Treatments of peritonsillar abscesses (PTAs) include observation with antibiotics, drainage by needle aspiration or incision, and quinsy tonsillectomy. Inadequately treated infections may have lethal complications like deep neck abscesses or mediastinitis. We reviewed 100 patients diagnosed as having PTAs on the basis of computed tomography (CT) findings between January 2013 and April 2016. The longest diameter of a PTA on axial view of enhanced CT using a contrast agent was measured. The PTA with the longest diameter located cranial to the palatine uvula was defined as a superior type, and the PTA with the longest diameter located caudally was defined as an inferior type. The longest diameters, presence of laryngeal edema, treatments, and treatment periods were investigated. Although the superior type had a longer diameter, the inferior type had laryngeal edema more frequently. Diameters of abscesses treated by observation with antibiotics were all shorter than 16 mm, and significantly shorter than those of abscesses treated by drainage or quinsy tonsillectomy. Drainage by needle aspiration or incision was selected mostly for the superior type, since the pus was drained sufficiently and the treatment period was shorter in this treatment compared to quinsy tonsillectomy. Quinsy tonsillectomy was selected more for the inferior type with large abscesses, since it could achieve complete drainage and prevent recurrence in almost the same treatment period as cases treated by aspiration or incision.

The elderly population is growing rapidly in Japan, and bronchoesophagologists need to provide care to this population. We investigated tracheostomies performed during the past 10 years at our acute care geriatric hospital. We analyzed data from 117 patients with an average age of 78.0 years. We perform tracheostomy with dissection of the thyroid isthmus as our usual surgical technique. Tracheal deviation, lower displacement of the larynx, and difficulty in extending the neck were the specific risk factors in these patients. The incidence of postoperative complications was 16.2%, and there were no surgery-related deaths. In cases in which we could not approach the membrane between tracheal rings 1 and 2, 2 and 3, or 3 and 4 safely, we performed the tracheostomy by partial resection of the cricoid cartilage. According to the literature and our report, the average age of the 30 patients who underwent tracheostomy by partial resection of the cricoid cartilage, including 6 patients in this report, was 77.3 years. The only postoperative complication was a granuloma in one patient. The tracheostoma could be closed in four patients, including two of our patients. Lower displacement of the larynx with age was the factor for which tracheostomy by partial resection of the cricoid cartilage was indicated in about half of the cases. The demand for tracheostomy in patients with the above-mentioned risk factors will increase due to the increase in the elderly population. It is important to choose the best approach to tracheostomy for each patient, depending on the risk factors and the individual features of the patient.

Background : Some patients who were euthyroid before hemithyroidectomy for thyroid tumor develop postoperative hypothyroidism. They must receive regular outpatient treatment and take L-thyroxine all their life. If we were able to predict residual thyroid function after hemithyroidectomy preoperatively, this would help us explain to patients their probability of developing postoperative hypothyroidism. Patients and Methods : To evaluate risk factors of postoperative hypothyroidism after hemithyroidectomy, we retrospectively reviewed 170 euthyroid (preoperative serum TSH and Free T4 level were within the reference values) patients. The patients were divided into three groups according to postoperative thyroid function, i.e. a normal group, elevated TSH group (Free T4 level was normal), and decreased Free T4 group. We then analyzed the risk factors which influenced the postoperative thyroid function. Results and Conclusion : We did not find any significant differences among the three groups with respect to age, gender, histological evaluation (malignant or benign) or anti-TPO/Tg antibodies. However, we found that postoperative hypothyroidism significantly correlated with the preoperative serum TSH and Free T4 levels. Our results suggest that 90% of patients whose serum TSH level is under 2.0 μU/ml will be euthyroid after surgery, and 71% of patients whose preoperative serum TSH level is over 2.0 μU/ml and serum Free T4 level is under 1.0 ng/dl will need thyroid hormone replacement therapy.

We report a rare case of esophageal schwannoma suspected to originate in the esophageal branch of the recurrent nerve. A 61-year-old male was admitted to our hospital after a tumor was found on a neck MRI taken at another hospital. We performed surgery with a diagnosis of schwannoma of the recurrent nerve. However, the tumor had occurred from the esophagus, and we performed enucleation. Microscopically, the tumor consisted of many spindle-shaped cells. We diagnosed the tumor as schwannoma. Because esophageal schwannoma is rare, we report this case with some literature review.

Zenker's diverticulum is relatively rare and is occasionally found in patients with a foreign body in the esophagus. We report the case of a 52-year-old male after accidental ingestion of a fish bone that penetrated into the Zenker's diverticulum, with esophageal wall injury. The extraluminal air surrounding the foreign body was identified on CT scans. When the foreign body was extracted by upper gastrointestinal endoscope, the esophageal injury was simultaneously observed. We performed surgery to diagnose the extent of injury to the esophagus and confirm the suspected existence of a Zenker's diverticulum by cervical approach. The diverticulum was identified by a radiographic contrast study intraoperatively, and was excised. In cases when diagnosis of a diverticular foreign body in the esophagus is endoscopically difficult because of esophageal injury, surgery by cervical approach is beneficial.

We report a case of bronchial foreign body which remained lodged over a long term. The patient was an infant boy aged 1 year and four months. He was brought to our hospital for a cough that had persisted for four months. He had been treated for pneumonia, but did not heal. By CT we diagnosed a bronchial foreign body in the chest and removed it by bronchoscope. The foreign body was cellophane tape. We believe that diagnosis of a bronchial foreign body was delayed because of the X-ray permeability of this particular foreign body, combined with failure of the doctor undertaking the initial medical examination to suspect a bronchial foreign body.

Lateral medullary infarction, also known as Wallenberg syndrome, usually causes multiple neurologic symptoms such as contralateral deficit in pain and temperature sensation, disequilibrium, dysphagia and Horner syndrome, but onset with a single symptom is rare. Here we present a case of simple dysphagia due to right lateral medullary infarction.

An otherwise healthy 66-year-old male presented with a four-day history of dysphasia without any other neurological findings. Videofluoroscopic swallowing study showed dysphasia and aspiration, but the patient had no recurrent nerve paralysis. Enhanced CT scan (head to chest) demonstrated no particular lesion. On the third day of admission, brain MRI including DWI (diffusion-weighted imaging) was performed and a small lesion from right lateral medullary infarction was revealed.

Swallowing is regulated by the nucleus tractus solitarii, dorsal motor nucleus of the vagus, central pattern generator (CPG) and nucleus ambiguus, and among these CPG plays a key role. In the present case, the lesion of infarction appeared to involve only a small area including the CPG and nucleus ambiguus. This finding seemed to explain the reason why the patient showed simple dysphagia without other symptoms.