TITLE:
Predictive Factors for the Occurrence of Pharyngostoma after Laryngectomy and Total Pharyngo-Laryngectomy in Yaounde and Douala
AUTHORS:
Andjock Nkouo Yves Christian, Bola Siafa Antoine, Meva’a Biouele Roger Christian, Kambou Fohom Armelle, Ngono Ateba Gladys, Mindja Eko David, Njock Richard, Djomou Francois
KEYWORDS:
Pharyngostoma, Predictive Factors, Yaounde and Douala
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.12 No.1,
January
31,
2023
ABSTRACT: Introduction and Aims: Pharyngostoma
or pharyngo-cutaneous fistula is a frequent complication of totals
laryngectomies and pharyngo-laryngectomies. Its incidence varies from one series to another from 13% to 58%.
Multiple risk factors are known. The data from our environment concerning this
condition are few. Thus, in order to contribute to the study of this
complication in our environment, we proposed to carry out this study, whose
objective was to determine the predictive factors for the occurrence of
pharyngo-cutaneous fistula or pharyngostoma
after total laryngectomy and total pharyngo-laryngectomy in Yaounde and Douala. Patients and Methods: This
was a retrospective, cross-sectional, descriptive study conducted in the 5 Ear-Nose-Throat (ENT) department
of hospital in the city of Yaounde and Douala. The study took place between
January 2009 and December 2020. All patients who underwent total laryngectomy
or total pharyngo-laryngectomy with a follow-up of at least one month were
included in the study. Incomplete records were excluded, as well as those of
patients who died before one month of postoperative follow-up. Results: We selected 48 cases of total laryngectomies (TL) and total
pharyngo-laryngectomies (TPL), and identified 37 cases of pharyngostoma. 45 men
(93.8%) and 3 women (6.3%). The mean age was 56.4 years with extremes ranging
from 37 to 86 years. Smoking and alcoholism were noted in 75% and 79.2% of our
patients respectively. A tracheotomy before TL and TPL was found in 41.7%. 100%
of the tumours found were T3 or T4. The surgery was in 34 cases (70.8%) TL and
in 14 cases (29.2%) TPL. Pharyngostomas were observed in 37 cases among 48
patients operated on, i.e. a
frequency of 77.1%. The average delay of appearance was 7 to 14 days. We had spontaneous
healing with pressure dressing and nasogastric tube feeding in 35 patients
(77.8%) and two patients benefited from pectoralis major flap treatment; the
healing time was 21 to 30 days. We did not find any correlation between gender,
age, tumour site of origin and locoregional extension and the occurrence of
pharyngostoma. Preoperative tracheotomy and radiotherapy were not significant risk factors for the occurrence of pharyngostoma.
However, preoperative anaemia (p = 0.02), LTP (p = 0.02), early complications
(p 0.001) and lack of continuous saliva aspiration postoperatively (p = 0.03)
were statistically significant predictors of
pharyngostoma in univariate analysis. Conclusion: Pharyngostoma
is the most common postoperative complication after TL and TPL. In our setting,
the main associated risk factors identified were: preoperative anaemia, LTP,
early complications and failure to continuously aspirate saliva
postoperatively.