Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-18T17:24:25.047Z Has data issue: false hasContentIssue false
  • English
  • Français

Role of Montgomery salivary stent placement during pharyngolaryngectomy, to prevent pharyngocutaneous fistula in high-risk patients

Published online by Cambridge University Press:  20 November 2012

S Bondi ,
L Giordano ,
P Limardo  and
M Bussi
S Bondi*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, S Raffaele Hospital, Vita-Salute University, Milan, Italy
L Giordano
Affiliation:
Department of Otolaryngology Head and Neck Surgery, S Raffaele Hospital, Vita-Salute University, Milan, Italy
P Limardo
Affiliation:
Department of Otolaryngology Head and Neck Surgery, S Raffaele Hospital, Vita-Salute University, Milan, Italy
M Bussi
Affiliation:
Department of Otolaryngology Head and Neck Surgery, S Raffaele Hospital, Vita-Salute University, Milan, Italy
*
Address for correspondence: Dr Stefano Bondi, Via Olgettina 60, 20132 Milan, Italy Fax: +39 0226433508 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the incidence of pharyngocutaneous fistula after pharyngolaryngectomy with and without a Montgomery salivary stent.

Design:

Retrospective analysis of patients with factors that predispose to the development of pharyngocutaneous fistula (i.e. disease extending to the supraglottic region, base of the tongue or pyriform sinuses, and/or radiochemotherapy).

Subjects:

Between 2002 and 2008, 85 pharyngolaryngectomies were performed in our clinic. Of these patients, 31 were at increased risk of fistula development, of whom 45 per cent developed fistulas post-operatively. This subgroup of 31 patients was compared with a second subgroup of 22 patients at high risk of fistula development, treated between 2009 and 2011 with pharyngolaryngectomy and with a Montgomery salivary stent placed in advance during closure of the neopharynx.

Results:

Statistical analysis showed a significant reduction in the rate of fistula development, from 45 to 9 per cent (p < 0.01), with application of the salivary stent.

Conclusion:

These data confirm the preventive effect of a salivary stent placed during pharyngolaryngectomy, for patients at high risk of fistula development.

Keywords

PharynxFistulaLaryngeal NeoplasmsPharyngectomyLaryngectomyStent
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 1 , January 2013 , pp. 54 - 57
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Galli, J, De Corso, E, Volante, M, Almadori, G, Paludetti, G. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Otolaryngol Head Neck Surg 2005;133:689–94CrossRefGoogle ScholarPubMed
2 Paydarfar, JA, Birkmeyer, NJ. Complication in head and neck surgery. A meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 2006;132:67–72 CrossRefGoogle ScholarPubMed
3 Tsou, YA, Hua, CH, Lin, MH, Tseng, HC, Tsai, MH, Shaha, A. Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer. Head Neck 2010;32:1494–500CrossRefGoogle ScholarPubMed
4 Boscolo-Rizzo, P, De Cillis, G, Marchiori, C, Carpenè, S, Da Mosto, MC. Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy. Eur Arch Otorhinolaryngol 2008;265:929–36CrossRefGoogle ScholarPubMed
5 Bohannon, IA, Carroll, WR, Magnuson, JS, Rosenthal, EL. Closure of post-laryngectomy pharyngocutaneous fistulae. Head Neck Oncol 2011;26:3–29 Google Scholar
6 Redaelli, de Zinis, LO, Ferrari, L, Tomenzoli, D, Premoli, G, Parrinello, G, Nicolai, P. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck 1999;21:131–8Google Scholar
7 Virtaniemi, JA, Kumpulainen, EJ, Hirvikoski, PP, Johansson, RT, Kosma, VT. The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae. Head Neck 2001;23:29–33 3.0.CO;2-P>CrossRefGoogle ScholarPubMed
8 Ganly, I, Patel, S, Matsuo, J, Singh, B, Kraus, D, Boyle, J et al. Postoperative complication of salvage total laryngectomy. Cancer 2005;103:2073–81CrossRefGoogle ScholarPubMed
9 Weber, RS, Berkey, BA, Forastiere, A, Cooper, J, Maor, M, Goepfert, H et al. Outcome of salvage total laryngectomy following organ preservation therapy. The radiation therapy oncology group trial 91–11. Arch Otolaryngol Head Neck Surg 2003;129:44–9CrossRefGoogle ScholarPubMed
10 Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685–90CrossRefGoogle Scholar
11 Montgomery, WW, Montgomery, SK. Manual for use of Montgomery laryngeal, tracheal and esophageal prostheses: update 1990. Ann Otol Rhinol Laryngol Suppl 1990;150:2–28 CrossRefGoogle ScholarPubMed
12 Sevilla Garcia, MA, Suarez Fente, V, Rodrigo Tapia, JP, Llorente Pendas, JL. Montgomery salivary bypass tube: a simple solution for the pharyngocutaneous fistula [in Spanish]. Acta Otorrinolaringol Esp 2006;57:467–70Google Scholar
13 Bitter, T, Pantel, M, Dittmar, Y, Guntinas-Lichius, O, Wittekindt, C. Stent migration to the ileum – a potential lethal complication after Montgomery salivary bypass tube placement for hypopharyngeal stenosis after laryngectomy. Head Neck 2012;34:135–7CrossRefGoogle Scholar
14 Gil, Z, Gupta, A, Kummer, B, Cordeiro, PG, Kraus, DH, Shah, JP et al. The role of pectoralis major muscle flap in salvage total laryngectomy. Arch Otolaryngol Head Neck Surg 2009;135:1019–23CrossRefGoogle ScholarPubMed