gms | German Medical Science

GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V. (DGHNOKHC)

ISSN 1865-1038

Endoscopic repair of pharyngocutaneous fistula following laryngectomy

Poster Endoskopie

  • corresponding author Petar Iliev - Department of neurosurgery and ENT diseases, Medical University Prof. Dr. P. Sto, Varna, Bulgaria
  • Lora Nikiforova - Department of neurosurgery and ENT diseases, Medical University Prof. Dr. P. Sto, Varna, Bulgaria
  • Nikolai Sapundzhiev - Department of neurosurgery and ENT diseases, Medical University Prof. Dr. P. Sto, Varna, Bulgaria
  • Petar Petrov - Department of imaging diagnostics and radiotherapy, Medical University Prof. Dr., Varna, Bulgaria
  • Darina Ivanova - Department of imaging diagnostics and radiotherapy, Medical University Prof. Dr., Varna, Bulgaria

GMS Curr Posters Otorhinolaryngol Head Neck Surg 2016;12:Doc121

doi: 10.3205/cpo001472, urn:nbn:de:0183-cpo0014726

Veröffentlicht: 11. April 2016

© 2016 Iliev et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Abstract

Introduction: Pharyngocutaneous fistula (PCF) is a typical complication after total laryngectomy, which is predominantly conservatively managed. A surgical treatment is required when the fistula has a large orifice and/or a substantial loss of surrounding soft tissue is present.

Objective: To report a new endoscopic surgical approach for closure of post-laryngectomy PCF using autologous fat graft injection.

Case report: A 61-year old male presented with a late PCF two years after total laryngectomy with partial resection of the tongue base for advanced laryngeal carcinoma with infiltration of the hypopharynx. Already at the time of the initial surgery the postopertive course was complicated with early PCF, managed conservatively. Rhinopharyngoscopy with a flexible scope revealed a well identifiable epithelized opening (4x4 mm) in the midline at the junction between the base of the tongue and the neohypopharynx. Further evaluation with CT and barium swallow radiographs showed a fistula between the neopharynx and the skin at the C2-C4 level. An endoscopic surgical repair was performed. The neohypopharyx was approached with the Weerda diverticuloscope. Fat tissue harvested from the abdomen was injected into the area surrounding the pharyngeal opening of the fistula. Further the opening was sclerosed and sutured. The repair was successful and for the next 6 months the patient had normal oral feeding without any signs of leakage or inflammation around the former PCF.

Conclusion: In conservative therapy-refractory cases of PCF surgical intervention is mandatory. In well selected cases a combination of endoscopic approach and autologous fat injection can be used.

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