Management of an Incomplete Pharyngocutaneous Fistula Following Salvage Laryngectomy With Polyethylene Glycol Hydrogel Sealant

采用聚乙二醇水凝胶密封剂治疗挽救性喉切除术后不完全性咽瘘

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Abstract

Pharyngocutaneous fistula (PCF) is a common complication following total laryngectomy, significantly affecting patients' postoperative courses. Its management is challenging, encompassing a broad spectrum of approaches, ranging from conservative measures to more invasive surgical interventions. A 75-year-old male status post salvage total laryngectomy with modified radical bilateral neck dissection after failure of definitive radiotherapy for squamous cell carcinoma of the larynx developed an incomplete pharyngocutaneous fistula postoperatively. Despite the conservative care during postoperative care, the incomplete fistula didn't resolve after a month. Through rigid pharyngoesophagoscopy, polyethylene glycol hydrogel was injected into the orifice of the fistula. A follow-up barium swallow study four weeks post-intervention revealed complete resolution of the fistula. Polyethylene glycol hydrogel sealant, primarily approved for neurosurgical and spinal applications, can be considered off-label for the management of pharyngocutaneous fistulas.

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