Abstract
Larynx is the second most common site for cancer in the upper aerodigestive tract. One of the dreaded complications following total laryngectomy has been pharyngo cutaneous fistula (PCF). PCF merits special attention due to its significant negative impact on the recovery process. Total laryngectomy profoundly alters speech. Effective voice restoration is essential for the rehabilitation of these patients. Inadequate consensus exists as to the best technique of pharyngeal repair to decrease incidence of PCF and ensure good quality voice following total laryngectomy. 21 patients were included in the study for total laryngectomy with trachea oesophageal voice prosthesis placement. Patients were randomised into 2 groups. Group A had their pharynx repaired in two layers and Group B had it done in three layers. Post operatively the patients were followed up for a period of 12 months to look for incidence of PCF. Subjective and objective evaluation of voice was done. 9.52% of patients developed PCF. All of the cases of PCF were in the group repaired in three layers. In cases with repair by two layers the mean Voice Handicap Index 10 (VHI 10) score was 19.27 and those with three layers pharyngeal repair was 23.20. Average maximum phonation time amongst the study population was 13.09. In three layers and two layers pharyngeal repair the average maximum phonation time was 12.56 and 13.58 respectively. Surgical repair of pharynx in two layers excluding the third layer of pharyngeal musculature reduces the chance of PCF. Two layers pharyngeal repair supplemented by cricopharyngeal myotomy led to significantly better voice outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cattaruzza M, Maisonneuve P, Boyle P (1996) Epidemiology of laryngeal cancer. Eur J Cancer B Oral Oncol 32(5):293–305
Markou K, Vlachtsis K, Nikolaou A, Petridis D, Kouloulas A, Daniilidis I (2004) Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence? Eur Arch Otorhinolaryngol 261(2):61–67
Paydarfar J, Birkmeyer N (2006) Complications in head and neck surgery. Arch Otolaryngol Head Neck Surg 132(1):67
Elmiyeh B, Dwivedi RC, Jallali N, Chisholm EJ, Kazi R, Clarke PM, Rhys-Evans PH (2010) Surgical voice restoration after total laryngectomy: an overview. Indian J Cancer 47:239–247
Singer M, Blom E (1980) An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 89(6):529–533
Edge S, Compton C (2010) The American Joint Committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474
Rosen C, Lee A, Osborne J, Zullo T, Murry T (2004) Development and validation of the Voice Handicap Index-10. Laryngoscope 114(9):1549–1556
Horgan EC, Dedo HH (1979) Prevention of major and minor fistulae after laryngectomy. Laryngoscope 89:250–260
Weber RS, Berkey BA, Forastiere A, Cooper J, Maor M, Goepfert H, Morrison W, Glisson B, Trotti A, Ridge JA, Chao KS, Peters G, Lee DJ, Leaf A, Ensley J (2003) Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg 129(1):44–49
Johansen LV, Overgaard J, Elbrond O (1988) Pharyngo-cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole. Cancer 61(4):673–678
Patel UA, Keni SP (2009) Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 141(2):190–195
Hui Y, Wei WI, Yuen PW, Lam LK, Ho WK (1996) Primary closure of pharyngeal remnant after total laryngectomy and partial pharyngectomy: How much residual mucosa is sufficient? Laryngoscope 106(4):490–494
Wang Ching-Ping, Tseng Tzu-Chan, Lee Rheun-Chuan, Chang Shyue-Yih (1997) The techniques of nonmuscular closure of hypopharyngeal defect following total laryngectomy: the assessment of complication and pharyngoesophageal segment. J Laryngol Otol 111:1060–1063
Chen Y, Ke N, Tan C et al (2015) Continuous versus interrupted suture techniques of pancreaticojejunostomy after pancreaticoduodenectomy. J Surg Res 193(2):590–597
Dirven R, Swinson BD, Gao K, Clark JR (2009) The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx. Laryngoscope 119(9):1691–1695
Haksever M, Akduman D, Aslan S, Solmaz F, Ozmen S (2015) Modified continuous mucosal connell suture for the pharyngeal closure after total laryngectomy: zipper suture. Clin Exp Otorhinolaryngol 8(3):281
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors of this article declare that he/she has no conflict of interest.
Human and Animal Rights
Animals were not involved in this study.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Saha, A.K., Samaddar, S., Choudhury, A. et al. A Comparative Study of Pharyngeal Repair in Two Layers Versus Three Layers, Following Total Laryngectomy in Carcinoma of Larynx. Indian J Otolaryngol Head Neck Surg 69, 239–243 (2017). https://doi.org/10.1007/s12070-017-1108-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-017-1108-3