The combination of the nasopharyngoscope“VNL-1590STi” (HOYA Corporation, PENTAX, Tokyo, Japan) and the processor“EPKi”generates high-definition images which have not been possible previously in the head and neck region. The EPKi processes images with image-enhanced technology known as“i-scan”. I-scan has three modes of image enhancement. One of them, tone enhancement called i-scan TE, that changes the tone curve of the combination of RGB components, is quite effective mode to enhance irregular mucosal lesion. The aim of this study is to find out the effectiveness of the VNL-1590STi with i-scan and Lugol's chromoendoscopy to determine surgical margin in transoral resection of oropharyngeal and hypopharyngeal cancers.
We used the VNL-1590STi with i-scan and chromoendoscopy during operations and determined the surgical margins. After each operation, we checked the margins of resected specimens pathologically.
In all cases, abnormal mucosal patterns were detected clearly with the VNL-1590STi and i-scan TE and chromoendoscopy. Reviews of resected specimens shown that with all patients the lesions including carcinoma in situ had been resected.
The VNL-1590STi with i-scan and chromoendoscopy is concluded to be effective for more precise resection in transoral resection of oropharyngeal and hypopharyngeal cancers. I-scan TE may lead to improvement of the accuracy of detection for early mucosal lesions.

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We describe a case in which subcutaneous emphysema, pneumomediastinum and bilateral pneumothorax developed after tracheotomy.
A 71-year-old male underwent a tracheotomy by local anesthesia for bilateral recurrent nerve paresis.
The mechanism was thought to involve extreme negative intrathoracic pressure induced by labored breathing and high intratracheal pressure caused by coughing and forced ventilation drawing air into the mediastinum and thorax.

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We report three cases of severe voice disorder induced by unilateral recurrent nerve palsy with ankylosis of the cricoarytenoid joint on the affected side. The voice quality of the patients was severe breathiness voice approaching aphonia. In all patients, the left recurrent nerve palsy occurred after an operation for aortic arch aneurysm displacement. (Patients 1 and 3 underwent dissection of the left recurrent nerve during surgery, and patient 2's pathological findings revealed neurogenic atropic change of the posterior cricoarytenoid muscle on the affected side.) During the operations for aortic arch displacement, transesophageal echocardiographies were performed to monitor the cardiovascular condition of all patients. These showed findings similar to laryngeal fiberscopic, CT and intraoperative findings. Laryngeal fiberscopic findings revealed that during inspiration the left vocal fold was fixed at an excessively lateral position higher than the right vocal fold, and vocal recess of the arytenoid cartilage on the left side could not be well detected. During phonation, severe glottal closure incompetence could be seen. CT findings showed the arytenoid cartilage atop and adhering to the posterior edge of the cricoid cartilage. During palpation of the left arytenoid cartilage, fixation of the cricoarytenoid joint could be detected. After stripping the posterior cricoarytenoid muscle on the left side posteriorly, it could be seen that the surface of the cricoarytenoid joint of the arytenoid cartilage was fixed crossing over the posterior edge of the cricoid cartilage posteriorly. We performed release of the fixation of the cricoarytenoid joint, and the pulled to rotate the muscular process of the arytenoid cartilage on the left side. The patients' voices improved.

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Adenocystic carcinoma most commonly develops in the major salivary glands, on the other hand it is rare for adenocystic carcinoma to develop in the larynx. We report a case of adenocystic carcinoma in the larynx.
A 54-year-old male was hospitalized with symptoms of hoarseness and dyspnea on exertion. He presented a tumor that developed at the base of the right arytenoid, and covered over the glottis. It was confirmed to be adenocystic carcinoma (solid type) by biopsy. PET-CT also revealed a left cervical lymph node metastasis and multiple pulmonary metastases (T1N2cM1). He was treated with proton therapy to the larynx to prevent airway obstruction by growth of the tumor and to preserve the larynx because he had uncontrollable pulmonary metastasis. Although the tumor vanished after the treatment, one month later he had halitosis, dyspnea and bilateral vocal cord palsy. Despite administration of an antibacterial drug and steroid, there was no improvement to the narrowness of the glottis. A tracheotomy was therefore performed three months after the proton therapy. PET-CT, which was performed after the tracheotomy, suggested growth of the residual tumor or laryngeal radionecrosis.
This study confirmed that proton therapy is effective for adenocystic carcinoma in the larynx. However, proton therapy also was found to cause laryngeal radionecrosis. These results indicate the importance of evaluating the side effects of radiation therapy and providing that information to the patient.

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We report a case of subglottic stenosis and laryngeal granuloma improved by three-drug combined therapy for gastroesophageal reflux disease (GERD). The case was a 62-year-old female whose chief complaints were cough and hoarseness. She presented with ulcerative colitis and had undergone surgery for it three times within two months. In addition, she was taking a proton pump inhibitor (PPI) (Takepuron^®) because of previously diagnosed GERD. Her laryngeal findings were a huge granuloma on the glottis and film-like subglottic stenosis in the larynx on flexible fiberscopy and neck CT. We administered mosapride citrate (Gasmotin^®) and Ri-Kunshi-To^® (TJ-43) in addition to the PPI. Her symptoms and laryngeal lesion subsequently improved.
These findings suggested that the laryngeal granuloma and subglottic stenosis occurred because of frequent intubation for surgery during treatment of GERD within a short term. Her symptoms and laryngeal lesion were improved by treatment of three-drug combined therapy for GERD.

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Introduction : For patients complaining of severe dysphagia after treatment of head and neck cancers, cerebrovascular diseases or neurodegenerative diseases, we have performed the swallowing improvement operation. Although the swallowing function was improved in most cases, many patients suffered post-operative complications. Here we investigate the surgical complications and examine how to reduce such complications.
Patients and Methods : This study included 7 patients who underwent a swallowing improvement operation at Tokai University Hospital between 2009 and 2012. The age, sex, pre-existing diseases, type of operation, surgical complications, and changes in diet before and after the operation were examined retrospectively.
Results : The ages of the patients, 6 males and 1 female, were 64 to 82 years old. Three patients had completed treatment for head and neck or esophageal cancers, and 4 patients for cerebrovascular or neurodegenerative diseases. A cricopharyngeal myotomy was performed in all 7 patients, 10 sides, and laryngeal elevation was also performed for 6 of the patients.
Three of the 6 patients who underwent laryngeal elevation suffered surgical site infection 3 months after the operation. One of the 3 patients who underwent bilateral cricopharyngeal myotomy suffered esophageal perforation and mediastinitis, and 2 of the 3 presented with gastroesophageal reflux. One patient with gastroesophageal reflux died of aspiration pneumonia.
Conclusion : Generally, the systemic condition of patients who have undergone a swallowing improvement operation are not favorable ; therefore reduction of surgical complications is an important issue. Control of postoperative gastroesophageal reflux and reduction of surgical site infection are essential to minimize suffering from surgical complications.

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We report a rare case of a 77-year-old woman with adenocarcinoma in a colonic interposition following esophagectomy. She underwent esophagectomy and extra fistula of the remnant esophagus for corrosive esophagitis in 1982 and reconstruction by the left colon through subcutaneous route in 1985. In 2010 she presented with passage disturbance and endoscopy detected a type 1 tumor about 12 cm from the front teeth. The biopsy from this area yielded a diagnosis of adenocarcinoma. No lymph nodes or distant metastases were detected on CT and US. Based on a diagnosis of adenocarcinoma in a colonic interposition we performed partial resection of the colonic interposition. The postoperative course was good. Pathological findings were well differentiated adenocarcinoma (tub1) pMP (INFb) ly1 v0 pPM0 pDM0 pRM0.

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Tracheal squamous papilloma (TSP) is the most prevalent type of benign tumor, accounting for 6%of all tracheal tumors including malignant tumors. TSP tends to present multiple tumors, and therefore the mainstay of treatment strategy is bronchoscopic intervention, except in malignant cases. We treated three cases of TSP between 1995 and 2010 : two female patients (49 and 54 y/o, both multiple TSP) and one male patient (67 y/o, solitary). One female case was associated with recurrent respiratory papillomatosis. The male patient underwent tracheoplasty because of suspected malignancy. Complete resection was performed and no recurrence was detected for five years. The two female cases underwent serial bronchoscopic electrosurgeries and laser ablations. In all cases pathologic examination revealed benign TSP. Human papilloma virus (HPV) infection was examined in one female case who presented recurrent respiratory papillomatosis, and the result was positive. By way of conclusion, the mainstay treatment for TSP is bronchoscopic intervention except in cases of malignancy. Association between TSP and HPV is obscure and further investigation is necessary.

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It is important to evaluate the quality of life (QOL) of patients with clinical dysphagia. The Dysphagia Handicap Index (DHI) is a questionnaire for dysphagia patients developed by Silbergleit et al. (2012). In the present study, we developed a questionnaire for Japanese-language speakers based on similar questionnaires for other languages, to achieve a Japanese version of the DHI. Approval to perform the translation was received from the original authors, and a forward translation, backward translation and pilot test were carried out. We found that the linguistic validity of the Japanese version accorded with the original DHI. Development of a Japanese questionnaire that is comparable internationally is beneficial. In the future, we aim to conduct an analysis of the validity and reliability of the developed questionnaire, and to elucidate its usefulness.

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