Vocal fold polyp is general though to required surgical removal. However, a certain proportion of polyps resolve with conservative treatment. We performed a clinical, statistical review of 565 cases of vocal fold polyp referred to Tokyo Voice Center between January 2001 and December 2008. We examined patient gender, age, duration of symptoms, smoking rate, color and size of the polyp, and strategy and outcome of treatment. Compared with previous reports, polyps were more large prevalent in females than in men, and there were two peaks in female distribution. We operated 433 cases, and 94% had a good course. Of the 132 non-surgical cases, 55 (41.7%) cases experienced complete remission, 29 (22.0%) showed lesion shrinkage. Conservative treatment should be considered for patients with smaller polyps of more recent onset.

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Background : Tracheostomy is usually performed for the purposes of securing the airway and preventing aspiration after surgery in patients with head and neck cancer who have undergone free reconstructive surgery. In order to prevent postoperative airway complications, it is important to recognize when a tracheal stoma should be closed and under what circumstances postoperative complications occur. We therefore conducted a retrospective study to assess postoperative airway management with a tracheostomy orifice in patients with head and neck cancer who underwent free reconstructive surgery.
Methods : Between 2001 and 2010, 71 patients with head and neck cancer receiving free reconstructive surgery underwent tracheostomy after surgery. We investigated differences in duration of the tracheostomy orifice for various diseases/flaps, associations between the area of the flap and duration of the tracheostomy orifice, and the causes of airway complications.
Results : In patients with meso/hypopharyngeal cancer, the duration of the tracheostomy orifice tended to extend in comparison with other cancers. Among the reconstructive flaps, in patients reconstructed with the jejunum and rectus abdominis muscle, the duration of the tracheostomy orifice was significantly extended. The duration of the tracheostomy orifice significantly correlated positively with the area of the flap in patients with tongue cancer. However, the occurrence of airway complications was not associated with the duration of the tracheostomy orifice or type of flap. The occurrence of airway complications increased on postoperative days 7-14 on changing the cuffed tracheostomy tube or following stomal closure.
Conclusion : In patients with meso/hypopharyngeal cancer who underwent reconstructive surgery using the jejunum, and patients who underwent reconstructive surgery with the rectus abdominis muscle, there was no urgency to close the tracheal stoma. Following improvement of the swallowing function and the protective mechanism of the larynx, it may then be appropriate to close the tracheal stoma.

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Forty-four children (25 males and 19 females) under 6 years old undergoing tracheostomy at Kurashiki Central Hospital between 2004 and 2009 were retrospectively reviewed. Twenty-eight cases were less than one year old when they underwent the tracheostomy. The indications of the tracheostomies were upper airway obstruction in 17 cases and respiratory management in 27 cases. Tracheostomies were performed with vertical skin incisions, and tracheal incisions were also made vertically except in two cases. Retention sutures were placed through the tracheal wall and skin on both sides of the tracheostomy orifices and secured until the stomas were stabilized to aid changing of the tracheostomy cannula. The option of a cannula, which is generally easily inserted, was taken in children with weight over 3000g. Granulation developed in 10 cases (22.7%); however, no life-threatening complication from this was noted. Sixteen cases died of primary disease and decannulation was accomplished in 3 cases (6.8%). Eleven patients needed artificial ventilation and 8 patients still required oxygen inhalation either at the time of transfer or now.
Pediatric tracheostomies should be performed with full awareness of the differences between children and adults. In our study no complication led to death, but prognosis of tracheostomized children, especially infants, was poor and a number of cases needed assistance in breathing.

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Objective : Tracheal tumors were classified into cervical (CT), mediastinal (MT), or bifurcation trachea (BT) according to the site of the tumor. We investigated treatments, surgical approaches and surgical procedures.
Subjects : Between 1987 and 2010, 55 patients underwent therapy for tracheal tumors in our hospital.
Results : Tumor sites were 14 CT, 8 MT and 33 BT. Patients underwent surgical treatment and/or interventional pulmonology (IP) ;surgical treatment/IP was performed in 10/8 CT, 3/5 MT, and 23/14 BT. Of the 10 patients who underwent surgical treatment of CT, 7 patients had curative surgery (tracheal resection 3;tracheolaryngectomy and mediastinal tracheostomy 4). The surgical approach for CT is via a cervical collar incision, but with mediastinal tracheostomy added to the upper median sternotomy. Three MT surgical treatments were tracheal resections, and these approaches were 2 right thoracotomies and 1 median sternotomy. Modes of carinal resection and reconstruction were 11 end-to-end anastomoses after pneumonectomy, 4 reconstructions of one stoma type, 4 reconstructions of montage type, and 4 wedge resections. Surgical approaches for BT were right thoracotomies in 20, left thoracotomies in 2, and median sternotomy in 1. Recently, efficacy of the clamshell approach was reported when it was necessary to resect the left lung.
Conclusion : It is necessary for surgical treatment of tracheal tumors to devise an approach according to the tumor site and organ resection. When many tracheal rings need to be resected or laryngectomy is necessary, mediastinal tracheostomy is performed. Complete resection can provide a good prognosis.

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The aim of this study was to identify factors related to successful decannulation in tracheotomized inpatients for chronic and long-term care. Thirty-five tracheotomized patients using non-speech-type cuffed tube on admission, showing no more than two digits in the Japan Coma Scale and completing follow-up of over 3 months were divided into 3 categories: (A) 23 patients continuously using only cuffed tube since admission, (B) 5 patients accomplishing conversion to non-cuffed speech tracheotomy tube but not decannulation, and (C) 7 patients accomplishing conversion to speech tracheotomy tube and subsequent decannulation. Among the 3 groups, consciousness level, order obedience ability, modified water swallowing test, pneumonia morbidity, condition of saliva swallowing and eatable food forms were compared. In the results, the consciousness level, order obedience ability and modified water swallowing test showed apparent differences between the A and B plus C groups but not between the B and C groups. Between the B and C groups, pneumonia morbidity, saliva spouting from the tracheal tube and eatable food forms exhibited distinct differences. These data suggested that prerequisites for conversion from a cuffed tube to a speech-type tube or subsequent decannulation include abilities of cognition or clearance in the lower respiratory tract and swallowing abilities, respectively.

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In recent years, endoscopic submucosal dissection (ESD) for early cancer of the oropharynx and hypopharynx has become popular in Japan. ESD has great advantages of a more minimally invasive treatment and a shorter treatment period than radiotherapy or open surgery. In addition, for the purpose of organ preservation, the proportion of radiotherapy has become larger. Therefore, if double cancer is discovered during observation, many such cases cannot be re-irradiated for their cancer. In this report, we performed ESD for superficial hypopharyngeal cancer with a history of irradiation. However, repeated local infection after ESD led to a total laryngectomy. In our institution, six cases with a history of irradiation, including this case, underwent ESD between January 2008 and October 2011. All cases except for this case have passed without complications. Early-stage head and neck cancer with a history of irradiation is considered as a good indication for ESD. However, ESD has a possibility of complication such as in this case, and therefore the abuse of ESD is dangerous. It is important to select and perform the appropriate treatment based on sufficient discussion between the otolaryngologist and endoscopist.

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A foreign body in the tracheobronchial tree is often seen among children younger than 2 years. The most common clinical manifestations due to foreign bodies, coughing attack and stridor, are sometimes treated as bronchial asthma or bronchitis. If we do not suspect a foreign body, it will not be diagnosed. The major extraction technique for foreign bodies in children involves a rigid bronchoscope combined with forceps, but we sometimes encounter cases that are difficult to extract using conventional methods. Here we report two cases that were difficult to extract by forceps under rigid bronchoscopy but could be extracted using two different bronchoscopes, rigid and flexible, combined with a Fogarty catheter.
Case 1 : A 1-year, 8-month-old boy aspirated a peanut. He had a persistent cough and was brought to a nearby clinic. At that time, he was treated as having bronchitis and was referred to our hospital because he showed no improvement. The foreign body was detected in the left main bronchus on a chest computed tomography scan, but it could not be grasped and removed by forceps under direct magnified vision because the site was too far distal. Therefore, a Fogarty catheter was introduced through the instrument channel of a bronchoscope ; it was then passed beyond the foreign body, and the balloon of the catheter tip was dilated at a distal site. The foreign body was finally extracted by pulling up the catheter. Case 2 : A 10-month-old boy swallowed a sunflower seed. He showed stridor and was treated as having bronchial asthma by a nearby doctor. He showed no improvement, so he was referred to our hospital with a suspected bronchial foreign body. Since his tracheal lumen was too small to intubate with a rigid bronchoscope, a Fogarty catheter was introduced using a thin type of flexible bronchoscope, and the tip of the Fogarty catheter was placed at a site distal to the foreign body while observing through a flexible bronchoscope in a tracheal intubation tube. The foreign body was removed by dilating the balloon and pulling up the catheter.
These examples demonstrate that an extraction technique that combined use of a Fogarty catheter with a bronchoscope was useful in both cases : one in which it was difficult to grasp and remove the foreign body using forceps under direct magnified vision because the site was too far distal, and the other case involving a tracheal lumen that was too small to intubate with a rigid bronchoscope. We also consider it possible to extract foreign bodies by combined use of a Fogarty catheter with not only a conventional bronchoscope, but also with a thin type of flexible bronchoscope.

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