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Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy

Published online by Cambridge University Press:  16 March 2020

M Narayan ,
S Limbachiya ,
D Balasubramanian ,
N Subramaniam ,
K Thankappan  and
S Iyer
M Narayan
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
S Limbachiya
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
D Balasubramanian*
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
N Subramaniam
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
K Thankappan
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
S Iyer
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India
*
Author for correspondence: Dr Deepak Balasubramanian, Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, India E-mail: deepakbala@live.com
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Abstract

Objectives

Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.

Methods

A retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy.

Results

In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.

Conclusion

Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.

Keywords

Diatrizoate MeglumineLaryngectomyFistulaDeglutitionDeglutition Disorders
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 4 , April 2020 , pp. 350 - 353
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Dr D Balasubramanian takes responsibility for the integrity of the content of the paper

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