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Review

Hyperbaric Oxygen Therapy for Pharyngocutaneous Fistula Following Head and Neck Surgery: A Comprehensive Review and Our Clinical Experience

by
Francesca Cascone
1,
Antonio Minni
1,2,
Marco de Vincentiis
1,
Christian Barbato
3,* and
Federica Zoccali
1,2
1
Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy
2
Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, 02100 Rieti, Italy
3
Institute of Biochemistry and Cell Biology (IBBC-CNR), Sapienza University Rome, Policlinico Umberto I, 00161 Rome, Italy
*
Author to whom correspondence should be addressed.
Oxygen 2025, 5(2), 3; https://doi.org/10.3390/oxygen5020003
Submission received: 5 March 2025 / Revised: 24 March 2025 / Accepted: 26 March 2025 / Published: 28 March 2025
Browse Figure
Versions Notes

Abstract

:
Pharyngocutaneous fistulas (PCF) are a common postoperative complication following head and neck surgery, particularly after total laryngectomy. These types of fistulas represent a challenge for both patients and clinicians due to their persistence and resistance to conventional healing methods. Hyperbaric Oxygen Therapy (HBOT) has been proposed as an adjunctive treatment to enhance healing and closure of PCF. While many studies report positive outcomes, the results are not universally consistent. This comprehensive review aimed to examine the clinical evidence supporting the efficacy of HBOT in the management of pharyngocutaneous fistulas, focusing on fistula closure rates, infection control, and overall healing improvement. All publications without the restriction of time and published in the English language were included. Searches were performed in the PubMed, MEDLINE, Scopus, and Embase databases. Ten articles were included in this review. The evaluation of our clinical experience with this method of treating PCF showed results comparable to those found in the literature and analyzed among the studies reviewed. Several studies indicate that HBOT promotes fistula closure, reduces healing time, and enhances the local immune response, but further investigation is required to optimize protocols and patients’ selections.

1. Introduction

Pharyngocutaneous fistulas (PCF) are a major complication following head and neck cancer surgeries, particularly total laryngectomy. These fistulas are abnormal, non-physiological connections between the pharyngeal mucosa and the skin, commonly arising from surgical trauma, infection, or delayed healing. The incidence of salivary leaks in patients undergoing significant head and neck surgeries has been reported to range from 3% to 65%, showing increased risks associated with surgeries involving the larynx and pharynx [1]. Salivary leakage is a risk in any ablative procedure that disrupts the mucosal, including total laryngectomy, major oral cavity resections, and oropharyngeal and hypopharyngeal cancer surgeries. The introduction of saliva into the previously sterile neck tissues not only exposes them to microorganisms but also to enzymes that cause inflammation, necrosis, and infection. Salivary leaks may present in the immediate postoperative period (within 30 days) or, less frequently, after a longer interval [2]. Early detection and timely management of salivary leaks are critical in reducing associated morbidity. Salivary leaks are linked to longer hospital stays, increased postoperative infection rates, failure of free flaps, delays in adjuvant treatments, difficulties with oral feeding, and higher healthcare costs [3,4,5]. Risk factors for delayed wound healing and an increased risk of postoperative salivary leaks include systemic conditions [6], hypothyroidism [4], malnutrition, anemia [7,8], gastroesophageal reflux disease [9], smoking, poorly controlled diabetes, tumor site [10], prior radiotherapy or neck surgery [4,6,10], and tracheostomy [11]. Preoperative interventions, such as thyroid hormone supplementation, initiation of parenteral feeding, smoking cessation, and optimizing glycemic control through endocrinology consultation, can reduce the likelihood of salivary leaks and improve wound healing outcomes [3]. Postoperative risk factors include the type of surgery [12,13], concurrent radical neck dissection [11], presence of residual tumor [14], the suture material used for pharyngeal closure [14], and complications such as wound infection or hematoma [15]. Although a recent meta-analysis suggests that early oral feeding may increase the risk of PCF [16], early oral hydration may reduce this risk by potentially mechanically clearing infected fluids and saliva from the pharyngeal suture site [17]. Salivary leaks typically present with facial or neck swelling, erythema, and tenderness. Timely diagnosis of the fistula is crucial. While no definitive test exists, the leak’s origin can often be identified through a careful inspection of the surgical site or by performing a contrast swallow study, depending on the location of the surgery. Intraoperative and early postoperative oral testing with blue dye can also be helpful [18]. In the presence of drains, saliva may be observed in the drainage, and amylase level testing of the collected fluid can help to confirm the diagnosis in ambiguous cases [19]. Once a salivary leak is confirmed, treatment may involve conservative or surgical approaches. Conservative management remains the primary treatment for PCFs, with success rates reaching up to 65%, though these rates decrease to 30–40% in patients who have received radiation therapy [20,21,22,23]. There is ongoing debate regarding the role and timing of surgical intervention, but many studies suggest that early conservative measures, such as debridement, wound care, and packing, can be effective. Hyman et al. (2015) demonstrated that 81% of patients with fistulas occurring within 30 days post-surgery successfully managed conservatively without additional surgery [24]. This approach includes debridement, wound care, intraoral and cervical packing, broad-spectrum antibiotics, and enteral nutritional support via nasogastric tube. Additional non-surgical strategies include negative pressure wound therapy (NPWT)/vacuum-assisted closure (VAC), botulinum toxin therapy, and hyperbaric oxygen therapy (HBOT). NPWT has been shown to enhance wound healing by accelerating granulation tissue formation and closure, though maintaining an airtight seal is challenging due to the proximity of the PCF to the tracheal stoma and the complications from high salivary output [25,26]. Despite its challenges, NPWT has minimal side effects aside from pain or discomfort [27] and potential hemorrhage if vessels are not adequately protected [28]. Sometimes, botulinum toxin injections into the major salivary glands may be used to induce temporary chemo-denervation, reducing salivary secretion and promoting healing [29]. Botulinum toxin begins to reduce salivary secretion in 72 h post-injection, with a more noticeable effect after 5 to 7 days. The effects are reversible, lasting 2–4 months, with minimal systemic side effects [30,31]. Scopolamine patches and octreotide, a synthetic somatostatin equivalent, have also been proposed as adjunctive treatments, with emerging evidence suggesting they may alter the salivary proteome to promote healing [32,33,34,35,36]. HBOT has emerged as a promising adjunctive treatment for wound healing, reducing fistula closure time [37]. HBOT involves administering 100% oxygen at pressures greater than atmospheric pressure, improving tissue oxygenation, stimulating angiogenesis, reducing inflammation, and promoting tissue regeneration. When conservative measures fail, surgical intervention is typically required, especially for large fistulas, those in high-risk areas, or those associated with exposed hardware or poor healing potential. The timing of surgery remains controversial, with some advocating for up to 6 months of conservative treatment before surgery [38], while others recommend surgery after 4 to 6 weeks if conservative measures fail [5,31]. Late fistula, developed more than 30 days post-surgery, generally have lower healing rates with conservative management, often requiring early surgical intervention [4,39]. The choice of surgical technique depends on the fistula’s size, location, surrounding tissue quality, and the patient’s overall health. Surgical options include simple debridement with local tissue rearrangement and primary closure or more complex reconstructions using local, regional, or free flaps. The pectoralis major myocutaneous flap remains widely used for its ease of harvest, reliable pedicle, and proximity to the neck [8,40]. Other options, such as the sternocleidomastoid flap and supraclavicular flap, are chosen when local tissue availability is limited. Free tissue transfer is generally reserved for cases where local or regional flaps are not enough or unavailable. Free flaps, such as the radial forearm free flap and anterolateral thigh free flap, are preferred for complex defects, particularly in previously irradiated areas [30]. The choice between these flaps depends on factors such as versatility, donor-site morbidity, and the need for a reliable blood supply for microvascular anastomosis. This review critically examines the current literature on HBOT’s efficacy in managing PCF, focusing on clinical outcomes, underlying mechanisms, and future directions.

2. Materials and Methods

The Literature Search Strategy: After conducting initial background research to define the conceptual foundations of this study, a systematic literature review was performed as recommended in the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement and was guided by the associated checklist. Two independent researchers (FC and FZ) performed a review of the scientific literature using the following international databases: PubMed, MEDLINE, Embase, and Scopus. The keywords used were “hyperbaric oxygen therapy”, “pharyngocutaneous fistula”, and “head and neck surgery”. The researchers screened the databases using the keywords and a combination of them in the research string.
Study Selection: The systematic review of the literature was conducted from September to December 2024 with no time restrictions by two independent researchers (FZ and FC). Studies had to meet the following criteria to be included in the review: (a) systematic review, meta-analysis, randomized controlled trials, retrospective studies, and case reports; (b) articles in the English language; (c) studies conducted on individuals who underwent head and neck surgery; (d) HBOT used for pharyngocutaneous fistula. Exclusion criteria were as follows: (a) studies with poor surgical or clinical relevance (letter and commentaries); (b) articles that discussed HBOT applications that do not exclusively belong to the treatment of pharyngocutaneous fistula developed after head and neck surgeries. The title and abstract were examined by two authors independently (FC and FZ), and disagreements were resolved by a discussion with a third author (AM).
Data extraction: Once the articles that fit the inclusion criteria were identified, each researcher (FC, FZ, and AM) read each article in full and added it to a digital database (Microsoft Excel, Microsoft Inc., Redmond, WA, USA). The database included author names, year of publication, type of study, number of patients included, fistula closure rates, infection control, and overall improvement.

3. Results

The search algorithm and review results are outlined in Figure 1. The initial search identified 61 studies, of which 34 remained after duplicate removal. After analysis of titles and abstracts, 19 studies were excluded due to their focus on jaw surgery and osteoradionecrosis; five of the remaining 15 articles were unavailable in full-text format. A total of 10 studies were included in the systematic review.
The detailed outcomes for the use of HBOT are presented in Table 1.

4. Discussion

The use of Hyperbaric Oxygen Therapy (HBOT) in the treatment of pharyngocutaneous fistulas (PCF) has generated increasing interest over the past few decades, particularly due to its potential to enhance tissue healing in a hyperoxic environment. Although the literature suggests that HBOT can improve fistula closure rates, reduce complications, and accelerate healing times, the variability of outcomes across different studies requires further in-depth analysis. In this discussion, we will explore the key findings from the existing literature, highlighting both the benefits and limitations of HBOT and future directions for research.

4.1. Mechanisms of Action of Hyperbaric Oxygen Therapy

HBOT works through a multifaceted mechanism that impacts various cellular and molecular processes. The principal effects of HBOT are outlined below.

4.1.1. Enhanced Oxygen Delivery to Hypoxic Tissues

The primary action of HBOT is the increase in oxygen saturation in plasma and tissues, which is crucial for patients with compromised vascularization or ischemic tissue. As tissue oxygen tension rises, oxygen is better delivered to areas where capillary perfusion is inadequate, such as at the edges of a fistula or in tissue with impaired blood flow. This is particularly important in cases of PCF, where wound healing is often hindered by poor local oxygenation [41,42,43,44].

4.1.2. Angiogenesis and Collagen Synthesis

HBOT stimulates angiogenesis by promoting the release of vascular endothelial growth factor (VEGF) and fibroblast growth factors (FGFs), which are key regulators of new blood vessel formation. Enhanced angiogenesis is critical for tissue repair and closure of a fistula. In addition, HBOT has been shown to promote collagen synthesis, which strengthens the extracellular matrix and supports tissue remodeling. This is crucial for achieving durable wound closure in PCF [45,46,47].

4.1.3. Reduction in Inflammation and Infection Control

One of the key complications in the development of PCF is the risk of infection, which can delay or prevent healing. HBOT exerts potent anti-inflammatory effects by reducing the levels of pro-inflammatory cytokines such as TNF-α and IL-1β and enhancing the activity of neutrophils and macrophages. Additionally, HBOT has been shown to increase the bactericidal activity of leukocytes, helping to reduce bacterial load at the site of the fistula [48,49].

4.1.4. Fibroblast Proliferation and Epithelialization

Another critical component of wound healing is the proliferation of fibroblasts, which produce extracellular matrix proteins and are essential for repairing damaged tissues. HBOT accelerates fibroblast activity and promotes the formation of granulation tissue, thus enhancing the process of epithelialization and supporting the closure of the fistula. Several studies have shown that fibroblast migration and collagen deposition are significantly enhanced under hyperbaric conditions, further supporting its utility in fistula management [45].

4.1.5. Hypoxia-Inducible Factor (HIF) Stabilization

Hypoxia-inducible factors are transcription factors that regulate the body’s response to hypoxic conditions. Under normal circumstances, HIFs are degraded under oxygen-rich conditions; however, during hypoxia, these factors accumulate and promote adaptive responses like angiogenesis. HBOT stabilizes HIFs, leading to prolonged angiogenic signaling and more effective tissue repair. In the context of PCF, where healing is often delayed by local hypoxia, this effect is of paramount importance [50].

4.2. Clinical Benefits of HBOT for PCF

Several clinical studies have demonstrated the efficacy of HBOT in the treatment of pharyngocutaneous fistulas, suggesting that the therapy can have a positive impact on fistula closure rates and the reduction in postoperative complications. A study published in 2016 in the European Archives of Oto-Rhino-Laryngology assessed eight patients with persistent fistulas following total laryngectomy and reported a fistula closure rate of 87.5% in patients treated with HBOT [51]. These results are corroborated by the study of Neovius et al., in which the healing processes appeared to be both initiated and expedited by Hyperbaric Oxygen (HBO) therapy [46]. In the HBO group, 12 out of 15 patients experienced complete healing, 2 showed partial healing, and only 1 patient did not achieve any healing. No life-threatening complications were observed. In the control group, only 7 out of 15 patients with similar wounds and no signs of healing eventually healed without the need for surgical intervention. Additionally, two patients in this group experienced severe postoperative hemorrhage, one of which was fatal [46]. This study demonstrated that HBOT improved fistula closure rates and reduced healing times, suggesting that the therapy may be particularly advantageous in cases where the fistula is resistant to conventional healing methods. A retrospective study [52] showed that HBOT is effective in post-radiation trismus, xerostomia, discharge, foul smell, discharging sinus, etc. However, it was not found to be significant in the closure of the fistula with exposed bone.
Additionally, HBOT has shown a crucial role in improving healing rates by reducing the incidence of infections. The efficacy of HBOT in reducing bacterial load and promoting a more favorable healing environment is documented in several studies, particularly regarding infections that can delay fistula closure. The mechanism through which HBOT helps control infections is based on increased phagocytic activity of neutrophils, which, in the presence of hyperbaric oxygen, are more effective at destroying pathogens [48,49].

4.3. Clinical Evidence Supporting HBOT for PCF

While the theoretical benefits of HBOT are compelling, clinical evidence regarding its efficacy in treating PCF has been variable. Below is a summary of the major studies that have assessed the use of HBOT in the management of PCF. Several prospective studies have demonstrated favorable outcomes with the use of HBOT in PCF. A key study published in Head and Neck (1997) involved 15 patients with persistent pharyngocutaneous fistulas after laryngectomy [46].
This study found that 75% of patients receiving HBOT and adjuvant therapy had complete fistula closure after a median of 20 sessions, compared to a 45% closure rate in the control group. Furthermore, patients in the HBOT group had significantly reduced pain levels and improved functional outcomes related to swallowing and speech. A 2011 Randomized Controlled Trial evaluated the effects of HBOT on a cohort of 48 patients with post-surgical PC + Fs [25]. The trial demonstrated that the group receiving HBOT as adjuvant therapy had a statistically significant reduction in healing time in patients undergoing HBOT compared to controls. The authors also noted a significant reduction in infection rates, as well as a faster resolution of drainage and odor, which are common complications in fistula management. In addition, a 2021 meta-analysis concluded that complete fistula closure following the initiation of non-surgical treatments (including HBOT), with a mean healing time of 25.0 days, resulted in an overall success rate of 92.6% [53].

4.4. Challenges and Limitations of HBOT in PCF Treatment

Despite the promising results, there are several challenges and limitations associated with the use of HBOT in treating pharyngocutaneous fistulas. One of the major limitations of HBOT in clinical practice is the lack of consensus on optimal treatment protocols. The number of HBOT sessions, the pressure at which oxygen is administered, and the duration of each session vary widely across studies. Some studies recommend 20–40 sessions over a period of 4–6 weeks, while others use more frequent, shorter sessions. This variability makes it difficult to compare results across studies and establish a standardized treatment regimen. The cost of HBOT is another significant barrier to its widespread adoption. The therapy requires specialized equipment and trained personnel, and the expenses associated with multiple sessions can be prohibitive for many patients. Furthermore, HBOT facilities are not universally available, particularly in rural or underserved areas, limiting access to treatment for some patients.
Although HBOT is generally considered safe, there are potential side effects, including barotrauma (damage to the ears or sinuses due to changes in pressure), oxygen toxicity (which can affect the lungs and central nervous system), and claustrophobia from being in a pressurized chamber. These risks must be carefully managed, especially in patients with pre-existing lung or ear conditions. The potential for hyperbaric oxygen therapy (HBOT) to enhance tumor proliferation and contribute to tumor recurrence has been suggested in the literature. In a study by Bradfield et al. (1996) [54], it was proposed that the tumor-promoting effect of HBOT might be due to increased tissue oxygen tension and angiogenesis, which together create a microenvironment enriched with oxygen and nutrients. However, different studies examining the effects of HBOT on tumor growth observed no increase in tumor growth rate or metastasis [55,56,57]. The underlying mechanisms by which HBOT may influence tumor growth remain unclear and warrant further investigation. While many studies report positive outcomes, the results are not universally consistent. Some studies have found minimal benefits of HBOT in treating PCF, and certain patients may not respond to the therapy. This suggests that HBOT may be most effective when used in combination with other treatments rather than as a stand-alone therapy.

5. Future Directions and Research Needs

To fully establish the role of HBOT in the treatment of pharyngocutaneous fistulas, several avenues for future research need to be explored. Although large-scale, multicenter studies are promising, current evidence is largely based on small, single-center studies. Large-scale, multicenter, randomized clinical trials will be essential to validate findings and establish clear clinical guidelines for HBOT in the management of PCF. Identifying blood or salivary biomarkers that predict which patients will benefit most from HBOT could help personalize treatment and optimize outcomes. Molecular profiling of fistula tissue, including levels of hypoxia markers, inflammatory cytokines, and angiogenic factors, may offer insights into which patients are most likely to benefit from hyperbaric oxygen therapy. Future studies should also explore the combination of HBOT with other adjunctive treatments, such as growth factors, platelet-rich plasma (PRP), or advanced wound care technologies. Combining therapies may enhance the overall healing response and reduce the need for additional surgical interventions. Given the high cost of HBOT, it is essential to conduct cost-effectiveness analyses to determine whether the benefits of HBOT in treating PCF justify the cost. Such analyses will be important for healthcare providers and policymakers when considering HBOT as a treatment option.

6. Our Experience with HBOT in PCF After Head and Neck Surgeries

A retrospective analysis was conducted among patients who underwent total laryngectomy at our department between 2016 and 2023. This study was approved by the institutional review board. All the medical records of non-healing postoperative pharyngocutaneous fistula (POPCF) patients were collected. The medical records were retrospectively reviewed for the following variables: age, gender, comorbidities, tumor stage, and site. Over the years analyzed, we performed 157 total laryngectomies. Among these patients, 68 developed a pharyngocutaneous fistula as a postoperative complication. In 39 patients, daily medications have been enough to close the fistula. In the remaining 29 patients, we had to perform a surgical revision of the fistula and reconstruction using a pectoralis major flap. Of these 29 patients, 5 underwent HBOT therapy due to the persistence of the fistulous tract, with complete healing after one treatment cycle. Each HBOT session was 90 min long and included three phases: compression, oxygen breathing, and decompression. The sessions took place daily from Monday to Saturday with a break of one day (30 sessions in total). Compression and decompression were performed with room air at a measure of 0.1 kPa atmospheres absolute pressure (ATA) per minute. All patients breathed 100% oxygen under 2 ATA (203 kPa) for 90 min through a face mask during the oxygen breathing phase. Among the five patients who underwent HBOT, three were male (range 51–70 years, mean age 62 years) and two female (range 58–63 years, mean age 60 years). One patient was affected by diabetes mellitus, two by hypertension, and one by hypothyroidism [Table 2]. All the patients were affected by laryngeal squamous cell carcinoma (stage IV) treated by total laryngectomy and radical neck dissection, and none of them had previously undergone radiotherapy or chemotherapy. During the first 7–15 days after surgery, all five patients developed pharyngocutaneous fistulas. These patients were initially managed with daily debridement and medication of the fistulous tract without benefit. Therefore, after 4 weeks of conservative management, it became necessary to perform surgical revision through reconstruction using the pectoralis major flap. Unfortunately, after 7 to 15 days, they all developed pharyngocutaneous fistulas again. As they also needed to undergo adjuvant radiotherapy and chemotherapy, we decided to subject them to a cycle of HBOT. All the patients completed the planned HBOT without any complications. In conclusion, we observed a very high rate of successful POPCF closure when utilizing HBOT, although, in our center, the first-line treatment remains conservative with daily medications. In case of failure and if it is tolerated by the patient, we recommend surgical revision of the fistula. Not all centers, in fact, have the possibility to subject patients to HBOT, but when available, it could be an excellent therapeutic strategy to propose in case of non-healing POPCF.

7. Conclusions

Hyperbaric Oxygen Therapy has demonstrated significant promise in improving outcomes for patients with pharyngocutaneous fistulas, particularly in terms of enhancing healing rates, reducing infection, and decreasing the need for surgical revision. The mechanisms by which HBOT promotes wound healing, including enhanced oxygen delivery, angiogenesis, and immune modulation, make it a valuable adjunct in the management of PCF. However, there are still many unanswered questions regarding optimal treatment protocols, patient selection, and long-term efficacy. As the body of evidence grows, further research is needed to refine the indications for HBOT, optimize treatment regimens, and determine its cost-effectiveness relative to other therapies. Under prolonged investigation, HBOT may become a standard part of the multidisciplinary approach to managing post-surgical fistulas in head and neck cancer patients.

Author Contributions

Conceptualization, A.M. and M.d.V.; methodology F.C.; resources, F.Z. and F.C.; data curation, F.Z.; writing—original draft preparation, F.C.; writing—review and editing, F.C., F.Z., A.M. and C.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflicts of interest.

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Oxygen 05 00003 g001
Figure 1. The preferred reporting item for systematic reviews and meta-analysis (PRISMA) diagram followed in this review. The diagram shows the information flow through the different phases of the review and illustrates the number of records that were identified and included.
Figure 1. The preferred reporting item for systematic reviews and meta-analysis (PRISMA) diagram followed in this review. The diagram shows the information flow through the different phases of the review and illustrates the number of records that were identified and included.
Oxygen 05 00003 g001
Table 1. Overview of the success rate of patients treated for PCF using hyperbaric oxygen therapy (HBOT).
Table 1. Overview of the success rate of patients treated for PCF using hyperbaric oxygen therapy (HBOT).
Type of ArticleNumber of PatientsMean AgeType of TreatmentSuccess Rate (%)
Retrospective study862.3HBOT + local debridement87.5
Case report158HBOT + local debridement100
Retrospective study1661.1HBOT87.5
Retrospective study2757.2HBOT55.81
Randomized Controlled Trial4863.5HBOT + general therapeutic measure 100
Retrospective study8654.6HBOT + medication62.79
Systematic Review1060.75HBOT68.75
Retrospective study1568.5HBOT + adjuvant therapies 86.7
Case reports260.5HBOT + debridement + flap100
Retrospective study1662.2HBOT + medication64.3
Table 2. Patients’ characteristics.
Table 2. Patients’ characteristics.
PatientAgeGenderComorbiditiesStageSite
151MaleDiabetes MellitusT3N2bM0Supraglottic
265MaleHypertensionT4N1M0Supraglottic
370Male T3N2aM0Glottic
458FemaleHypothyroidismT3N2bM0Glottic
563FemaleHypertensionT3N2bM0Supraglottic
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Cascone, F.; Minni, A.; de Vincentiis, M.; Barbato, C.; Zoccali, F. Hyperbaric Oxygen Therapy for Pharyngocutaneous Fistula Following Head and Neck Surgery: A Comprehensive Review and Our Clinical Experience. Oxygen 2025, 5, 3. https://doi.org/10.3390/oxygen5020003

AMA Style

Cascone F, Minni A, de Vincentiis M, Barbato C, Zoccali F. Hyperbaric Oxygen Therapy for Pharyngocutaneous Fistula Following Head and Neck Surgery: A Comprehensive Review and Our Clinical Experience. Oxygen. 2025; 5(2):3. https://doi.org/10.3390/oxygen5020003

Chicago/Turabian Style

Cascone, Francesca, Antonio Minni, Marco de Vincentiis, Christian Barbato, and Federica Zoccali. 2025. "Hyperbaric Oxygen Therapy for Pharyngocutaneous Fistula Following Head and Neck Surgery: A Comprehensive Review and Our Clinical Experience" Oxygen 5, no. 2: 3. https://doi.org/10.3390/oxygen5020003

APA Style

Cascone, F., Minni, A., de Vincentiis, M., Barbato, C., & Zoccali, F. (2025). Hyperbaric Oxygen Therapy for Pharyngocutaneous Fistula Following Head and Neck Surgery: A Comprehensive Review and Our Clinical Experience. Oxygen, 5(2), 3. https://doi.org/10.3390/oxygen5020003

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