Videofluoroscopic swallowing study to detect pharyngeal leak after total (pharyngo-) laryngectomy: Retrospective assessment of a single-institution protocol

Head Neck. 2024 Apr;46(4):740-748. doi: 10.1002/hed.27617. Epub 2024 Jan 3.

Abstract

Background: We aimed to assess the effectiveness of a single-institution protocol of videofluoroscopic swallowing study (VFSS) for the detection of pharyngeal leak (PL) and its usefulness to mitigate evolution into subsequent pharyngocutaneous fistula (PCF) after total (pharyngo-) laryngectomy (TL).

Methods: This retrospective single-center study was conducted between February 2014 and December 2022. We included all patients who underwent TL and performed a VFSS between Day 7 and Day 14 postoperatively to detect a subclinical PL.

Results: Two-hundred and forty-eight patients met the inclusion criteria. Among the 186 patients (75%) with a negative VFSS, 11 patients (5.9%) developed a secondary PCF after oral intake resumption (false negative of VFSS). Among the 62 patients (25%) with a positive VFSS, the occurrence of a PCF was avoided in 59.7% of cases.

Conclusion: This study showed a good effectiveness of VFSS in the detection of PL after TL, alongside a usefulness to mitigate evolution into subsequent PCF.

Keywords: contrast swallow test; pharyngeal leak; pharyngocutaneous fistula; total laryngectomy; videofluoroscopic swallowing study.

MeSH terms

  • Cutaneous Fistula* / diagnostic imaging
  • Cutaneous Fistula* / epidemiology
  • Cutaneous Fistula* / etiology
  • Deglutition
  • Humans
  • Laryngeal Neoplasms* / surgery
  • Laryngectomy / adverse effects
  • Pharyngeal Diseases* / diagnostic imaging
  • Pharyngeal Diseases* / etiology
  • Pharynx / diagnostic imaging
  • Postoperative Complications / epidemiology
  • Retrospective Studies