After total laryngectomy, which complication would be least of concern?

• A. Aspiration of the bolus
• B. Stricture of the UES
• C. Abnormal tissue pockets in the pharynx
• D. Development of a fistula

Answer: (A)

After total laryngectomy the airway and the esophagus are separated, so swallowing no longer poses a direct risk of material entering the lungs. This makes aspiration of the bolus largely unlikely and thus the least concern among the listed possibilities. However, other issues can still arise: scarring at the upper esophageal sphincter can narrow that junction (a stricture), causing difficulty with the passage of the bolus; abnormal tissue pockets in the pharynx can form and trap material, leading to residue and clearance problems; and a pharyngocutaneous fistula can develop, creating an abnormal link between the pharynx and the skin and posing infection and healing challenges.