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Head and Neck Surgery

(067) Botulinum Toxin-A Injection Reduces Hospitalization Length in Post-Laryngectomy Pharyngocutaneous Fistulas

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Kunjan B. Patel, MD

    Resident
    Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine
    Winston Salem, North Carolina, United States

    • Co-Author(s)

  • Maria C. Masciello, MD

    PGY-3
    Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine
    Winston Salem, North Carolina, USA

    • Senior Author(s)

  • CS

    Christopher A. Sullivan, MD

    Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA

Disclosure(s):
Kunjan B. Patel, MD: No relevant relationships to disclose.


Introduction: Pharyngocutaneous fistula (PCF) is a common complication after Total Laryngectomy (TL), occurring in as many as 15-20% of previously non-irradiated patients. Most wounds (60-80%) close with non-surgical wound management such as packing or vacuum assisted therapy. Injection of Botulinum Toxin A (BoNT-A) into major salivary glands has been proposed as a low-risk tool to promote fistula closure by reducing saliva production. Among healthy patients, BoNT-A can reduce saliva production by 80% for up to 4 months. Data on its efficacy for PCF closure is lacking, with only 25 reported cases. The current study investigates salivary gland BoNT-A injection for PCF after TL and its effects on fistula closure rates and length of hospitalization (LOH).

Methods: IRB-approved retrospective review of patients with T3/4 laryngeal squamous cell carcinoma undergoing TL and neck dissections without prior chemotherapy or radiation at a tertiary care center. BoNT-A was injected into bilateral submandibular glands within 3 days of developing PCF. Neck incisions were also opened, and all patients received local wound care with packing changes to the wound. PCF closure rates and LOH were recorded and compared with matched historical controls.

Results: Six out of six patients (100%) achieved PCF closure without surgical management. Average time to PCF closure was 29.7 days. LOH was 12.1 days. Two-year stage-matched historical controls had PCF closure rates of 84% when managed non-surgically, with a 16.3 day LOH.

Conclusions: BoNT-A injection for patients with PCF after TL reduces LOH and improves non-surgical PCF closure rate in this small sample. BoNT-A injection may provide a low-risk tool to aid management of PCF. A prospective study is underway to further evaluate the efficacy of BoNT-A in PCF management.