Table of Contents
International Scholarly Research Notices
Volume 2014, Article ID 373825, 6 pages
Research Article

Predictors of Salivary Fistulas in Patients Undergoing Salvage Total Laryngectomy

Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 2333 Post Street, 3rd Floor, San Francisco, CA 94143, USA

Received 5 September 2014; Revised 24 October 2014; Accepted 27 October 2014; Published 20 November 2014

Academic Editor: Chih Y. Chien

Copyright © 2014 Shethal Bearelly and Steven J. Wang. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Salivary fistula is a common complication after salvage total laryngectomy. Previous studies have not considered the number of layers of pharyngeal closure and have not classified fistulas according to severity. Our objective was to analyze our institutional experience with salvage total laryngectomy, categorize salivary fistulas based on severity, and study the effect of various pharyngeal closure techniques on fistula incidence. Methods. Retrospective analysis of 48 patients who underwent salvage total laryngectomy, comparing pharyngeal closure technique and use of a pectoralis major flap with regard to salivary fistula rate. Fistulas were categorized into major and minor fistulas based on whether operative intervention was required. Results. The major fistula rate was 18.8% (9/48) and the minor fistula rate was 29.2% (14/48). The overall (major plus minor) fistula rate was 47.9%. The overall fistula and major fistula rates decreased with increasing the number of closure layers and with use of a pectoralis major flap; however, these correlations did not reach statistical significance. Other than age, there were no clinicopathologic variables associated with salivary fistulas. Conclusion. For salvage total laryngectomies, increasing the number of closure layers or use of a pectoralis major flap may reduce the risk of salivary fistula.