Education  |   February 2018
Images in Anesthesiology: Tracheopharyngeal Fistula from Treated Hypopharyngeal Carcinoma
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Charles D. Collard, M.D., served as Handling Editor for this article.
    Charles D. Collard, M.D., served as Handling Editor for this article.×
  • Address correspondence to Dr. A. T. Truong: atruong@mdanderson.org
Article Information
Education / Images in Anesthesiology / Airway Management / Gastrointestinal and Hepatic Systems / Respiratory System / Trauma / Burn Care
Education   |   February 2018
Images in Anesthesiology: Tracheopharyngeal Fistula from Treated Hypopharyngeal Carcinoma
Anesthesiology 2 2018, Vol.128, 386. doi:10.1097/ALN.0000000000001858
Anesthesiology 2 2018, Vol.128, 386. doi:10.1097/ALN.0000000000001858
TRACHEOPHARYNGEAL fistulas, in contrast to tracheoesophageal fistulas, are extremely rare. Only one case from trauma caused by foreign body impaction has been reported.1  In cancer patients, these fistulas result from tissue necrosis caused by pharyngeal radiation therapy, scarring from previous surgical resections, immunosuppression, chronic infection, and malnutrition.
Image A obtained during endoscopic investigation of a hypopharyngeal carcinoma shows diffuse postradiation supraglottic fibrosis, significant bilateral arytenoid edema, and a thickened U-shaped epiglottis causing narrowing of the glottic entrance. Through-and-through wall necrosis, characteristic of late radiation effects, has resulted in a large tracheopharyngeal fistula (thick arrow).
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