Introduction:
The body is made of various openings that help to exchange blood and oxygen to different parts of the body. Some of these openings or communications are present naturally, while others may have occurred accidentally or as a result of injury. These accidental openings can be extremely harmful as they may be a source of infection and there are chances of leak of bodily fluids. If left unnoticed, it could cause serious health issues, resulting in sepsis. Therefore, timely treatment can save the life of an individual and prevent any serious complications.
For example, a pharyngocutaneous fistula refers to an abnormal opening between the pharynx and the external skin over the neck. It may occur post-surgery, or during intubation in patients with difficulty in eating or post certain surgeries. In intubation, a small incision is made over the superficial layer of the skin over the neck and the tube is slowly passed through the opening to ensure proper transmission of liquids and fluids. The tube and incision site are constantly monitored for infections. Post-recovery, the tube is removed, once the patient is capable of chewing and consuming food on their own. Due to the long-term intubation in some patients, there may be a large opening in the neck at the incision site. Sometimes, this site may not heal properly, resulting in a pharyngocutaneous fistula. Hence, the surgeon may perform surgery to close the opening and restore function.
What Is a Fistula?
Any abnormal opening or connection between two body parts like an organ or blood vessel is called a fistula. Some fistulas are congenital, while others occur as a result of injury or surgery.
What Are the Causes of a Fistula?
Fistulas may be congenital or acquired. They act as a communication or opening between two body parts. They cause discomfort to the patients. If left untreated, they may cause infection, which could possibly be dangerous. A severe form of the fistula may lead to sepsis, which is a dangerous condition. It leads to low blood pressure, damages the organs, and results in death.
Are Fistulas Curable?
Most fistulas may require a few surgeries, which are performed by surgeons. It may take a while to heal from the surgery. However, most fistulas do not disappear on their own.
What Is Pharyngocutaneous Fistula?
A pharyngocutaneous fistula is an inflammation in the lining of the pharynx that allows saliva to leak out of the throat portion of the swallowing channel. Up to 20 percent of patients who have had a total laryngectomy may experience this briefly; the sixth postoperative day is when it happens most frequently. Fistulization risk appears to be elevated by prior radiation therapy.
In the past, pressure dressings were applied after a straight midline incision and the insertion of a penrose drain. Suction drains are used in modern therapy to prevent salivary leakage and enable the remaining skin flap to cling to the neck. In order to enable the tract to close from top to bottom, the drain is then taken out, shortened, and put back in a number of times.
During procedures like total laryngectomy when a portion of the larynx is removed, there could be a possible injury to the nearby structure, the pharynx. The pharynx and larynx are severely adherent. In simple terms, it is a communication between the digestive tract and neck skin. It is a common complication of primary closure of pharyngeal defect after tumor resection.
What Is the Most Common Site of Pharyngeal Fistula?
The most common site of the pharyngeal fistula is the lower submandibular gland. The submandibular gland is one of the major salivary glands that are responsible for salivary production. There are two pairs of submandibular glands. These glands secrete saliva, which helps to keep the oral cavity moist by acting as a lubricant and flushing bacteria. It also acts as a tooth cleanser and has many other properties. It is one of the important bodily fluids.
What Are the Complications of Pharyngocutaneous Fistula?
Some of the common complications of pharynx cutaneous fistula are listed below:
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Flap failure.
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Carotid artery rupture.
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Pharyngeal stricture.
Since it is a difficult condition to manage, it may require multiple surgeries to completely treat the condition and improve the quality of life. Patients who are diagnosed very late may have higher risks and complications. Hence it is important to take timely treatment to avoid consequences and enjoy a healthy life.
How Is Pharyngocutaneous Fistula Treated?
A conservative and surgical approach is required in the treatment of surgical fistula. Negative pressure wound therapy and endoscopic techniques, provide good results in treating the condition. The incidence of this fistula may vary between 8 to 22 percent.
In managing the fistula in patients with total laryngectomy, the process of complete removal of the larynx is pretty difficult, especially post-radiotherapy. A study was conducted on nine patients to treat pharyngocutaneous fistula. The first five patients had been conservatively treated, before repairing the fistula, and the other four patients were treated after a month of fistula formation. Out of these nine patients, almost eight patients had frozen necks, which demanded neck resurfacing. The fistulas occurred within 8 to 30 days after a total laryngectomy. The early repair had more benefits than late repair. Because in late repairs it had been noticed that many patients had severe scarring and stricture that had occurred due to long-standing fistula.
The treatment required hospitalization for approximately seven days, and there were very less chances of recurrence after following for 11 to 48 months. The patients had achieved 100 percent oral alimentation. Five to six patients were able to achieve fluent speech. Therefore, early repair is strongly recommended in the treatment of pharyngocutaneous fistula due to better prognosis and lesser chances of recurrence.
How to Prevent Pharyngocutaneous Fistula?
In order, to prevent accidental fistula formation, the surgeon should be careful while performing pharyngeal surgeries. Especially surgeries related to the pharynx are very technique-sensitive and may easily rupture the pharyngeal membrane. Also, post-surgery the patient should strictly follow the doctor’s advice for proper healing of the surgical site. The fistula can be prevented by using a vacuum drain, which leads to pharyngocutaneous fistula development.
Conclusion:
The pharynx cutaneous fistula is the opening or communication between the pharynx and the external skin surface. It occurs accidentally post-surgery and may cause constant irritation and discomfort to the patient. Treating the fistula is crucial, to prevent the body fluids from leaking and to prevent any cross-contamination. If left untreated, these openings may lead to infection, which can be harmful to health. The treatment for pharyngocutaneous fistula involves a conservative surgical procedure, to avoid tissue scarring over the neck area. Post-surgery, it is important to follow up with the patients for any infections. Timely treatment and management can bring about the best outcomes and help lead a quality life.
