Endoscopic Vacuum-Assisted Closure for Radiation-Induced Laryngotracheoesophageal Fistula

Radionecrosis can occur in any irradiated area of the head and neck, and when it involves the laryngotracheal region, it may lead to a laryngoesophageal fistula, causing dysphagia, aspiration, and life-threatening bleeding. A 45-year-old male with renal cell carcinoma (RCC) was referred due to prolonged dysphagia, recurrent aspiration, and hemoptysis after radiation therapy for a metastatic cervical spine lesion. Laryngoscopy and CT scan revealed destruction of the posterior cricoid cartilage and the membranous trachea, with a fistula formed between the laryngotrachea and pharynx. Due to extensive necrosis, wide debridement with reconstruction was initially considered. However, as the patient was receiving palliative treatment for multiple metastatic diseases, endoluminal vacuum-assisted closure (EVAC) was applied instead. EVAC, combined with antibiotics and nutritional support, successfully closed the fistula, allowing the patient to resume a normal diet. This case demonstrates that EVAC is a feasible method for treating laryngotracheal fistula while preserving laryngeal function with minimal complications.