{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:36:23Z","timestamp":1793194583987,"version":"4.5.0"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Pharyngocutaneous fistula (PCF) is the most common and clinically significant complication following total laryngectomy, often leading to delayed recovery and increased morbidity. Accurate and early detection of pharyngeal leak is critical; however, conventional imaging modalities such as contrast swallow studies and computed tomography (CT) have limitations in precise anatomical localization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included 117 patients who underwent total laryngectomy between January 2020 and December 2025. Patients were divided into two groups according to the postoperative imaging protocol: Gastrografin swallow followed by immediate CT (Gastrografin\u2013CT group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922) and conventional imaging (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200995). Leak localization was assessed using a four\u2010point ordinal scale, and surgically actionable localization was defined as a score \u2265\u20092. Clinical outcomes and impact on management were also evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The Gastrografin\u2013CT protocol demonstrated significantly improved leak localization compared with conventional imaging (mean localization score: 3.00\u2009\u00b1\u20090.00 vs. 1.62\u2009\u00b1\u20090.83,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Surgically actionable localization was achieved in all patients in the Gastrografin\u2013CT group compared with 51.2% in the conventional group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). Leaks were identified on initial imaging in 100% of patients in the Gastrografin\u2013CT group versus 82.9% in the conventional group. Although clinical outcomes, including time to oral feeding, complication rates, and hospital stay, did not significantly differ, the Gastrografin\u2013CT protocol provided more precise anatomical delineation, facilitating targeted surgical planning.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Performing CT immediately after an oral Gastrografin swallow significantly improves anatomical localization of pharyngeal leaks following total laryngectomy. By integrating leak detection and anatomical delineation in a single imaging session, this protocol enhances surgical decision\u2010making and may serve as a practical adjunct for postoperative evaluation and management of PCF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70606","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:14:52Z","timestamp":1792430092000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Oral Gastrografin Followed by Immediate\n                    <scp>CT<\/scp>\n                    for Precise Leak Localization and Surgical Planning After Total Laryngectomy"],"prefix":"10.1002","volume":"11","author":[{"given":"Seung Jo","family":"Jeong","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Asan Medical Center, University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minsu","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Asan Medical Center, University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6534-5753","authenticated-orcid":false,"given":"Yoon Se","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Asan Medical Center, University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3399-8167","authenticated-orcid":false,"given":"Young Ho","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Asan Medical Center, University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung\u2010Ho","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Asan Medical Center, University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7156-993X","authenticated-orcid":false,"given":"Seung Hoon","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Asan Medical Center, University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.01390"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199310000-00014"},{"issue":"3","key":"e_1_2_11_4_1","first-page":"314","article-title":"Pharyngocutaneous Fistula After Laryngectomy: Incidence, Predisposing Factors, and Outcome","volume":"11","author":"Saki N.","year":"2008","journal-title":"Archives of Iranian Medicine"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12443"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","DOI":"10.1177\/01455613251335526","article-title":"Risk Factors of Pharyngocutaneous Fistula Following Primary and Salvage Total Laryngectomy","volume":"25","author":"Kharrat R.","year":"2025","journal-title":"Ear, Nose, and Throat Journal"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1102\/1470-7330.2007.0015"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1597538"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(99)70224-X"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215125000143"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.351130150"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.13400"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12051851"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23804"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/019459989210600310"},{"issue":"4","key":"e_1_2_11_16_1","first-page":"S46","article-title":"Prediction of Pharyngocutaneous Fistulas After Laryngectomy","volume":"136","author":"Morton R. 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