{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:44:27Z","timestamp":1787863467244,"version":"build-2784847793"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,10,12]],"date-time":"2017-10-12T00:00:00Z","timestamp":1507766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Orocutaneous and pharyngocutaneous fistula (OPCF) is a debilitating complication of head and neck surgery for squamous cell carcinoma (SCC), resulting in delayed adjuvant treatment and prolonged hospitalization. As yet, there is no established test that can help in prompt and accurate diagnosis of OPCF. This study aims to determine the accuracy of bedside blue dye testing and its role as part of an algorithm for early diagnosis. We also analyze the risk factors predisposing to OPCF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study from 2012 to 2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with head and neck SCC who underwent major resection and reconstruction, at risk of OPCF, were included. Results of blue\u2010dye and video\u2010fluoroscopic swallow\u2010studies (VFSS) testing for OPCF were recorded. For the patients that were noted to develop OPCF, the length of time to diagnosis of fistula and subsequent mode of management were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 93 patients in this study, 25 (26.9%) developed OPCF. Advanced T\u2010classification (T3\/T4) was the only significant predisposing risk factor (<jats:italic>p<\/jats:italic>\u2009=\u20090.013). The sensitivity and specificity of the bedside blue dye testing was found to be 36.4% and 100%, respectively. The test positive patients were diagnosed with OPCF at a median of postoperative day (POD) 9.5 as compared to POD 13 for the test negative patients (<jats:italic>p<\/jats:italic>\u2009=\u20090.001). Early diagnosis was associated with faster fistula resolution with treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Blue dye testing is a simple bedside test that can assist in the early diagnosis of OPCF in patients, allowing treatment to be instituted earlier with improved outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.112","type":"journal-article","created":{"date-parts":[[2017,10,12]],"date-time":"2017-10-12T07:46:40Z","timestamp":1507794400000},"page":"363-368","source":"Crossref","is-referenced-by-count":20,"title":["Salivary fistula: Blue dye testing as part of an algorithm for early diagnosis"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6999-4195","authenticated-orcid":false,"given":"Kimberley L.","family":"Kiong","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngian Chye","family":"Tan","sequence":"additional","affiliation":[{"name":"the Singhealth\/Duke\u2010NUS Head and Neck Centre  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thakshayeni","family":"Skanthakumar","sequence":"additional","affiliation":[{"name":"the Division of Surgical Oncology National Cancer Centre  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance E.H.","family":"Teo","sequence":"additional","affiliation":[{"name":"the Singhealth\/Duke\u2010NUS Head and Neck Centre  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khee Chee","family":"Soo","sequence":"additional","affiliation":[{"name":"the Division of Surgical Oncology National Cancer Centre  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiang Khoon","family":"Tan","sequence":"additional","affiliation":[{"name":"the Singhealth\/Duke\u2010NUS Head and Neck Centre  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Roche","sequence":"additional","affiliation":[{"name":"Department of Speech Therapy Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaisin","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Speech Therapy Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. Gopalakrishna","family":"Iyer","sequence":"additional","affiliation":[{"name":"the Singhealth\/Duke\u2010NUS Head and Neck Centre  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(199903)21:2<131::AID-HED6>3.0.CO;2-F"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.129.1.44"},{"key":"e_1_2_7_4_1","first-page":"136","article-title":"Pharyngocutaneous fistulae in laryngectomy patients: The Toronto Hospital experience","volume":"27","author":"Parikh SR","year":"1998","journal-title":"J Otolaryngol"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1482.16092"},{"key":"e_1_2_7_6_1","first-page":"314","article-title":"Pharyngocutaneous fistula after laryngectomy: incidence, predisposing factors, and outcome","volume":"11","author":"Saki N","year":"2008","journal-title":"Arch Iran Med"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(99)70224-X"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajot.2002.126321"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199904010-00010"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199310000-00014"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23443"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23393"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00020840-200304000-00003"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19880215)61:4<673::AID-CNCR2820610410>3.0.CO;2-C"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/019459988409200104"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59980300714-9"},{"key":"e_1_2_7_17_1","first-page":"67","article-title":"Evaluation of amylase levels in the neck drainage and serum for early diagnosis of the pharyngocutaneous fistula","volume":"19","author":"Kasapo\u011flu F","year":"2009","journal-title":"Kulak Burun Bogaz Ihtis Derg"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.11.030"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21732"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2015.04.002"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0347(200101)23:1<29::AID-HED5>3.0.CO;2-P"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.07.025"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc1521"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20974"}],"container-title":["Laryngoscope Investigative Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flio2.112","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.112","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T18:36:05Z","timestamp":1696012565000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lio2.112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,12]]},"references-count":23,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1002\/lio2.112"],"URL":"https:\/\/doi.org\/10.1002\/lio2.112","archive":["Portico"],"relation":{},"ISSN":["2378-8038","2378-8038"],"issn-type":[{"value":"2378-8038","type":"print"},{"value":"2378-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,12]]}}}