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Delayed pharyngoesophageal perforation: a complication of anterior spine surgery.

Stabilization of the cervical spine is often accomplished via an anterior cervical approach. Bone grafts and/or plates and screws are used to achieve stabilization. Injuries to the pharynx and esophagus are known complications in anterior exposure of the cervical spine. These injuries are manifest in the early postoperative period. Reports of late perforations are very rare. We present four cases of delayed injury to the pharynx and esophagus that resulted in abscess or fistula. We postulate that graft displacement with resulting erosion was responsible for these serious complications. Postoperative odynophagia in patients who undergo anterior cervical fusion warrants evaluation of the bone graft location. Early surgical intervention and repair may decrease prolonged morbidity in these patients.

Abscess↗

Barium swallow is a predictor of salivary fistula following laryngectomy.

Pharyngocutaneous salivary fistula after laryngectomy is a serious complication that can lead to prolonged hospitalization and increased patient morbidity. A postoperative barium swallow provides the surgeon with information regarding the integrity of the pharyngeal suture line. In an attempt to determine whether this information can be used to predict or prevent salivary fistula, we reviewed the records of 109 patients who underwent total laryngectomy, including 51 who had a barium swallow before they began oral intake. Ten patients (20%) demonstrated a sinus tract originating from the pharyngeal suture line. A clinical salivary fistula developed in all four patients with a sinus tract 2 cm or longer, but in only one of six patients with a tract shorter than 2 cm. Other factors predictive of salivary fistula included tumor stage, previous radiation therapy, and the presence of concurrent postoperative complications. A single fistula developed in the 58 patients not studied with barium. Information provided by postlaryngectomy barium swallow appeared to predict, but not prevent salivary fistula formation.

Adult↗

Postparotidectomy fistula: a different treatment for an old problem.

There is little consensus on the optimal management of postparotidectomy salivary fistulas. Timely treatment is important since fistulas may result in wound dehiscence and infection. Management options include pressure dressings, total parotidectomy, tympanic neurectomy, graft interpositioning, surgical closure of the tract, radiation therapy, and pharmacotherapy. Unfortunately, many therapies require weeks to months for resolution and possess additional risks. The affected patient often suffers social embarrassment from the drainage. Through our work with neurologically impaired children with sialorrhea, we have had success with using glycopyrrolate, an anticholinergic frequently used to decrease salivary secretions. We present a case of a patient with a postparotidectomy fistula which was successfully treated with glycopyrrolate and pressure dressings. The rationale and potential use of glycopyrrolate for the treatment of a salivary fistula are the focus of this presentation.

Adenoma, Pleomorphic↗

Palatal trauma: an unusual cause of a parotid sinus.

A case is described of a 3-year-old boy who presented with a seemingly trivial injury to his soft palate, who went on to develop a parotid sinus as a result of a retained foreign body. This is a rare clinical problem and it highlights the difficulty in the clinical assessment of a palatal injury--especially in children. The child had the foreign body removed successfully 5 months after the initial injury and made an uneventful recovery.

Child, Preschool↗

Pseudoaneurysm of the carotid artery with haemorrhage into the hypopharynx.

Pseudoaneurysms of the extracranial carotid arteries are rarely seen following irradiation for cancers of the head and neck. We present a patient with a pseudoaneurysm of the common carotid artery following a radical neck dissection and irradiation for thyroid carcinoma 20 years earlier. Following oesophagoscopical examination, a pseudoaneurysm of the right common carotid artery ruptured into the piriform sinus. The common carotid artery was embolized with multiple coils and the bleeding was halted. The relationship between the carotid artery aneurysm and irradiation, and the treatment of carotid artery aneurysm, is discussed.

Aneurysm↗