Post Laryngectomy Complications: Common contrast swallow appearances

Congress:

ECR 2020

Poster Number:

C-01401

Type:

Educational Exhibit

Keywords:

Not applicable, Fistula, Dynamic swallowing studies, Contrast agent-oral, Fluoroscopy, Ear / Nose / Throat, Head and Neck

Authors:

T. R. Eriksen, M. Buchanan, M. Hall; GLASGOW/UK

DOI:

10.26044/ecr2020/C-01401

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-01401

Fig. 1: "T-shaped" closure

Fig. 2: Pseudodiverticulum without anastomotic leak. Contrast lying in a pouch...

Fig. 3: Pseudodiverticulum with anastomotic leak. Contrast is passing into the...

Fig. 4: Leak along the anterior closure line.

Learning objectives

1. Identify common complications following laryngectomy on water soluble contrast swallow studies. 2. Gain an understanding of the operative procedure, in particular, how the neopharynx is closed. 3. Relate the operative procedure to the imaging findings.

Background

Total laryngectomy is a procedure carried out in the treatment of laryngeal malignancy.[1] Post operatively patients are naso-gastrically fed to allow healing of the neopharynx. Contrast studies are used to examine for the presence of an anastomotic leak, pharyngocutaneous fistula and for the investigation of dysphagia. An understanding of the surgical procedure and where the suture lines lie can help identify areas that may give rise to complications, improving contrast swallow interpretation.

Findings and procedure details

Total laryngectomy involves dissection of strap muscles and thyroid, stoma formation, excision of the larynx, epiglottis, and hyoid bone, and closure of the remaining pharyngeal mucosa to create the neopharynx. “T shaped closure” and “vertical closure” techniques for neopharynx closure are practiced locally based on preference of the surgeon. T shaped closure involves creating a T shaped suture line with a midline trifurcation. Vertical closure involves a single midline longitudinal suture line only. Lack of mucosal support after hyoidectomy may lead to prolapse of the...

Conclusion

An understanding of the surgical technique of total laryngectomy can help identify sites that may give rise to post-operative complications.

Personal information and conflict of interest

T. R. Eriksen; Glasgow/UK - nothing to disclose M. Buchanan; Glasgow/UK - nothing to disclose M. Hall; Glasgow/UK - nothing to disclose

References

Ceachir O, Hainarosie R, Zainea V. Total Laryngectomy - Past, Present, Future. Maedica (Buchar). 2014 Jun; 9(2): 210-216. Van der Kamp MF, Rinkel RNPM, Eerenstein SEJ. The influence of closure technique in total laryngectomy on the development of a pseudodiverticulum and dysphagia. Eur Arch Otorhinolaryngol. 2017; 274(4):1967-1973. Jatin Shah’s Head and Neck surgery and oncology, 4th Ed, Ch 10, 424; 2012 Dedivitis RA et al, Pharyngocutaneous fistula following total laryngectomy, Acta Otorhinolaryngol Ital. 2007 Feb; 27(1): 2-5.