Preservation of the recurrent laryngeal nerves (RLN) is very important anatomically in thyroid surgery. However, even when the RLNs are preserved during surgery, paralysis occurs in some cases postoperatively. We studied the clinical features of patients who presented RLN paralysis after thyroid surgery. We analyzed the data of 161 patients who had undergone surgery at our hospital between December 2010 and October 2015. Some patients had been operated on both sides or resected the RLN, thereby resulting in a total of 151 patients and 164 RLN thyroid surgeries in which the RLN had been preserved. 151 patients were included in this study, and details were distributed as follows : non-paralysis, 133 cases ; temporary paralysis, 10 cases ; permanent paralysis, 8 cases. There were no cases of bilateral RLN paralysis. According to our pathological diagnosis, of the 133 non-paralysis cases 82 were benign and 51 were malignant ; of the 10 temporary paralysis cases, 4 were benign and 6 were malignant ; and of the 8 permanent paralysis cases, 1 was benign and 7 were malignant. Postoperative RLN paralysis was thus associated with pathological diagnosis (p<0.05). The mean intraoperative hemorrhage was 29.8 g in the non-paralysis group, 53.2 g in the temporary paralysis group, and 81.3 g in the permanent paralysis group. The intraoperative hemorrhage in the permanent paralysis group was thus significantly larger than in the non-paralysis group (p<0.01). The mean operative duration was 123.6 minutes in the non-paralysis group, 124.3 minutes in the temporary paralysis group, and 218.0 minutes in the permanent paralysis group. The operative duration in the permanent paralysis group was thus significantly longer than in the non-paralysis group (p<0.05). The lobe size of the thyroid in preoperative CT axial image tended to be larger in the temporary paralysis group, but showed no significant differences among the three groups. However, pathological malignancy, the volume of hemorrhage and operative duration were found to exert an influence on the likelihood of postoperative permanent RLN paralysis in thyroid surgery. The lobe size of the thyroid in preoperative CT axial image may be an indicator of risk of postoperative temporary RLN paralysis in thyroid surgery.

Subcutaneous emphysema is commonly caused by head and neck surgery such as tracheostomy, deep neck infection, trauma and chest surgery. It is not well known that mediastinal emphysema may occur after dental treatment. We report a rare case of a 21-year-old male with mediastinal emphysema that was caused by use of an air turbine and air syringe.

The patient consulted our hospital complaining of swelling and pain across his right face and neck, coupled with a feeling of dyspnea following dental treatment. At the time of admission his vital signs were almost normal and O₂ saturation was 96%. Computed tomography findings showed an air accumulation in the right infratemporal space, pterygomandibular space, buccal space, upper part of the parapharyngeal space, retropharyngeal space, along the deep cervical fascia, and extending to the mediastinal space. Conservative treatment consisted of intravenous antibiotic therapy with SBT/ABPC (sulbactam/ampicillin) and clindamycin, and no oral feeding. CT findings showed the air had decreased in his face, neck and mediastinal space. After 12 days he was discharged. The cause was the use of dental handpieces, especially air turbine and air syringe. CT is very useful for assessing the extent of emphysema and air accumulation. The otolaryngologist should be aware that emphysema can be caused by dental treatment.

It is well known that anaplastic thyroid carcinoma (ATC) typically offers an extremely poor prognosis, and it is rare for a patient with ATC to survive more than a year after a definitive diagnosis even with a variety of treatments. Recently, several molecular target drugs such as Sorafenib or Lenvatinib have appeared as new oncotherapeutic methods. Even so, at this time surgery remains the first choice offering the possibility of a complete cure. In 2012 a consortium on ATC put forward prognosticators of anaplastic carcinoma and individualized treatments based thereon. We investigated the extent to which our treatments against anaplastic carcinoma coincided with the treatment guidance offered by the consortium. The results showed that the contents of the individualized treatments in the guidance were largely acceptable, indicating that the guideline can be helpful when deciding on treatment of anaplastic carcinoma. However, it is difficult to determine treatment methods for all cases only using the current prognosticators; in actual practice, consideration must be paid individually for each patient.

We reported an esophageal duplication cyst in a 43-year-old male detected by upper digestive tract examination in health screening. Endoscopy detected a submucosal translucent tumor in the left side of the lower esophagus. Endoscopic ultrasonography (EUS) and CT/MRI revealed fluid collection and a septal wall in the tumor. We diagnosed that the tumor was an esophageal duplication cyst. The patient underwent tumor resection through left thoracic-abdominal approach and gastric fundopexy for defect of the proper muscle in the lower esophagus. The tumor consisted of a cyst containing brownish serous fluid with a septal wall. Pathologic findings showed that the inner surface of the esophageal cyst was covered by single ciliated and embryonic squamous cell epithelium. Postoperative course was good without complication. Esophageal duplication cyst is a rare disease, but its presence can involve various problems in both diagnosis and treatment.

Epithelioid sarcoma is a rare soft tissue sarcoma which has a poor prognosis and very rarely occurs in the head and neck region. We report a case of epithelioid sarcoma which occurred in the right neck. A 50-year-old male presented with a growing right supraclavicular mass. Fine needle aspiration cytology showed carcinoma, but PET/CT did not reveal the primary lesion. For the purpose of definitive diagnosis, right selective neck dissection was performed. As the mass was firmly adhered to the sternocleidomastoid muscle, combined resection was carried out. Histopathological examination of the specimen revealed a malignant tumor with rhabdoid cells that was unclear as to its primary or metastatic lesion. Immunohistochemical examination revealed loss of INI1 expression. Based on both examinations, the tumor was diagnosed as epithelioid sarcoma. The patient underwent postoperative concurrent chemoradiotherapy. Five-year follow-up showed no sign of recurrence.

Introduction: Among emergency admission cases, mediastinal emphysema is sometimes encountered incidentally. If not diagnosed and treated promptly, this condition may become severe, and therefore in an ER setting clinicians need to be mindful of mediastinal emphysema. Objective: The aim of this study was to investigate cases of traumatic mediastinal emphysema in an ER setting. Patients: Four patients with traumatic mediastinal emphysema encountered between October 2013 and November 2014 were enrolled in this study. Cases: Case 1 involved severe trauma. Endoscopic examination revealed laceration in the esophagus. We approached the damaged area via the neck and performed drainage. Case 2 involved trauma caused by a traffic accident. Because the patient was febrile, we performed a CT examination, which revealed emphysema and abscess in the mediastinum. We approached the affected area via the neck and performed drainage. Case 3 also involved trauma caused by a traffic accident. Although mediastinal emphysema was evident, there were no problems in the esophagus and trachea, and the patient was treated conservatively. Case 4 involved collapse after vomiting. Because of diabetic ketoacidosis, the patient was treated conservatively. All patients recovered and were discharged. Conclusions: Even in an ER setting, it is necessary to conduct prompt and detailed examination for mediastinal emphysema. Cure can be achieved without severe complications if treatment is conducted on the basis of individual evaluation.