Suction drain management of salivary fistulas

Salivary fistulas remain an unpleasant complication of upper aerodigestive tract surgery. To avoid a disastrous outcome such as carotid rupture, clinicians "medialize" (i.e., incise the skin flap in the anterior aspect of the neck and insert a Penrose drain) to divert fistula fluid from the carotid sheath and then perform laborious wound care. Meanwhile, patients endure the unpleasant odor, discomfort due to the wound dressing, occasional secondary surgical procedures, a lengthened hospital stay, and increased financial costs. In an effort to mitigate these problems, suction drains that had been placed at the time of the original surgical procedure were used as an alternative management technique. Out of a population of 118 reviewable patients who underwent standard or extended variations of supraglottic laryngectomy, partial laryngopharyngectomy, near-total laryngectomy, or total laryngectomy between 1988 and 1992, 16 patients appropriate for inclusion in this study developed postsurgical fistulas. Eight of these patients were treated with traditional medialization procedures, and the other 8 patients were treated with suction drainage. Comparison of the two groups revealed no significant difference with respect to complications or time to fistula closure. The advantages of simplified postsurgical care, less patient discomfort, reduced time demands on the clinician, and cost containment were noted for the group treated with suction drainage.