To the Editor.—Postoperative pharyngocutaneous fistulas are a common occurrence (up to 20%) after surgery on a radiated larynx.1 One of the reasons for the occurrence of these fistulas may be due to the tonic contraction of the upper esophageal sphincter. Studies have shown that there is a disturbance in the relaxation and coordination of the sphincter after laryngectomy.2 During the critical postoperative period, this obstruction, though temporary, obstructs and hinders the free flow of saliva and secretions down the repaired pharynx past the nasogastric tube into the esophagus. Physiologically, the exact nature of the opening of the upper esophageal sphincter is not well understood. Contributory factors are sequential contraction of the pharyngeal constrictors, upward and forward full pull of the larynx on the cricopharyngeus muscle, and neural control by the way of the vagus nerve.3,4 All these factors do not play a role in the postoperative
RAMAN R. Cricopharyngeal Myotomy With Laryngectomy. Arch Otolaryngol Head Neck Surg. 1988;114(4):465. doi:10.1001/archotol.1988.01860160109036
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