Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome

Ciuntu, Bogdan-Mihnea; Timofte, Daniel Vasile; Ludușanu, Andreea; Corlade-Andrei, Mihaela; Ciuntu, Roxana Elena; Abdulan, Irina Mihaela; Zamfir, Alexandra-Simona; Tanevski, Adelina; Maxim, Mădălina; Balan, Gheorghe; Bordianu, Anca; Cobzeanu, Bogdan

doi:10.3390/life15111660

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Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome

by

Bogdan-Mihnea Ciuntu

^1,2,

Daniel Vasile Timofte

^1,2

,

Andreea Ludușanu

^1,2,

Mihaela Corlade-Andrei

³,

Roxana Elena Ciuntu

⁴,

Irina Mihaela Abdulan

^5,*,

Alexandra-Simona Zamfir

⁶,

Adelina Tanevski

^1,2,

Mădălina Maxim

^1,2,

Gheorghe Balan

⁷,

Anca Bordianu

⁸ and

Bogdan Cobzeanu

⁹

¹

Department of General Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania

²

General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania

³

Department of Emergency Medicine, Surgery II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

⁴

Department of Ophtalmology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania

⁵

Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

⁶

Department of Medical Sciences III, Pulmonology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

⁷

Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

⁸

Department of Vascular Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania

⁹

ENT Clinic Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

^*

Author to whom correspondence should be addressed.

Life 2025, 15(11), 1660; https://doi.org/10.3390/life15111660 (registering DOI)

Submission received: 27 September 2025 / Revised: 15 October 2025 / Accepted: 20 October 2025 / Published: 23 October 2025

(This article belongs to the Section Medical Research)

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Abstract

Background: Perforation of the piriform sinus is a rare but severe clinical event that can lead to cervico-thoracic mediastinitis, a life-threatening condition requiring urgent multidisciplinary intervention. Among its etiologies, accidental ingestion of foreign bodies, including dental prostheses, is uncommon but poses significant risks due to the anatomical vulnerability of the hypopharyngeal structures. Methods: We report a rare case of right piriform sinus perforation secondary to the ingestion of a dental prosthesis, complicated by cervico-mediastinitis, sepsis, tracheostomy, and sacral pressure ulcer. The clinical course required emergency surgical intervention and intensive supportive care. Results: A novel aspect of this case was the use of the Endoscopic Vacuum-Assisted Closure (EVAC) irrigation system as an adjunctive technique in the management of deep cervical drainage. Rather than approaching the fistula from within the lumen, the team created a controlled external drainage system, adaptation of the vacuum-assisted closure therapy directly over the fistulous tract. Conclusions: This case highlights the importance of early diagnosis, high clinical suspicion and coordinated management in the treatment of piriform sinus perforations. It also illustrates the potential applicability of modern technologies such as negative pressure irrigation in the complex management of deep neck infections and mediastinitis.

Keywords: piriform sinus; perforation; mediastinitis; dental prosthesis ingestion; EVAC; deep neck infection; foreign body; sepsis; tracheostomy

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MDPI and ACS Style

Ciuntu, B.-M.; Timofte, D.V.; Ludușanu, A.; Corlade-Andrei, M.; Ciuntu, R.E.; Abdulan, I.M.; Zamfir, A.-S.; Tanevski, A.; Maxim, M.; Balan, G.; et al. Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome. Life 2025, 15, 1660. https://doi.org/10.3390/life15111660

AMA Style

Ciuntu B-M, Timofte DV, Ludușanu A, Corlade-Andrei M, Ciuntu RE, Abdulan IM, Zamfir A-S, Tanevski A, Maxim M, Balan G, et al. Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome. Life. 2025; 15(11):1660. https://doi.org/10.3390/life15111660

Chicago/Turabian Style

Ciuntu, Bogdan-Mihnea, Daniel Vasile Timofte, Andreea Ludușanu, Mihaela Corlade-Andrei, Roxana Elena Ciuntu, Irina Mihaela Abdulan, Alexandra-Simona Zamfir, Adelina Tanevski, Mădălina Maxim, Gheorghe Balan, and et al. 2025. "Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome" Life 15, no. 11: 1660. https://doi.org/10.3390/life15111660

APA Style

Ciuntu, B.-M., Timofte, D. V., Ludușanu, A., Corlade-Andrei, M., Ciuntu, R. E., Abdulan, I. M., Zamfir, A.-S., Tanevski, A., Maxim, M., Balan, G., Bordianu, A., & Cobzeanu, B. (2025). Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome. Life, 15(11), 1660. https://doi.org/10.3390/life15111660

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Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome

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