We read with interest the case reported by Gooi et al. describing long term oral intake through a salivary bypass tube (SBT) with a chronic pharyngocutaneous fistula (PCF).We agree that PCF is a significant complication of salvage laryngectomy that has become more problematic with the increased use of organ preserving chemoradiotherapy [1]. The authors use of the SBT for the early management of their patient is entirely appropriate. This clearly corrected the patient's nutritional status and consequently his general physiological status. However, we consider the use of a SBT for long term management is inappropriate in other than a most exceptional case which this does not appear to be. Our main concern with the proposed management as a long term solution is that the PCF is allowed to persist and as such the inherent problems and risks associated with PCFs remain. Apart from the morbidity and burden of such a wound on the patient and family, there is a mortality risk from major neck vessel erosion and haemorrhage.
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