Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Diagnosis and Treatment of Pharyngocutaneous Fistula After Treatment of Oral Cavity and Pharyngolaryngeal Cancer

구강과 인후두의 악성종양 치료시 발생한 누공의 진단과 치료

  • Hong, Hyun Joon (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Song, Seung Yong (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Lee, Won Jai (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Lew, Dae Hyun (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Rah, Dong Kyun (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
  • 홍현준 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실) ;
  • 송승용 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실) ;
  • 이원재 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실) ;
  • 유대현 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실) ;
  • 나동균 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실)
  • Published : 2009.09.15
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Abstract

Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.

Keywords

References

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