ISSN 1115-2613 NIGERIAN JOURNAL of MEDICINE www.nigerianjournalofmedicine.com IN THIS ISSUE AWARENESS AND ACCEPTABILITY OF ROTAVIRUS VACCINE AMONG MOTHERS OF UNDER-FIVE CHILDREN ATTENDING CHILDREN OUT PATIENT CLINIC OF EKITI STATE UNIVERSITY TEACHING HOSPITAL. A FIVE-YEAR REVIEW OF NEPHRECTOMIES AT THE LAGOS STATE UNIVERSITY TEACHING HOSPITAL (LASUTH) IKEJA LAGOS. PROTEINURIA AND HAEMATURIA IN APPARENTLY HEALTHY PRIMARY SCHOOL CHILDREN IN ENUGU, NIGERIA. EFFECTIVENESS OF KINESIO TAPING AND COMBINED CHAIN EXERCISES IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS: A CASE SERIES GIANT SCROTAL LEIOMYOMA: REPORT OF A RARE CASE AND REVIEW OF LITERATURE. Currently listed in SCOPUS, Scimago, EBSCO and AJOL AN INTERNATIONAL PEER REVIEWED MEDICAL JOURNAL VOL. 29 NO. 1 PUBLISHED BY NIGERIAN ASSOCIATION OF RESIDENT DOCTORS JANUARY - MARCH 2020 UNIVERSITY OF IBADAN LIBRARY NIGERIAN JOURNAL OF MEDICINE MEDICAL VOL. 28 NO. 4 OCTOBER - DECEMBER 2019 ISSBN 1115-2613 Content The Nigerian Journal of Medicine Board and NARD National Officers Committee………………............……………...........I Editorial Notices………………………………………………………………………………………………………………………………..........…......…..ii Writing for the Nigerian Journal of Medicine………………………………………………………………………………………................…iii Original Articles Awareness and Acceptability of Rotavirus Vaccine among Mothers of Under-Five Children Attending Children out Patient Clinic of Ekiti State University Teaching Hospital Babatola A.O, Ojo T.O, Ogundare E.O, Ajite A.B, Oluwayemi I.O, Wuraola I., Fadare J.O, Olatunya O. S 1 A Five-year Review of Nephrectomies at the Lagos State University Teaching Hospital (LASUTH) Ikeja Lagos. Olufunmilade A. Omisanjo, Olufemi O. Ojewuyi, Omolara M. Williams, Abimbola A. Abolarinwa, Olufemi O. Akinola, Adekunle A Adebayo, Stephen O. Ikuerowo, Dr Fatai A Balogun. 7 Assessment of Knowledge and Materials Availability in the Implementation of Integrated Diseases Surveillance And Responses In Public Facilities In South-south Nigeria. Emmanuel Friday Osagiede, Essy Clementina Isah, Ebenezer Adeiza Ozomata, Ferguson Ayemere Ehimen, Johnbull jumbo, Veronica Emoghare Dinyain, Ese Tracy Osagiede. 11 Paediatric Nasal Foreign Body in Calabar: A Review of 5 -years Experience Francis P.M, Adekanye A.G, Mgbe R.B, Offiong M.E, Enyuma C.O.A 20 Hepatitis B Virus Infection: Knowledge of Antenatal Attendees in A Tertiary Hospital Odelola O.I, Akadri A.A, Shorunmu T. O 24 Dietary Habits and Physical Exercise among Undergraduate Students In Southeast Nigeria. Okeke Chinyere C, Agwu-Umahi Olanike R, Umeobieri Ancilla K., Azodo Chisom , Idoko Arthur C., Uzochukwu Benjamin S.C. 29 Proteinuria and Haematuria in Apparently Healthy Primary School Children in Enugu, Nigeria. Chime Paschal U, Muoneke Uzoamaka V, Una Alfred F, Mbanefo Ngozi R, Bisi-Onyemaechi Adaobi .I, Igbokwe Obianuju O. 38 Effectiveness of Kinesio Taping and Combined Chain Exercises in Individuals with Knee Osteoarthritis: A Case Series Musa Sani Danazumi, Bashir Bello, Shehu Usman Ibrahim, Abdulsalam Mohammed Yakasai. 43 Prevalence and Clinical Characteristics of Nigerian Patients with Early-Onset Type 2 Diabetes Balogun, W.O; Onasanya, A.S, Azeez, T.A 49 Comparison of Maternal and Fetal Outcomes of Elective and Emergency Caesarean Deliveries. Bello O.O, Akinajo O.R. 55 Hepatitis B and C: An Assessment of Risk Exposure and Prevalence among Preclinical Medical Students in Northwestern Nigeria. Musa Abubakar Kana, Nanben Victoria Omole, Awawu Grace Nmadu, Istifanus A. Joshua, Zainab Kwaru Muhammad-Idris 62 Pharyngo-Cutaneous Fistula Post Total-laryngectomy: A Local Experience Ogunkeyede S. A, Adeyemo A. A, Daniel A., Yaro P.J., Ogundoyin O.A 69 Assessing Change in Knowledge and Attitudes of Student Nurses in Calabar Towards Mental Disorders Following an Educational Program Okafor C.J, Ndubuisi A.U., Audu A.A, Edet B.E, Abasiubong F. 73 Determinants of Antiretroviral Therapy Adherence among Hiv-infected Adolescents Attending a Tertiary Health Facility in Abuja, Nigeria. EkopEno E., OkechukwuAdaora A., Airede Kareem I. 80 A Descriptive Analysis of Optical Services in a Tertiary Hospital in South-south Nigeria. Etim Bassey A., Oraegbunam Nnenna H., Ajewole Jeff., Abatai Mercy O 88 Comparison of Changes in Serum Prostate Specific Antigen in Prostate Cancer Patients Treated Either with Flutamide or Stilboestrol Monotherapy. Otobo O.F, Ekwere, P.D,, Nkposong E.O., Omoruyi K, Ugbem T, Eyam, E.E 94 Over Diagnosis of Typhoid and Malaria Co-infection by Health Care Workers In North Central Nigeria: A Cross-sectional Study. Shehu N.Y, Bimba J, Nantok D, Kelly I, Obrerhor O, Gomerep S.S.I, Onyedibe K.I. 100 Preferred Age of Marriage and Fertility Intention of University Students in Kano, Northern Nigeria. Taiwo G. Amole, Ibrahim A. Mus, Mustapha A. Yusuf, Adewale O. Ashimi, Zubairu Iliyasu 104 Early Versus Delayed Foley Catheter Removal After Transurethral Resection of the Prostate Akpayak I.C, Shuaibu S.I., Onowa V.E., Agbo C.A. 111 i Nigerian Journal of Medicine, Vol. 29 No. 1 January - March 2020 ISSBN 1115-2613 UNIVERSITY OF IBADAN LIBRARY NIGERIAN JOURNAL OF MEDICINE MEDICAL Accuracy Evaluation and Comparison of Three Blood Glucose Meters in Anemergency Paediatric Unit of a Tertiary Hospital in Nigeria. Akeredolu Festus Dele, Jarrett Olumide Olatokunbo, Idris HafsatuWasagu, Oyenusi Elizabeth Eberechi 115 Cultural Practices and the Use of Icterogenic Agents in Glucose 6 Phosphate Dehydrogenase Deficient Neonates: Any Effect? Jatau, E.D, Zakari A., Damulak O. D, Toma, B.O., Egesie, O. J , Akor E. A . 120 The Role of the Employer in Workplace Violence: The Health Care Workers' Perspective. Ndu A.C, Agwu-Umahi O. R, Kassy W.C, Arinze-Onyia S.U, Okwor T.J, Ogugua I.J ,Onyedinma C.A, Aguwa E.N, Okeke T. A. 125 Factors Associated with Compliance to Chemotherapy Amongst Cancer Patients in a Radiotherapy Facility Shehu S. Umar, Salihu Muhammad, Albert M. Alfred, Ehiosa C. Okuofo, Charles Okwonna, Ismail H. Zubair, Tessy O. Ahmadu. 132 Paediatric Otorhinolaryngology, Head and Neck Emergencies at a Tertiary Health Care Centre in Nigeria. Adegbiji W.A, Olatunya O.S, OlajuyinO.A, Babatola A.O, Komolafe A.K. 137 Antenatal Blood Donation: Perception of Pregnant Women in a Rural Community Northwest Nigeria. Ashimi Adewale O., Amole Taiwo G., Halima Umar Ibrahim, Usman Hauwa 142 Management Outcome of Ruptured Ectopic Pregnancy at a Secondary Level of Health Care Delivery in South-West, Nigeria. Dr. Mathew Adeyemo , A.O. Arowojolu, Dr. Ian Damole, Dr. Mary Ajayi, Dr. Abiola Shittu, Dr. Michael Gbala 147 Stage-Specific Five-Year Survival Outcomes in Women Treated For Early Stage Breast Cancer in Ibadan, Nigeria Omobolaji O. Ayandipo , Oludolapo O. Afuwape, Olalekan J. Adepoju, Jomiloju A. Ajiboye , Temidayo O Ogundiran 152 Review Article Mortality Pattern Among Tuberculosis Patients on Treatment in Nigeria: A Systematic Review and Meta-Analysis Musa B. M, Bashir H.A, Uloko A.E, Garbati M.A, Bakki B, Gumi H.S, Yusuf A, Bello Manga H 158 Case Report Giant Scrotal Leiomyoma: Report of a Rare Case And Review of Literature. Usman Mohammed Tela, Abba Bukar Zarami, Hamidu Umar Pindiga, Abdulkadir Abubakar 163 Cystic Hygroma: Anaesthetic Considerations in Emergency Excision I.M. Chukwu,, J. Ojebo,, F. O. Omosofe, N.P. Edomwonyi 166 Crohn's Disease with Pyoderma Gangrenosum in a Patient in Northern Nigeria: A Case Report. Manko M, Mohammed M. F, Bello A.K, Egbegbedia P, Sambo S.A, Osanyibofu E, Umar A., Shehu A, Suleiman D. E, Mustapha S. K 169 Lipoma of the Transverse Colon: Review of Literature and a Case Report in a Young Nigerian Female Muktar Muhammad Umar, Ahmed Hamza, OlokoNasirudeen, Adogu Adoge Ibrahim 172 Prostate Adenocarcinoma with Unilateral Testicular Metastasis: Two Cases with Different Presentations Musliu Adetola Tolani, Muhammed Ahmed, Ahmad Bello, Balarabe Kabir, Lovely Fidelis, Hussaini Yusuf Maitama 175 Commentary Quality of Reproductive Health Care in Nigeria: A Critical Appraisal. Awowole IO, Badejoko OO, Bola-Oyebamiji SB, Onwudiegwu U 178 Corrigendum Benign Breast Disease Pattern And Prevalence In Calabar: A 5 Year Histopathologic Review 182 Comparative Analyses Of Three Radiographic Dental Age Estimation Methods Amongst Nigerians 183 Medical Law: Exploring Doctors' Knowledge on the Laws Regulating Clinical and Medical Laboratories in Nigeria. 184 i Nigerian Journal of Medicine, Vol. 29 No. 1 January - March 2020 ISSBN 1115-2613 UNIVERSITY OF IBADAN LIBRARY Original Article PHARYNGO-CUTANEOUS FISTULA POST TOTAL-LARYNGECTOMY: A LOCAL EXPERIENCE Ogunkeyede S. A1 Adeyemo A. A2 Daniel A.1 Yaro P.J.4 Ogundoyin O.A3 1Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan and University College Hospital, Ibadan, Nigeria. 2Institute of Child Health, College of Medicine, University of Ibadan,Ibadan and University College Hospital, Ibadan, Nigeria. 34Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria. 4Department of Otorhinolaryngology, Jos University Teaching Hospital, Jos, Nigeria. ABSTRACT Background: Pharyngo-cutaneous fistula is a major complication of total laryngectomy. Despite its significant impact on thepatients' nutrition and management outcome, there is lack of consensus forrecognising high-risk patients andfactors associated with fistula formation.Hence, this study was aimed at determining the incidence ofpharyngo-cutaneous fistula and factors associated with fistula formation. Methods: A retrospective collection of data on all cases of laryngeal cancer diagnosed histologically and had total laryngectomy, in the Otorhinolaryngology Department of a tertiary centre in Southwestern, Nigeria, from 2007 – 2016. The data collected includeage, gender, tumour stage, tracheostomy, adjuvant therapyextent of laryngectomy procedure and factors for pharyngocutaneous fistula. Results:Forty-two patients had total laryngectomy, male to female ratio was 7.4:1 andmean age was 52.3 ± 2.1 years. All patients had pathological diagnosis of stage 3 (83.3%) and stage 4 (16.7%) laryngeal cancer, respectively. The incidence of pharyngo-cutaneous fistula was11.9% and the factors related to fistula formation were prior radiotherapy treatment and diabetes. Age, gender, neck dissection procedures, site of primary tumor and emergency tracheostomy did not contribute to fistula formation. Spontaneous fistula closure was achieved in all cases except one patient who had surgical closure. Conclusion:Pharyngo-cutaneous fistula formation post-surgery is related to the presence of co-morbidities. The high percentage of spontaneous closure underscores the need for a conservative management approach. Keywords: Laryngeal Cancer, Laryngectomy, Neck dissection, Pharyngo-cutaneous fistula, Post-surgery, Radiotherapy. NigerJmed 2020: 69-72 © 2020. Nigerian Journal of Medicine morbidity and mortality of the patient.3 INTRODUCTION The incidence of pharyngo-cutaneous fistula after total laryngectomy ranges from 3% to 65%, with an average time of appearance of 10 days after surgery.3,4Identified factors Post laryngectomy pharyngo-cutaneous fistula is an contributing to the wide disparity in the prevalence of abnormal connection between the skin and pharyngo-cutaneous fistula include the use of radiation in pharyngeal mucosa, with leakage of oral feeds and organ preservation.4, 5Radiation therapy reduces blood saliva due to dehiscence of the pharyngeal repair.1 it is supply and causes tissue fibrosis; in addition, it impairs associated with surrounding tissue necrosis. The fistulas leukocytesmigration and hinders wound healing. can also occur higher in the neck, at the level of the junction Deficiencies of vitamins and micronutrients in patients between the pharyngeal mucosa and the base of the with head and neck cancers could also be responsible for tongue. The leakage of saliva into the surrounding tissue the development of pharyngocutaneous fistula due to poor results in infection and micro-venous thrombosis with wound healing.6The variation in the fistulae rate seen in tissue necrosis, partly due to impaired wound healing as a different studies may be due to the differencesin the result of micro-angiopathy, and poor immune tumour stage and extent of pharyngeal resection at response.2Pharyngo-cutaneous fistula could be a surgery.7Despitethe description of a large number of debilitating condition that may significantly increase the factors associated with the development of pharyngo- cutaneous fistula no set of factors is consistently significant.8,9 Correspondence to: Diagnosis of pharyngo-cutaneous fistula is exclusively Dr. Ogunkeyede S.A Department of Otorhinolaryngology, clinical, though the occurrence of fever in the first College of Medicine, University of Ibadan, postoperative day is significant predictor for pharyngo- Ibadan and University College Hospital, cutaneous fistula development.10 Pharyngo-cutaneous Ibadan, Nigeria. P.M.B 5118, fistula can be diagnosed by dye test (methylene-blue) or by Tel: +2348033723634 observing a salivary leak in the neck.Other clinical E-mail: segunkeyede@yahoo.com 69 Nigerian Journal of Medicine, Vol. 29 No. 1 January - March 2020 ISSBN 1115-2613 UNIVERSITY OF IBADAN LIBRARY methods of early diagnosis includes - skin flap oedema, pharyngocutaneous fistula. The interval between neck erythema3, sinus tract on barium swallow tracheostomy and total laryngectomy varied between 20 study5,fever (101.5° F) in the first 48 hours post days and 8 months. Medical-comorbid conditions like operatively 1 0 and an elevated wound amylase hypertension 5 (11.9%), diabetes mellitus 3(7.1%), chronic concentration.11 obstructive pulmonary disease 1(2.3%) occurred in the Pharyngo-cutaneous fistula is associated with increased patients. The primary tumor was supra-glottic in 5 patients morbidity, prolonged hospital admission, increased health (11.9%), glottic in 19 (45.2%), trans-glottic in 16 (38.1%), and care costs, delay of oral feeding, delay in initiating pharyngo-laryngeal in 2 (4.8%). The disease was stage 3 in radiotherapy and voice rehabilitation with subsequent 35(83.3%) and stage 4 in 7(16.7%), as shown in table 1. hindrance of the adjunct postoperative care.12,13The impact Thirty-nine (92.9%) patients had total laryngectomy as the of pharyngo-cutaneous fistula underscores the importance primary treatment for the laryngeal cancer, while 3(7.1%) of identifying factors associated with pharyngo-cutaneous patients had received radiotherapy prior to total fistula formation. Moreover, complicated pharyngo- laryngectomy. cutaneous fistula has significant impact on the patients' The surgeries were performed by 5different surgeons quality of life, and could escalate to pharyngeal stenosis, with similar experience, and their operative techniques dysphagia, carotid artery rupture, sepsis, mediastinitis, were consistent. The pharyngoesophageal repair was in 2 pneumonia and even death. Conservative management of layers. The first layer was closed continuouslywith Vicryl small fistula results in spontaneous closure without suture and the second layer was closed interruptedly with sequelae; however, there is significant reduction in vicryl suture. The patients were fed via nasogastric tube pharyngeal dimensions in large fistula which may feeding 24 to 48 hours post-surgery, while oral feeding was necessitate a reconstruction surgery with local or free flaps. initiated on post-surgery day 5 to 10 after a negative dye We conducted an audit of total laryngectomy procedures test. in our hospital to determine the factors associated with The integrity of the pharyngeal repairs was tested using a pharyngo-cutaneous fistula formation in other to improve dye test (methylene blue) at the time of surgery in the care of patients with laryngeal carcinoma.Patients and 13(31.0%) patients, and in case of dye leak the affected Methods: This is a retrospective study using the hospital mucosal area were re-apposed to prevent a leak, this records of patients with laryngeal carcinoma and who had method was used by one of the surgeons to prevent total laryngectomy between January 2007 and December pharyngocutaneous fistula. 2016, in the Department of Otorhinolaryngology, Chemo-radiation therapy was received by 3out of 42 University College Hospital, Ibadan. Hospital admission patients, in a period ranging from 8 months to 3 years records, case notes and operative theatre records were before total laryngectomy, among which 1 developed retrieved.Data extracted were demographic indices, pharyngocutaneous fistula. The other patients with smoking and alcohol consumption, medical history, pharyngo-cutaneous fistula had pharyngeal extension of tumour stage, laboratory investigations, details of surgical the laryngeal cancer and diabetes, respectively. procedure and post-operative care. A pharyngo-cutaneous The fistulas were managed conservatively in 4(9.5%) fistula was defined as wound dehiscence resulting in a patients, and 1(2.4%) patient had surgical closure by using fistula, and it was diagnosed clinically in this study using pectoralis major myocutaneous flap.There was no methylene-blue dye test or by observation of a salivary association between pharyngo-cutaneous fistula and age leak in the neck. The laryngeal cancer staging was done (p = 0.23) or gender (p = 0.24), pre-laryngectomy using the International Union Against Cancer (UICC) tracheostomy (p = 0.29), the surgeons that perform the TNM classification system. 1 4 The participant's surgery (p = 0.19)and time of post-operative feeding (p = socioeconomic status was assessed by their occupation, 0.24),but it was associated with low socioeconomic status while the last job was used to assess the economic status of (p = 0. 02). As shown in table 2. those that had retired.15Statistical analysis was performed using IBM- SPSS 20, continuous variables were analyzed DISCUSSION with t-test and categorical variables were analyzed with The male predominance in this study was similar to earlier Fisher's exact test, with level of significance set at p =0.05 t reports that laryngeal tumour is prevalent among 16,17 95% confidence interval. men. All the patients had histological diagnosis of RESULTS: Forty-two patients had total laryngectomy squamous cell carcinoma, buttressing reports of high during the study period, the male to female ratio was 7.4:1 prevalence of squamous cell carcinoma of the larynx in (Table 1). The patients' age ranged from 36 years to 77 sub-Saharan Africa. 17 The mean age of the patients in this years, mean age was 56.9 ± 11.8 years. The incidence of study is similar to the reported mean age of patients with 18 pharyngo-cutaneous fistula in this study was 11.9%. laryngeal tumour in Nigeria. Fistula development occurred between day 6 and day 10 The incidence of pharyngo-cutaneous fistula (11.9%) in post-surgery(mean:6.8day± 1.7). this study falls within the range of 5.2% to 14% reported in previous studies3,17,19,20All the patients had histological diagnosis of squamous cell ,but lower than 65% reported by 21 carcinoma laryngeal tumor and had similar preoperative/ Bresson et al. The wide variation in the prevalence of and postoperative care. The duration of laryngeal pharyngo-cutaneous fistula may be due to prior symptoms prior to hospital presentation ranged from radiotherapy with aim of organ preservation seen in 3months to 3 years. (Median: 6months). patient populations who presents early to the hospital but Twenty-six (61.9%) patients had emergency tracheostomy who subsequently had failed treatment and thus required 3,22 prior to total laryngectomy, of which 2(7.7%)had surgery. Virtaniemi et al. reported low incidence of pharyngo-cutaneous fistula in patients who had 70 Nigerian Journal of Medicine, Vol. 29 No. 1 January - March 2020 ISSBN 1115-2613 UNIVERSITY OF IBADAN LIBRARY laryngectomy without prior adjunct radiotherapy.3 factor, the extent of surgery and malnutrition, no factor Advanced tumour stages seen in this study were due to significantly influenced the occurrence of postoperative delay in hospital presentation, and are similar to previous fistulae in this study except patients with low reports from sub-Saharan Africa.16,18However, there was no socioeconomic status who had higher incidence of fistula association between the advanced disease and occurrence formation. This is similar to other studies whereby there of pharyngo-cutaneous fistula in this study, corroborating was lack of significant association between pharyngo- observations that rate of fistula formation does not increase c u t a n e o u s f i s t u l a f o r m a t i o n a n d d e f i n e d 1 9 , 3 1 with advancing tumor stage.3,23The prevalence of pre- factors. Theassociation of f istula with low laryngectomy tracheostomywas high in this study, this socioeconomic factor may be due to poor hygiene and was probably related to late hospital presentation,similar malnutrition, but this is beyond the scope of this study. to other local report from sub Saharan Africa.16,17,24 Though Conclusion: our records showed thatpharyngo-cutaneous pre-laryngectomy tracheostomy was associated with fistula formation does not significantly associated with pharyngo-cutaneous fistulae in some studies, probably tumour staging or extent of surgery, however prior due to tumour seedling in advanced lesions.7 However, radiotherapy treatment, diabetes and low socioeconomic our experience was similar to other authors who did not status predisposes to fistula formation. Our experience observe an association between occurrence of established that most fistulascan be successfully managed tracheostomy and the duration of tracheostomy before with conservative care. total laryngectomy with the development pharyngo- Table1:Demographicandclinicalfeaturesofthepatientsthathadtotallaryngectomy cutaneous fistula.3 There were no significant differences between the Factors Pharyngo-cutaneous fistula No Yes surgeon's ability (evaluated on the basis of postgraduate n = (88.1%) n = 5 (11.9%) training experience and surgical technique of determining the integrity of pharyngeal repair using dye test) and Age Mean age (years) 51.2±1.2 58.1±3.0 occurrence of pharyngo-cutaneous fistula in this study Sex Male 32(76.1%) 5(11.9%) thoughsurgical experience is an important determinant Female 5 (11.9%) 0(0%) Socioeconomic status Low 29(69%) 4(9.5%) factor in fistula formation.25 The pharyngeal repair in this Middle 6(14.2%) 1(2.3%) study was a vertical line repair; this type of repair is High 2(4.6%) 0(0%) Histology Poorly differentiated 4(9.5%) 2(4.6%) associatedwith low pharyngo-cutaneous fistula Moderately differentiated 1(2.3%) 0(0%) formation26 andmay contribute to the low fistula incidence squamous carcinoma in this study. Conversely the “T" or "Y"-shaped pharyngeal Well differentiated 32(76.2%) 3(9.5%) squamous carcinoma closure is potentially weak at the three-point junction, and Radiotherapy prior to laryngectomy No 35(3.3%) 4(9.5%) this is associated with fistula formation.27,28 Suture Yes 2(4.6%) 1(2.3%) materials used in pharyngeal repair contributes to the wound healing process and could potentially influence pharyngo-cutaneous fistula formation. Vicryl suture used Concurrent neck dissection Nil 22(52.3%) 4(9.5%) Functional 1(2.3%) 0(0%) in the surgical procedures in this study is strong, Modified 19(45.3%) 1(2.3%) stimulates less inflammatory response, and has a long half- life, these properties will likely reduce the incidence of Site of tumour Supraglottic 5(11.9%) 0(0%) Glottis 18(42.7%) 1(2.3%) pharyngo-cutaneous fistula.29,30The extent of surgery Subglottic 0(0%) 0(0%) (standard laryngectomy ± neck dissection) did not have Transglottic 12(28.5%) 4(9.5%) Pharyngo-larynx 2(4.6%) 0(0%) any relationship with pharyngocutaneous formation, Diabetes Yes 3(7.1%) 1(2.3%) though combining neck dissection with total laryngectomy No 34(81.0%) 4(9.5%) has been associated with development of pharyngo- Tumour staging T3 35(83.3%) 4(9.5%) cutaneous fistula.7Advanced laryngeal tumour may lead to T4 7(16.7%) 1(2.3%) extensive resection of the pharyngeal mucosa, this may Type of laryngectomy Standard 36(85.7%) 4(9.5%) Extended 1(2.3%) 1(2.3%) lead to pharyngeal closure under tension, and subsequent wound break down with fistula formation.3,31,32 Antibiotic Table2:Factors responsible for pharyngo cutaneous fistula formation prophylaxis against anaerobes and gastroesophageal Factors p- value(s) reflux prophylaxis postoperatively are associated with Age 0.23 reduced incidence of fistula formation.3,33,34This regimen is Gender 0.24 Low Socioeconomic Status 0.02 standard practice in our hospital and may have Tumour staging 0.98 contributed to the low pharyngo-cutaneous fistulas Diabetes 0.40 Pre-laryngectomy tracheostomy 0.29 incidence seen.The presence of concomitant medical Time of post-operativecommencement of feeding 0.24 diseases such as diabetes, radiationtherapy of= 30Gray's Surgeon’s expertise 0.19 and above, prior to laryngectomy or an interval less than 3months between radiation and subsequent laryngectomy REFERENCES is associated with fistula formation.2,3 Although, pharyngo- 1 Makitie AA, Irish J, Gullane PJ. 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