A clinical study was conducted on 98 patients with laryngeal cancer treated in the Department of Otolaryngology at the National Hospital Organization Kure Medical Center and Chugoku Cancer Center over the 8 years between April 1995 and March 2003. Their mean age was 66.7 years, and the male to female ratio was 8: 1. Of the 98 patients, 62 (63.3%) had glottic cancer, 35 (35.7%) supraglottic cancer, and 1 (1.0%) subglottic cancer. According to the 1997 UICC TMN classification system, 49 (50.0%) were in stage I, 22 (22.4%) stage II, 9 (9.2%) stage III, and 18 (18.4%) stage IV. Three-year and five-year survival rates were 93.1% (stage I: 100%; stage II: 100%; stage III: 77.8%; stage IV: 68.8%) and 88.1% (stage I: 95.1%; stage II: 100%; stage III: 72.9%; stage IV: 60.6%), respectively. Five-year organ preservation rates were 93.4% in T1, 92.3% in T2, 54.5% in T3, and 33.9% in T4.
After 1999, eleven patients in stage III or IV were assigned to receive concurrent chemoradiotherapy with cisplatin and 5-fluorouracil. Of these eleven patients, ten remain alive with laryngeal preservation. Concurrent chemoradiotherapy is considered to be an effective treatment for advanced laryngeal cancer.

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Gender identity disorder (GID) is a condition in which a divergence exists between a person's biological sex and psychosocial sex.
We have performed surgery to raise the speaking fundamental frequency (SFF) in male-to-female GID (MTF/GID), and in this paper we report the results.
The subjects were 32 patients with MTF/GID who had been diagnosed and undergone surgery in our institution during the period from 1999 to 2006. We performed type 4 thyroplasty on 32 patients. In some patients, we added resection (shaving) of the laryngeal prominence.
SFF rose in all 32 patients. Mean preoperative SFF was 133.8 Hz (35.6 semitones), and postoperatively the mean value was 237.8 Hz (46.5 semitones). Since the operations were performed under local anesthesia, in all cases it was possible to adjust the pitch to a SFF level that was acceptable to the patient during the operation.
The type 4 operation requires special skills, and seemed to be useful for pitch elevation surgery in MTF/GID.

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Object: The effectiveness of airway dilatation by use of a self-expandable metallic stent (SEMS) as a palliative treatment for malignant airway stenosis due to invasion of esophageal cancer was studied. Subjects: Ten cases with recurrence or re-growth after treatments for esophageal cancer, three cases with too advanced esophageal cancer and one case without treatment were included. Eleven cases suffered from dyspnea, and in two of these with severe dyspnea a tracheal intubation had been carried out before stenting. In the three cases, an airway stent was employed to prevent airway stenosis due to stenting of the esophagus. In all cases, a self-expandable nitinol stent was employed. Results: In all cases, the SEMS placement was successful. Dyspnea was improved in all eleven cases. Complication occurred in three cases (chest pain: 1, ingrowth: 1, dislocation: 1), but good quality of life was maintained by additional medication and other treatment. Median survival time after the stenting was 76 ± 100 days. Five cases died within one month after the stenting, two from tumor bleeding, two from lymphangitis carcinomatosa and one from cachexie. In these cases, the effect on life extension was scant, but in four cases with severe trachea stenosis the airway stenting saved life without tracheal intubation even for a time. Thirteen patients (93%) were able to ingest meals, because their performance status became better by improvement of dyspnea. Twelve cases could continue to ingest until the cancer considerably weakened them. Five cases (36%) could leave the hospital temporarily. Conclusion: The placement of a self-expandable metallic airway stent for malignant severe airway stenosis due to esophageal cancer can achieve anticipated effects with minimum burden, so this is excellent as a palliative treatment for the end stage of esophageal cancer. There were some cases who could not get sufficient benefit, however, and therefore we must decide the indication carefully, and take informed consent from the patient and the family.

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Objectives: The purposes were to evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCR) in patients with resectable squamous cell carcinoma (SCC) of the hypopharynx and to assess the feasibility of larynx preservation.
Patients and Methods: Forty-three eligible patients were treated with two chemotherapy regimens between October 1998 and July 2004. One of the chemotherapy regimens consisted of a combination of four drugs: cisplatin, 5-fluorouracil, methotrexate and leucovorin (CF-MTX-LV). The other regimen consisted of two drugs (carboplatin and UFT: CBDCA-UFT) for elderly cases or cases with complications. Radiotherapy was delivered 5 days a week using a single daily fraction of 1.8 to 2.0 Gray, to a total dose of 70 Gray.
Results: The 5-year disease-specific survival and the 5-year disease-specific survival with larynx preservation of cases receiving CF-MTX-LV were 73.3% and 56.4%, respectively. The 3-year disease-specific survival and the 3-year disease-specific survival with larynx preservation of cases receiving CBDCA-UFT were 30.5% and 15.2%, respectively. The main toxicities in these CCR modalities were neutropenia, dermatitis, mucositis, infection and nausea/vomiting.
Conclusion: It was thought that the adverse events appeared strongly in the CF-MTX-LV treatment group, and the intensive care was necessary for management. In terms of larynx preservation, the present regimens appeared to be useful for selective patients with resectable SCC of the hypopharynx.

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In rare case, posterior glottic adhesion may cause vocal cord pseudoparalysis. We reported a 63-year-old female who developed posterior glottic adhesion with a granulomatous mass in the subglottal space secondary to endotracheal intubation. We performed laryngofissure and surgical resection with CO₂ laser, followed by T-tube insertion for two weeks. After removal of the T-tube, vocal cord movements recovered.

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A 19-year-old female presented with postoperative subglottic stenosis after traumatic disruption of the laryngotracheal junction. Several attempts, including ballooning, laser coagulation, and stent insertion, were performed without success. Ten months after the first operation, primary laryngotracheal anastomosis with laryngofissure was performed. A T-tube was placed for modeling the rigidity of the larynx for 5 months. After removal of the T-tube, the patient was able to respire and vocalize through the mouth with the tracheal stoma RETAINER closed. Surgical intervention is feasible even after postoperative complex subglottic stenosis.

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The videoendoscope has a small charge-coupled device (CCD) chip built into its tip that provides a clear image. This report concerns office-based esophageal foreign body extraction using a transnasal videoendoscope.
Two types of videoendoscopes (with and without a working channel for irrigation, air insufflation and forceps) were used. The diameters of the videoendoscope tips were 4.1 mm and 5.3 mm.
The advantages of this intervention were 1) Videoendoscopes presented clear dynamic color images on a color video monitor and provided excellent resolution and recording, and thus yielded high diagnostic accuracy and fine intervention. 2) The videoendoscope diameter was relatively small and resulted in less discomfort to the patient. 3) Patients could be treated in a supine position on a procedure chair at the otolaryngology outpatient clinic, which obviated sedation or general anesthesia. 4) Pernasal endoscopy allowed the doctor to treat patients who had a strong gag reflex. 5) Good image documentation on the color video monitor allowed the physician to carry out safe intervention. A disadvantage of this procedure was that the extraction of different kinds of foreign bodies was limited, but this depended in part on the efficacy of the forceps.
Esophageal foreign body extraction using a transnasal videoendoscope is a reliable procedure that has widened the indications for office-based endoscopy.

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We report on a patient who underwent a tracheostomy made difficult due to severe cervical deformity. The patient is a 73-year-old male who has had progressive kyphosis of the cervical spine since 12 years ago. Deformity of the neck was so severe that the mandible almost touched the sternum. When he fell from down a staircase, bilateral paralysis of the lower extremities appeared, and he was admitted to the ICU of our hospital. Soon after, he was intubated and connected to a respirator because of weakened spontaneous respiration. Prolonged intubation necessitated a tracheostomy, and we were requested to operate. Because of the severe deformity of the neck, we performed the tracheostomy by lateral cervical approach under general anesthesia. We discuss and evaluate various approaches to a tracheostomy in difficult cases such as this one.

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