Medical Treatment of Pharyngo-Cautaneus Fistula After Laryngectomy with Phenytoin,Clindamycin, Acetic Acid and Dexamethasone Combination in 50 Patients Affected By Laryngeal Cancer in Emam Hospital, Ahvaz,IRAN During 2001-2008

Document Type : Original Article


Assistant Professor of Otolaryngology. Department of Otolaryngology,School of Medicine, Ahvaz Jundishpour University of Medical Sciences, Ahvaz, Iran.


Background and Objective:  pharyngo-cautaneus fistula is the most common complication (8.7%-22%) after laryngectomy. Multiple factors such as radiotherapy are associated with complications after laryngectomy. Spite of the different treatments such as local, regional and advanced flaps, the ideal method for closing larg fistula of pharyngo- cautaneus is stiil a mater for debate.
Subjects and Methods: In this investigation, 8 cases from 50 patients between 2001-2008 as prospective and 19 controls from 130 patients between 2001-2008 as retrospective underwent total laryngectomy for laryngeal cancer in Emam Khomeini hospital, Ahvaz, Iran, were chosen. All of the cases underwent antibiotic therapy, irrigation of wound with solution of clindamycin, acetic acid, dexamethasone and phenytoin and change of dressing 4 time in day. 
Results: In the case and control groups, 8 (16%) and 19 (14%) patients were affected by pharyngo-cautaneus fistula. In the case group, six patients underwent radiotherapy before operation (12%). The mean time for beginning fistula formation and repair in cases and control group was 6.5,9.6 and 27,24 respectively . All of these cases responded well to this medical therapy method and 2 patients from control group needed surgery for fistula repair.
Conclusion: In this study showed that the large fistula in patients with radiotherapy can also be cure with non-surgical treatment and special cares.


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