Pharyngocutaneous fistula

The occurrence of pharyngocutaneous fistula after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery. The cause and management guidelines are still controversial. Contributing risk factors of impaired wound healing should be recognized in preoperative planning. Perioperative technical issues and preventive postoperative care play a major role in the prevention of fistulae, limiting the severity of the fistula and minimizing secondary complications. Surgical salvage of cancers treated with organ preservation approaches is associated with higher rates of postoperative complications, particularly in cases in which mucosal membranes are transgressed and surgically closed. Patients who require surgical repair are best treated by the use of regional myocutaneous flaps or free tissue transfers. This subset of patients is likely best treated in regional centers of excellence with well developed multidisciplinary programs for ablative and reconstructive head and neck surgery.     

Post-parotidectomy fistula

Today parotidectomy is a common, safe surgical procedure. With the increase in the number of parotidectomies being performed there have been many reviews of both the immediate and delayed operative complications. Postoperative salivary fistula, although a common occurrence, is usually glossed over or barely mentioned in most reviews. The present study reviews the parotid experience at a major teaching hospital, The Wellesley Hospital, University of Toronto, over a 10-year period. This information was used to draw general conclusions concerning the incidence, etiology and treatment of salivary fistulas as well as their prevention.     

Perilymph fistula

PLF is an enigmatic otologic disease that may be congenital or acquired through surgery, trauma, neoplasm, or infection. The exact incidence of PLF is unknown, primarily because it is difficult to diagnose. A careful, thorough history is important in recognizing PLF. If a PLF exists, repair can be effected simply and quickly and may be very beneficial to the patient. There is a small but real risk of total hearing loss with operation to repair any PLF. Currently, the most useful diagnostic tests for PLF involve the vestibular system, and further studies of vestibular responses to PLF hold promise in improving our diagnostic ability.     

Noise-induced perilymph fistula

Perilymph fistulae are difficult to diagnose because they present with a wide variety of signs and symptoms, they are associated with many etiologies, and they often mimic other conditions. In this article, we describe a case of perilymph fistula that featured one of its more rare causes: acoustic trauma--specifically, damage from a loud blast from the siren of a fire engine. We also review the literature and discuss the difficulties of diagnosis and treatment and the possible mechanisms by which acoustic trauma and other etiologies cause perilymph fistulae.     

Idiopathic perilymph fistula

This article presents 6 cases with idiopathic perilymph fistulae. The etiology of idiopathic perilymph fistula may be congenital malformation of the otic capule. Diagnosis of idiopathic perilymph fistula primarily depends on history and exploratory tympanotomy, but ENG-fistula test and positional audiometry are worth of diagnosing. During microsurgical procedure, attention must be paid to the presence of membrane of the round window niche. If a good repair of fistula is not followed by a good result, other lesions such as double labyrinth membrane rupture should be considered.     

Carotico-cavernous sinus fistula

We present a rare case of carotico-cavernous sinus fistula who presented with proptosis with gradual diminision of vision following a roadside accident. Contrast enhanced CT scan and angiography confiruned the diagnosis and it was managed by transfemoral embolisation of right ICCF.     

Traumatic perilymph fistula

Between July 1976 and August 1979, 14 patients underwent surgical repair of a traumatic tympanic membrane perforation. Of these 14 patients, 9 were found to have a profuse perilymph fistula of the round and/or oval window. The perilymph fistula involved the oval window in 2 patients, the round window in 2 patients, and both the oval and round windows in 5 patients. The paucity of suggestive symptoms was the rule, rather than the exception. The mean sensorineural component of hearing loss in the 9 patients was only 11 db, and was often so slight as to be overlooked preoperatively. Only 1 of the 9 patients had vertigo. Six of the 9 had no unsteadiness. Of the 9 patients, 6 had intermittent or no tinnitus; 6 of the 9 paaients had a history of bloody otorrhea; and at their initial examination, 6 of the 9 patients had a dry tympanic membrane perforation. The fistula test was positive in 4 of the 5 patients tested. Of the 8 patients tested, 6 had a positive tandem Romberg sign. The fistulas were repaired with a tissue graft and all had their sensorineural hearing loss return to normal. There was very little difference between the hearing, complaints of tinnitus, unsteadiness, and vertigo in patients with traumatic tympanic membrane perforations with profuse perilymph fistulas and those without fistulas. This fact, coupled with the high incidence (64%) of associated perilymph fistulas, leads the authors to suggest early repair of traumatic tympanic membrane perforations with careful examination of both the round and oval windows. Perilymph fistulas should be suspected in patients with a positive fistula test and/or a positive tandem Romberg sign.     

Traumatic perilymphatic fistula

We present the case of a patient with a traumatic perilymphatic fistula and discuss the most reliable diagnostic sign in detecting this challenging disorder.