeryLouisiana State University Health ShreveportShreveportLouisianaUSA
| | - Merry Sebelik
- Department of Otolaryngology–Head and Neck SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Karuna Dewan
- Department of Otolaryngology–Head and Neck SurgeryLouisiana State University Health ShreveportShreveportLouisianaUSA
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Hanubal KS, Chheda NN, Dziegielewski PT. Neopharyngeal Stricture following Laryngectomy. Semin Plast Surg 2023; 37:31-38. [PMID: 36776807 PMCID: PMC9911225 DOI: 10.1055/s-0042-1759796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stricture formation is a serious complication following pharyngeal reconstruction. These strictures can be life-threatening and can severely impact quality of life. In this article, the existing literature on surgical risk factors linked to neopharyngeal stricture formation is reviewed. Intraoperative preventative measures reconstructive surgeons should consider are also discussed. Finally, this article will describe the evaluation and management of pharyngoesophageal strictures, including the challenges and options when dealing with refractory strictures.
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Affiliation(s)
| | - Neil N. Chheda
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T. Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida
- University of Florida Health Cancer Center, Gainesville, Florida
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Salzillo R, Boriani F, Carta F, Tatti M, Atzeni M, Persichetti P, Haywood RM, Puxeddu R, Figus A. Perforator‐based chimeric anterolateral thigh flap U‐shaped insetting for total pharyngoesophageal reconstruction: Surgical technique and functional outcomes. Microsurgery 2022; 43:347-356. [PMID: 36468794 DOI: 10.1002/micr.30991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pharyngoesophageal reconstruction with the tubed anterolateral thigh (ALT) flap is burdened by possible strictures and pharyngocutaneous fistulae (PCF). We present our experience with the U-shaped insetting of perforator-based chimeric ALT flap focusing on surgical technique, complications and functional outcomes. METHODS We retrospectively included 10 patients with a total circumferential defect of the hypopharynx undergoing reconstruction with ALT flap. A perforator-based chimeric ALT flap with two independent skin paddles was harvested: the trapezoid paddle with the greater base cranially and the height oriented vertically was used for pharyngoesophageal reconstruction while the second paddle was exteriorized and used for flap monitoring and reducing tension on skin closure. Mean age was 56.4 years. Eight patients were affected by squamous cell carcinoma. Modified barium swallow radiogram and fiberoptic laryngoscopy were performed to assess strictures and PCFs. Swallowing and speech outcomes were evaluated through the Deglutition Handicap Index (DHI), M.D. Anderson Dysphagia Inventory (MDADI) and Voice Handicap Index (VHI) questionnaires. RESULTS Mean flap dimension was 7.9 × 6 × 9.2 cm. Mean ischemia time was 58.2 min (range 42-80). No flap loss nor flap-related complications were reported. Two PCFs were observed. Fiberoptic laryngoscopy documented a complete integration of the flap with no strictures or stenosis. Mean follow-up was 13.6 months (range 1-45 months). Mean DHI score was 33.8, mean MDADI score was 62.5, mean VHI score was 32.2. CONCLUSIONS The ALT flap U-shaped insetting is a reliable option for pharyngoesophageal reconstruction yielding a high success rate, low number of strictures and fistulae and good swallowing and voice outcomes.
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Affiliation(s)
- Rosa Salzillo
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
- Campus Bio‐Medico University of Rome, Department of Plastic, Reconstructive and Aesthetic Surgery University Hospital Campus Bio‐Medico Rome Italy
| | - Filippo Boriani
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
| | - Filippo Carta
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Otorhinolaryngology Unit University Hospital Duilio Casula Cagliari Italy
| | - Melania Tatti
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Otorhinolaryngology Unit University Hospital Duilio Casula Cagliari Italy
| | - Matteo Atzeni
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
| | - Paolo Persichetti
- Campus Bio‐Medico University of Rome, Department of Plastic, Reconstructive and Aesthetic Surgery University Hospital Campus Bio‐Medico Rome Italy
| | - Richard M. Haywood
- Norfolk and Norwich University Hospital NHS Foundation Trust, Department of Plastic and Reconstructive Surgery University of East Anglia, Norwich Medical School Norwich UK
| | - Roberto Puxeddu
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Otorhinolaryngology Unit University Hospital Duilio Casula Cagliari Italy
| | - Andrea Figus
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
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Costantino A, Pace GM, Festa BM, Ferreli F, Malvezzi L, Spriano G, Mercante G, De Virgilio A. Salivary bypass tube in total laryngectomy: Systematic review and meta-analysis. Head Neck 2022; 44:2608-2620. [PMID: 35920404 DOI: 10.1002/hed.27169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/02/2022] [Accepted: 07/21/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of postoperative pharyngocutaneous fistula (PCF) and pharyngeal stenosis (PS). This study was conducted in conformity with the PRISMA statement. 1960 patients with a median age of 62.0 years were included. A SBT was placed in 980 (50%) patients (SBT group). The cumulative PCF incidence in the SBT group was 15.8% (95% CI: 9.3-23.6). The measured pooled OR comparing PCF incidence in patients with SBT compared to those without was 0.40 (95% CI: 0.24-0.65). The pooled PS incidence in the SBT group was 12.3% (95% CI: 5.4-21.6). The measured pooled OR comparing PS incidence in patients with SBT compared to those without was 0.43 (95% CI: 0.24-0.65). PCF and PS could be prevented by the intra-operative placement of a SBT.
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Affiliation(s)
- Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano MI, Italy
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Bohlok A, Richet T, Quiriny M, Willemse E, Dekeyser C, Andry G, Donckier V, Digonnet A. The effect of salivary bypass tube use on the prevention of pharyngo-cutaneous fistulas after total laryngectomy. Eur Arch Otorhinolaryngol 2021; 279:311-317. [PMID: 34554309 DOI: 10.1007/s00405-021-07082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this retrospective study was to assess the efficacy of Salivary Bypass Tube (SBT) for preventing pharyngo-cutaneous fistula (PCF) in a recent cohort of patients who underwent primary and salvage total laryngectomy (TL). METHODS A consecutive series of 133 patients who underwent total laryngectomy between 1997 and 2019 was reviewed. The incidence of PCF was compared between patients who did not receive SBT (nSBT group; n = 55) and those preventively receiving SBT (SBT group; n = 78) in both primary and salvage TL. Risk factors for PCF were evaluated in a univariate and multivariate analyses. RESULTS The overall PCF rate was 30%. Preoperative characteristics were similar between the nSBT and SBT groups, except for older age (p = 0.016), lower preoperative hemoglobin (p = 0.043), and lesser neoadjuvant chemotherapy (p = 0.015) in the SBT group. The rate of PCF the nSBT group, was 41.5%, compared to 21.8% in the SBT group (p = 0.020). In multivariate analysis, only the use of SBT was associated with lower risk of PCF (OR = 0.41 (95% CI 0.19-0.89), p = 0.026). This effect was verified only in the subgroup of patient operated for salvage TL (OR = 0.225; 95% CI 0.09-0.7; p = 0.008). CONCLUSION The use of SBT in our series in salvage TL, appears to be associated with a decreased risk of PCF.
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Affiliation(s)
- Ali Bohlok
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium.
| | - Theo Richet
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Marie Quiriny
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Esther Willemse
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Cécile Dekeyser
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Guy Andry
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Vincent Donckier
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Antoine Digonnet
- Department of Surgical Oncology, Institut J. Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
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Do Salivary Bypass Tubes Reduce the Risk of Pharyngocutaneous Fistula after Laryngopharyngectomy-A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13112827. [PMID: 34204054 PMCID: PMC8201015 DOI: 10.3390/cancers13112827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary Salivary bypass tubes (SBT) have been introduced in order to reduce the risk of pharyngocutaneous fistula (PCF) after laryngectomy with pharynx reconstruction. Although the current literature is rather heterogenous, our meta-analysis demonstrates a favorable effect of SBT insertion on PCF formation in patients after laryngopharyngectomies. Abstract To evaluate the effect of salivary bypass tube (SBT) usage on the occurrence of pharyngocutaneous fistula (PCF) in patients after a laryngopharyngectomy, a total of 20 studies, published between 1988 and 2021, were identified including 2946 patients. We performed a meta-analysis assessing the risk of PCF occurrence in patients after SBT application compared to those without. PCF occurred in 26.8% of cases (669/2496) and SBT was applied in 33.0% of patients (820/2483). There was an overall trend towards lower PCF rates when using SBTs (22.2% vs. 35.3%; p = 0.057). We further selected five studies, comprising 580 patients who underwent laryngopharyngectomies, for meta-analysis showing that application of SBT reduced the risk of PCF formation (OR 0.46; 95% CI 0.18–1.18; p = 0.11). The meta-analysis demonstrates a beneficial effect of SBT insertion on PCF formation in patients after laryngopharyngectomy.
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León X, García J, López M, Bulboa C, Pujals G, Quer M. Oncological Results of Salvage Treatment in Patients With Hypopharyngeal Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Minni A, Ralli M, Di Cianni S, Cialente F, Candelori F, Colizza A, Cambria F, de Vincentiis M. Montgomery Salivary Bypass Tube in Head and Neck Cancer: The Experience of Our Otolaryngology Clinic. EAR, NOSE & THROAT JOURNAL 2020; 101:463-467. [PMID: 33044843 DOI: 10.1177/0145561320961754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION One of the most common complications in the immediate and late postoperative period following total laryngectomy or pharyngolaryngectomy is pharyngocutaneous fistulae (PCF) formation and pharyngoesophageal stenosis (PES), causing significant mortality and morbidity. Since 1978, Montgomery salivary bypass tube (MSBT) has been used to reduce the incidence of PCF and PES. The aim of this retrospective study was to analyze the outcomes of using MSBT both as a tool to prevent PCF and PES and to treat these complications in the postoperative period. METHODS Between January 2013 and December 2019, we inserted 109 MSBT in 87 patients with laryngeal/hypopharyngeal cancer treated in the Unit of Otolaryngology of our University Hospital. RESULTS Sixty (86.9%) patients healed from complications with primary and secondary placement of MSBT. Seven patients presented a persistence of PCF and 2 presented a recurrence of PES. Secondary placement of MSBT allowed treating successfully 15 (83%) of 18 patients. Only 3 of them presented a PCF at the end of the follow-up period. CONCLUSION According to our experience, the MSBT is an affordable, easy to apply and well-tolerated tool. Although it is generally used for PCF treatment, it can also be used intraoperatively for PCF and PES prevention.
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Affiliation(s)
- Antonio Minni
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, University Sapienza of Rome, Italy
| | | | | | | | - Andrea Colizza
- Department of Sense Organs, University Sapienza of Rome, Italy
| | | | - Marco de Vincentiis
- Department of Oral and Maxillo-Facial Surgery, University Sapienza of Rome, Italy
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Torrico Román P, García Nogales A, Trinidad Ruíz G. Utility of the Montgomery salivary tubes for preventing pharyngocutaneous fistula in total laryngectomy. Am J Otolaryngol 2020; 41:102557. [PMID: 32497952 DOI: 10.1016/j.amjoto.2020.102557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the prophylactic, protocolized, and standardized use of a Montgomery tube in preventing pharyngocutaneous fistulas after total laryngectomy and neck dissection. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral centre. SUBJECT AND METHODS A Montgomery salivary bypass tube was placed in 44 patients undergoing total laryngectomy and neck dissection, observing the percentage of fistula appearance and the time of start of deglutition. Comparison was made with a group of 28 patients prior to the implantation of the protocol in whom the tube was not used. RESULTS There was a statistically significant decrease in the percentage of fistulas and an earlier onset of deglutition in the salivary bypass tube patients compared to those in whom the tube had not been used. CONCLUSION Prophylactic and standardized use of the Montgomery salivary bypass tube in patients undergoing total laryngectomy and neck dissection might decrease the incidence of pharyngocutaneous fistula and improve the course of one that is already established.
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León X, García J, López M, Bulboa C, Pujals G, Quer M. Oncological results of salvage treatment in patients with hypopharyngeal carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:85-91. [PMID: 32473712 DOI: 10.1016/j.otorri.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/18/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE The aim of this study is to analyse the variables related to the feasibility of salvage surgery with radical intention in patients with a local recurrence of hypopharyngeal carcinoma, and to evaluate the oncological performance of this type of surgery. METHODS Retrospective study of 96 patients with hypopharyngeal carcinoma with local tumour recurrence RESULT: Only 27 patients (28.1%) were considered for surgical salvage treatment. The variables related to feasibility of salvage surgery were non-surgical initial treatment of the tumour and a disease-free interval greater than 6 months. All 69 patients non-candidates for salvage surgery died as a result of tumour progression in a period of less than 2.5 years. The 5-year disease-specific survival rate for the patients treated with salvage surgery was 39.5%. The only variable significantly related to disease-specific survival was the status of the resection margins. Patients with extensive tumour recurrence (rT3-T4) or with simultaneous nodal involvement had a lower survival rate, but the differences did not reach statistical significance. CONCLUSION Only 28% of the patients with hypopharyngeal carcinoma with local recurrence of the tumour were eligible for salvage surgery with radical intention. The patients treated with salvage surgery had a 5 -year disease-specific survival of 39.5%.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Constanza Bulboa
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Gerard Pujals
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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Bacterial colonization of Montgomery salivary bypass tubes after hypopharyngeal reconstruction in head and neck cancer patients. Eur Arch Otorhinolaryngol 2019; 277:1149-1154. [PMID: 31848731 PMCID: PMC7072055 DOI: 10.1007/s00405-019-05768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/09/2019] [Indexed: 12/24/2022]
Abstract
Background Hypopharyngeal reconstruction after salvage pharyngolaryngectomy results in high postoperative morbidity. The use of salivary bypass tubes can reduce pharyngocutaneous fistula (PCF) formation. The influence of bacterial colonization has not been described in literature. Methods Bacterial swipes from 26 consecutive patients reconstructed after laryngopharyngectomy in combination with Montgomery salivary bypass tubes (MSBT) were analyzed in regards to PCF formation. Results PCF occurred in 2 untreated primary and in 9 salvage laryngopharyngectomies, respectively. Bacterial colonization showed high rates of gram-negative pathogens and drug resistance to standard Ampicillin treatment. Type of bacteria was not associated with fistula formation. Antibiotic resistance was found in 6 out 11 patients (54%) with PCF. Conclusions We identified high rates of antibiotic-resistant Gram-negative pathogens on MSBT. Although not statistically significant, PCF were found more frequently in drug-resistant patients. Bacterial colonization of hypopharyngeal reconstructions should therefore be taken into account for perioperative prophylaxis.
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Routine use of salivary bypass tubes in laryngectomy patients: systematic review. The Journal of Laryngology & Otology 2018; 132:380-384. [PMID: 29444718 DOI: 10.1017/s0022215118000154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to reduce the incidence of fistulae and neopharyngeal strictures. METHOD Following a systematic search of Embase, Medline and Cochrane databases (1946 - current), included articles were assessed for bias according to the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Three case-control trials showed reduced pharyngocutaneous fistula rates with the use of salivary bypass tubes; six case series reported widely varied fistula rates. With regards to stricture rates, the largest case-control trial found no improvement with salivary bypass tube use. No fatal adverse events were observed among the 204 patients who received a salivary bypass tube. CONCLUSION Low-level evidence suggests salivary bypass tubes may reduce the incidence of fistula in high-risk patient groups. A robust randomised controlled trial, or large, multicentre cohort studies, are needed to further examine this intervention.
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Piazza C, Bon FD, Paderno A, Grammatica A, Montalto N, Taglietti V, Nicolai P. Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects. Laryngoscope 2017; 127:2731-2737. [PMID: 28573675 DOI: 10.1002/lary.26705] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/06/2017] [Accepted: 04/27/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES/HYPOTHESIS Different reconstructive options are available for defects following total laryngectomy (TL) and circumferential (CH) or partial hypopharyngectomy (PH). We evaluated the flap success, pharyngocutaneous fistula, and pharyngoesophageal stenosis rates in two groups of patients treated by different policies. STUDY DESIGN Comparison between two cohorts of patients treated by TL with PH/CH ± cervical esophagectomy and reconstructed according to different strategies. METHODS Group A (historical) was composed of 89 patients reconstructed by pectoralis major myocutaneous (PMMC), radial forearm (RF), and anterolateral thigh (ALT) flaps. A salivary bypass stent (SBPS) was not routinely applied and left in place for a maximum of 14 days. Forty-four (49%) patients received preoperative radiotherapy/chemoradiotherapy (RT/CRT). Group B (prospective) included 105 patients reconstructed by RF or ALT with long-lasting SBPS left in place for a maximum of 45 days. Sixty-one (59%) received preoperative RT/CRT. RESULTS In group A, flap failure occurred in four (4%) cases, and all were managed by PMMC. We encountered 22 (26%) fistulas and 14 (16%) stenoses. In group B, flap failure occurred in six (6%) cases and was managed by PMMC. We encountered seven (7%) fistulas and three (3%) stenoses. Comparing complications among the two groups, we encountered a statistically significant difference in favor of group B for both fistula (P < .001) and stenosis (P = .001). We did not evidence any significant difference in terms of flap success rate. CONCLUSIONS First-line application of RF and ALT free flaps with long-lasting SBPS in reconstruction after PH/CH allows obtaining reduced incidences of both fistula and stenosis. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2731-2737, 2017.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Nausica Montalto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Valentina Taglietti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
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Hone RWA, Rahman E, Wong G, Annan Y, Alexander V, Al-Lami A, Varadharajan K, Parker M, Simo R, Pitkin L, Mace A, Ofo E, Balfour A, Nixon IJ. Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis. Eur Arch Otorhinolaryngol 2016; 274:1983-1991. [PMID: 28011997 PMCID: PMC5340845 DOI: 10.1007/s00405-016-4391-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/11/2016] [Indexed: 01/12/2023]
Abstract
Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy.
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Affiliation(s)
- Robert W A Hone
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK.
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
| | - Eqramur Rahman
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK
| | - Gentle Wong
- Ear, Nose and Throat Department, Brighton and Sussex University Hospital, 177 Preston Rd, Brighton, UK
| | - Yvette Annan
- Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK
| | - Victoria Alexander
- Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK
| | - Ali Al-Lami
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
| | - Kiran Varadharajan
- Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK
| | - Michael Parker
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK
| | - Ricard Simo
- Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK
| | - Lisa Pitkin
- Ear, Nose and Throat Department, Royal Surrey County Hospital, Egerton Rd, Guildford, Surrey, UK
| | - Alasdair Mace
- Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK
| | - Enyinnaya Ofo
- Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK
| | - Alistair Balfour
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
| | - Iain J Nixon
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
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Somuk BT, Çiftçi O, Aygenç E. Evaluation of Cases Who Underwent Reconstruction Through Pectoralis Major Myocutaneous Flap after Laryngopharyngectomy. Turk Arch Otorhinolaryngol 2016; 54:58-62. [PMID: 29392018 DOI: 10.5152/tao.2016.1603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/07/2016] [Indexed: 11/22/2022] Open
Abstract
Objective In this retrospective study, we discussed the results of patients who underwent hypopharynx reconstruction through a pectoralis major myocutaneous flap (PMMF) after laryngopharyngectomy. Methods Twenty-three patients who underwent total laryngectomy, subtotal pharyngectomy, and/or esophagus upper segment resection due to advanced-stage (T3 and T4) laryngeal, hypopharyngeal, and esophagus upper segment-located squamous cell carcinoma and subsequent reconstruction with PMMF were retrospectively evaluated. While the minor complications were determined to be wound site infection, hemorrhage, and disruption of suture at the donor site, major complications were determined to be anastomotic line disruption, fistula, and dysphagia. Results Eighteen (78.2%) patients were male and five (21.7%) were female; their ages varied between 33 and 72 years (mean: 60.1). According to lesion localization, 11 patients were evaluated as having laryngeal cancer, seven as having hypopharyngeal cancer, and five as having esophagus upper segment-located cancer. The rate of minor complications was 30.4%: fistula was observed in 11 (47.8%) patients and 13 (56.5%) patients mentioned difficulty swallowing only solid foods. The total follow-up period ranged from 4 to 60 (mean: 31.6) months. Conclusion PMMF is continuing to be a good alternative reconstruction method for the reconstruction of partial hypopharyngeal defects because it is easily obtainable, one surgical team is sufficient when using the flap, and it is associated with low morbidity and mortality rates.
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Affiliation(s)
- Battal Tahsin Somuk
- Department of Otorhinolaryngology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Onur Çiftçi
- Department of Otorhinolaryngology, Private Güven Hospital, Ankara, Turkey
| | - Erdinç Aygenç
- Department of Otorhinolaryngology, Private Güven Hospital, Ankara, Turkey
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Espitalier F, Ferron C, Leux C, Jégoux F, Durand N, Beauvillain de Montreuil C, Malard O. Results after U-shaped pectoralis major myocutaneous flap reconstruction of circumferential pharyngeal defects. Laryngoscope 2012; 122:2677-82. [PMID: 22965756 DOI: 10.1002/lary.23567] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate surgical, functional, carcinologic results after circumferential pharyngolaryngectomy and reconstruction with U-shaped pectoralis major myocutaneous flap. STUDY DESIGN Retrospective case series. METHODS Forty-one patients included spanning a 6-year period. RESULTS General and local complications occurred in 10% and 22% of patients respectively, without early death. Swallowing and vocal functions were satisfactory for 82% and 43% of patients respectively, despite 39% of neopharynx stricture and 22% of pharyngocutaneous fistula. With a 20-month mean follow-up, cancer recurrence was present in 58% of patients. The overall survival rate was 29% at 3 years. CONCLUSIONS This flap is simple, reliable, and allows adequate reconstruction of the hypopharynx. However, the neopharynx stricture rate is high and the quality of voice rehabilitation is poor when compared with free flaps. This procedure, which is an option for the reconstruction of circumferential pharyngeal defects, must be considered in selected cases.
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Affiliation(s)
- Florent Espitalier
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Nantes, France.
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López F, Obeso S, Camporro D, Fueyo A, Suárez C, Llorente JL. Outcomes following pharyngolaryngectomy with fasciocutaneous free flap reconstruction and salivary bypass tube. Laryngoscope 2012; 123:591-6. [PMID: 22951963 DOI: 10.1002/lary.23695] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Reconstruction of the pharyngoesophageal defects is one of the most challenging for head and neck surgeons. We evaluated our experience in the hypopharyngeal reconstruction using a fasciocutaneous free flap in conjunction with a Montgomery salivary bypass tube (MSBT). STUDY DESIGN Retrospective review. METHODS The charts of 55 patients who had undergone hypopharynx reconstruction using either a radial forearm free flap (RFFF) (24) or an anterolateral thigh (ALT) flap (31) with MSBT were reviewed. There were 40 circumferential and 15 near-circumferential defects. Outcomes analyzed included fistula and stricture rates and swallowing function. RESULTS Pharyngocutaneous fistula occurred in 9% of patients (16% using RFFF and 3% using ALT), and strictures occurred in 5% (8% using RFFF and 3% using ALT). Of patients reconstructed with this technique, 95% were able to resume oral alimentation. CONCLUSIONS The use of fasciocutaneous free flaps in conjunction with the MSBT is a useful tool for pharyngoesophageal reconstruction.
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Affiliation(s)
- Fernando López
- Department of Otorhinolaryngology and Head and Neck Surgery, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Asturias, Spain.
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Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg 2012; 20:77-88. [PMID: 22327791 DOI: 10.1097/moo.0b013e328350a5cc] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The present review is focused on the main reconstructive options currently used after partial or circumferential resection of the hypopharynx and cervical esophagus. The advantages and disadvantages of pectoralis major myocutaneous (PMMC) pedicled flap, fasciocutaneous free flaps as radial forearm and anterolateral thigh (ALT), and visceral free grafts like jejunum and gastro-omental are overviewed. RECENT FINDINGS For partial hypopharyngeal defects with limited extension to the cervical esophagus, no specific pedicled or free flap is deemed superior over others: the patient's body habitus and surgeon's preference remain the most important factors affecting the reconstructive choice. In contrast, after circumferential hypopharyngectomy, pharyngocutaneous fistula (PCF) and stricture rates of PMMC are higher than those obtained by free flaps. In the most recent series applying ALT and jejunum, PCF and stricture occurrence is comparable, whereas reduced mortality, overall complication rate, and donor-site morbidity of ALT and its better swallowing and speech outcomes have contributed to make this option progressively more popular. On the other hand, gastro-omental seems to offer an unparalleled amount of highly vascularized tissue to manage the difficult situation of salvage surgery after chemoradiation, even though complication rates remain not negligible and this technique has not been widely adopted. SUMMARY The reconstructive armamentarium of head and neck surgeons involved in hypopharyngeal and cervical esophagus reconstruction should encompass every option described herein in order to appropriately deal with specific clinical needs and patient requirements. However, fasciocutaneous free flaps (especially ALT) seem to play an ever greater role in restoration of pharyngoesophageal continuity.
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Chan YW, Ng RWM, Liu LHL, Chung HP, Wei WI. Reconstruction of circumferential pharyngeal defects after tumour resection: reference or preference. J Plast Reconstr Aesthet Surg 2011; 64:1022-8. [PMID: 21481656 DOI: 10.1016/j.bjps.2011.03.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 02/18/2011] [Accepted: 03/03/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reconstruction of circumferential hypopharyngeal defects is often challenging. The aim of the study is to examine the result of our experience and to formulate improved management guidelines. METHOD Between 1980 and 2009, all patients who have circumferential pharyngectomy were recruited. Data were recorded prospectively for analysis. RESULTS A total of 202 patients were recruited. Majority had primary tumour in the hypopharynx (n=165), and the remaining patients had recurrent laryngeal carcinoma. Radiotherapy was given preoperatively in 72 patients and postoperatively in 108 patients. A pectoralis major (PM) flap was used in 92 (45.5%) patients, a free anterolateral thigh (ALT) flap in 24 (11.9%) patients and a free jejunal flap in 86 (42.6%) patients. Early fistula rate was 23.9% in the PM flap group, 12.5% in the ALT group and 4.6% in the jejunum group. Late anastomotic stricture rate was 27.2% in the PM flap group, 12.5% in the free ALT group and 2.3% in the jejunum group. Early fistula formation significantly increased the risk of subsequent anastomotic stricture (p=0.023). In patients with no stricture, 61.9% of them in the jejunal group were able to resume solid diet, compared with 35.8% and 38.1% in the PM and ALT groups. After PM flap harvesting, 34.8% of the chest wall defects could not be closed primarily, which were best repaired using the lateral thoracic flap. The donor-site morbidity of ALT and jejunal flap was low. CONCLUSION In suitable patients, free jejunal flap reconstruction of circumferential pharyngectomy defects achieves the best functional outcome with minimal donor-site morbidity.
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Affiliation(s)
- Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
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[Oropharynx and hypopharynx reconstruction. What have we learnt?]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:272-6. [PMID: 20399416 DOI: 10.1016/j.otorri.2010.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 02/13/2010] [Accepted: 02/18/2010] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Oropharyngeal and hypopharyngeal reconstructions require significant human and technical resources. This study analysed our reconstruction program over the last 13 years. MATERIAL AND METHODS Retrospective study in a tertiary reference centre. RESULTS Forty-three reconstruction procedures, of which 67.4 % (29/43) were microvascular (radial forearm 17, rectus abdominis 10, scapular 1, jejunum 1) and 42.6% (14/43) myocutaneous (pectoralis major 13, latissimus dorsi 1). Of these reconstructions, 83% (37/43) were for oropharyngeal defects and 17% (6/43) for hypopharyngeal defects, with 70% Stage iv (30/43), 26% Stage iii (11/43) and 4% (2/43) Stage ii. Mean Hospital stay was 54 days. Complications were present in 74.4% (32/43), salivary fistula being the most frequent (62.5%; 20/32). Ischemic necrosis was present in 20% (6/29) of the microvascular flaps. One microvascular flap was performed every 5.5 months, and one myocutaneous every 11.1 months. Previous radiotherapy and salvage surgery did not significantly increase the rate of complications. CONCLUSIONS Reconstruction of pharyngeal defects is a challenging and demanding task, one that is great when everything runs perfectly and disastrous when failure takes place, mainly for the patient. Disciplines related with head and neck reconstruction should create multidisciplinary teams to increase experience, particularly in centres where the number of patients available makes it difficult to get the expertise and confidence this surgery demands for accomplishing the objectives of patient satisfaction and functional restoration.
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González-Botas JH, Álvarez Buylla M, Vázquez Barro C. Oropharynx and hypopharynx reconstruction. What have we learnt? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Alcalde JM, Gimeno-Vilar C, Montes-Jovellar L, Manrique R, Sanhueza I. Reconstrucción de defectos faríngeos. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 60:283-90. [DOI: 10.1016/j.otorri.2009.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 03/05/2009] [Indexed: 11/30/2022]
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Alcalde JM, Gimeno-Vilar C, Montes-Jovellar L, Manrique R, Sanhueza I. Reconstruction of pharyngeal defects. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009. [DOI: 10.1016/s2173-5735(09)70144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Inman JC, Kim P, McHugh R. Retroesophageal subclavian artery--esophageal fistula: a rare complication of a salivary bypass tube. Head Neck 2008; 30:1120-3. [PMID: 18446837 DOI: 10.1002/hed.20854] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Salivary bypass tubes have been used with great success in preventing neck wound contamination from saliva and decreasing the risk of pharyngoesophageal stenosis. However, complications from esophageal tubes and risk factors for these complications should not be overlooked. Complications can be fatal, as demonstrated in this case of esophageal-subclavian artery fistulization. Retroesophageal subclavian artery (RRESA) is 1 of the most common anatomical variations of the aortic system. Typically producing no symptoms, its discovery is usually coincidental. However, under the right circumstances, this artery can form a fistulous tract. This occurrence has also been documented in cases of long-term nasogastric tube placement and incorrect use of "esophageal" stents. This unique case describes a 62-year-old man who suffered an arterioesophageal fistula during use of a Montgomery salivary bypass tube (MSBT)--a frequently used and exceptionally safe management tool in patients with head and neck cancer.
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Affiliation(s)
- Jared C Inman
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
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Fístula aortoesofágica en paciente con tubo de derivación salival de Montgomery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73255-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Blanco Pérez P, Batuecas Caletrío Á, Muñoz Herrera Á, Cruz Ruiz SS. Aorto-Oesophageal Fistula in Patient With Montgomery Salivary Bypass Tube. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
PURPOSE OF REVIEW Reconstruction of the hypopharynx continues to present a clinical challenge for the reconstructive surgeon. Trends continue to evolve as many viable options exist, depending on individual patient characteristics and institutional preferences. The article reviews the most current literature available on the subject. RECENT FINDINGS Surgical resections resulting in pharyngoesophageal defects require timely reconstruction to minimize patient morbidity while optimizing quality of life, specifically in regards to speech and swallowing. Contemporary reconstructive options include various gastrointestinal flaps, pedicled myocutaneous flaps, and fasciocutaneous free flaps. Institutional trends often depend on the availability, training, and expertise of the reconstructive surgeon. The current options available differ in their complication rate and overall morbidity, and must take into account each patient's general medical health. Increased availability of surgeons trained in microvascular reconstruction and the continued high published success rates have made free flaps an attractive option for hypopharyngeal reconstruction. Functional outcome regarding swallowing and speech rehabilitation after free flap reconstruction is promising. SUMMARY With continued publication of overall high success rates coupled with superior functional outcome and increased availability of surgeons trained in microvascular reconstruction, fasciocutaneous free flap reconstruction of the hypopharynx will probably surpass intestinal flaps in reliability and popularity.
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Affiliation(s)
- Jeremy D Richmon
- University of California, San Diego, Division of Otolaryngology-Head and Neck Surgery San Diego, California 92103-889, USA
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Sevilla García MA, Suárez Fente V, Rodrigo Tapia JP, Llorente Pendás JL. [Montgomery salivary bypass tube: a simple solution for pharyngocutaneous fistulas]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:467-70. [PMID: 17228647 DOI: 10.1016/s0001-6519(06)78750-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The pharyngocutaneous fistulas (PCF) are among the complications surgeons and nursing personnel fear the most due to their complexity to prevent and/or cure them. Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the PCF following laryngectomy. The aim of our study was to describe our experience with salivary bypass in the treatment of the PCF. METHODS This was a retrospective analysis of pharyngocutaneous fistulas in 21 patients in whom total laryngectomy was performed for squamous cell carcinoma of the larynx or hypopharynx (January 1999-December 2005). We determinate the overall efficacy of the Montgomery salivary bypass tube in the treatment of the PCF. RESULTS A pharyngocutaneous fistula developed within a mean time of 7 days from surgery (from 2nd to 20th day). Montgomery salivary bypass tube was the therapeutic option in all these PCF.12 patients required local anesthesia to introduce the tube and in 9 patients the insertion method was with general anesthesia with direct vision of the hypopharynx. The mean healing time was 26 days, except in one case. This PCF achieved spontaneous closure with local wound care after the bypass was removed. CONCLUSIONS The observed results corroborated the relevance of Montgomery salivary bypass tube as an important therapeutic option in the treatment of the PCF. There was no need of surgical treatment.
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Affiliation(s)
- M A Sevilla García
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias.
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Kezirian EJ, Yueh B. Accuracy of terminology and methodology in economic analyses in otolaryngology. Otolaryngol Head Neck Surg 2001; 124:496-502. [PMID: 11337651 DOI: 10.1067/mhn.2001.114675] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Economic studies increasingly guide health care resource allocation decisions. Because rigorous adherence to accepted definitions and research techniques is critical to ensure accuracy, we evaluated the terminology and methods of otolaryngology economic analyses. STUDY DESIGN A total of 71 articles published from 1990 to 1999 in 6 peer-reviewed otolaryngology journals with terms such as "cost-effective" in their title or representing economic analyses were reviewed for terminology and use of established methodology guidelines. RESULTS Over half (35 of 66) of terms such as "cost-effective" were used incorrectly, and 60% of articles (39 of 64) confused "charge" and "cost" data. Eleven percent (7 of 64) of papers specified the perspective of their analysis. About half (17 of 30) reported a summary measure such as a cost-effectiveness ratio. Only one third (23 of 63) performed sensitivity analyses. CONCLUSION Adherence to accepted definitions and research methods is inconsistent, although we did note moderate improvements in making the distinction between costs and charges, defining of study perspective, and performing sensitivity analysis. SIGNIFICANCE Greater attention to both terminology and methodology can enhance the quality of economic analyses and ultimately improve certain resource allocation decisions.
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Affiliation(s)
- E J Kezirian
- University of Washington, Seattle 98195-6515, USA.
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