REVIEW article
Front. Oncol.
Sec. Head and Neck Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1597538
This article is part of the Research Topic150 Years of Laryngectomy: Reviews on the State of the Art and Future PerspectivesView all 3 articles
Preventing and managing pharyngocutaneous fistula after total laryngectomy -A narrative review
Provisionally accepted
- 1ENT department, Spedali Civili di Brescia, Brescia, Italy
- 2University of Brescia, Brescia, Lombardy, Italy
- 3University Hospitals Leuven, Leuven, Brussels, Belgium
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Pharyngocutaneous fistula (PCF) remains one of the most frequent and serious complications following total laryngectomy (TL). PCF can lead to severe health issues such as infections and thromboembolic events prolonging hospitalization, as well as to life-threatening large neck vessels blowout and mediastinitis. Despite technical advancements, PCF rate after TL remains around 10%, underlining its challenges in terms of prevention and management. Numerous studies have identified risk factors contributing to PCF development: they can be distinguished into patient-, tumor-, and surgical technique-related variables. Nevertheless, a wide consensus has yet to be reached for most of them. Two of the most encountered and recognized risk factors are certainly represented by salvage setting after failure of (C)RT and extension of TL to oro-, hypopharynx or cervical esophagus. In the first scenario, use of both pedicled and free flaps either with an onlay or an inlay technique have been described, while in case of extended TL, general consensus has been reached in favor of inlay free flaps. Simultaneous use of salivary bypass tube is another commonly applied tool for PCF prevention. This review aims to describe current strategies for prevention and management of PCF after primary and salvage TL with possible extension to adjacent sites.
Keywords: Pharyngocutaneous fistula, prevention, Management, Total laryngectomy, salvage setting, free flap, Pedicled flap, salivary bypass tube
Received: 21 Mar 2025; Accepted: 29 Apr 2025.
Copyright: © 2025 Piazza, Montenegro and Vander Poorten. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Claudia Montenegro, ENT department, Spedali Civili di Brescia, Brescia, Italy
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