Radiologic assessment of the early postoperative total-laryngectomy patient.

Pharyngocutaneous fistula is a significant cause of postoperative morbidity following total laryngectomy. The records of 132 patients at the Johns Hopkins Hospital were reviewed retrospectively to determine the role of radiographic contrast studies in the early postoperative period after total laryngectomy. Radiographic studies were performed in 41 cases, of which 38 were cinepharyngoesophagograms. Fistulae occurred postoperatively in 28 patients (21%). In patients with no clinical signs or symptoms suggestive of an impending fistula (fever, wound erythema, wound swelling, or persistent elevated neck drain output), there is no need to perform a cinepharyngoesophagogram before starting oral alimentation. The presence of soft-tissue air in the neck seen on preliminary scout spot films, suggestive of an impending fistula seen in patients who also underwent a neck dissection, did not correlate with a clinical fistula if no extravasation of contrast was observed.