Many patients are hospitalized in our rehabilitation center with swallowing disorder and/or speech disorder after tracheotomy. Among 99 patients examined, tracheal cannula exchange was performed on 76, 35 underwent laryngeal endoscopy. Of the 76 patients cited, 66 developed granulation tissue, which was significant in 25; airway obstruction occurred in 21 when the tracheal cannula was removed; and re-insertion was difficult in 13 cases. To prevent granulation tissue formation, the tracheal mucosa and skin should be sutured to create a tracheal cartilage flap. For long-term tracheal cannula use, percutaneous tracheotomy should be avoided. As a method of treating granulation, trichloracetic acid and a power punch have proven effective.

This is an analytic report on treatments of dysphagia conducted over a period of 28 years. The subjects were 205 patients of dysphagia who could not take solid foods and liquids orally and required a feeding tube before treatment. We performed physical therapy and operations such as cricopharyngeal myotomy, laryngeal suspension fixed to the mandibular or hyoid bone, velopharyngeal flap and pharyngeal circumferential suture. Patients who no longer required a feeding tube after treatment were evaluated as successful cases. Two patients died and 5 patients rejected treatment.

A total of 198 patients were statistically analyzed. Seven patients were under 16 years old:of these, the causes of dysphagia were ruptured cerebral arteriovenous malformation (CAVM) in 4 cases, and traumatic brain injury (TBI),traumatic cerebral infarction and hemangioma in the posterior fossa respectively in the remaining 3 cases. Among the 4 cases caused by ruptured arteriovenous malformation, 2 had successful results:one was able to walk independently while the other was confined to a wheelchair. Two cases died from re-rupture of CAVM after treatment.

Among the 191 patients aged 16 and over, 152 were male and 39 were female. Their average age was 56.1±16.0. In 96 patients the cause of dysphagia was cerebral vascular disorder (CVD); in 16, traumatic brain injury (TBI); in 15, spinal cord injury (SCI); in 14, brain tumor (BT); in 12, miscellaneous tumor other than brain tumor (MT); in 10, immunological neuro-muscular disease (INMD); and in 28, miscellaneous causes (MC).Of the 191 patients, 100 showed successful results. Of these, the causes of dysphagia were CVD in 55 patients, TBI in 7 patients, SCI in 5 patients, BT in 11 patients, MT in 5 patients, INMD in 6 patients, and MC in 11 patients.

There were no significant differences between the results for men and women. The results for patients under 65 were significantly better than those for patients 65 and over. The results for patients able to walk at discharge were significantly better than those for patients who could not walk and required a wheelchair, and those capable of driving their own wheelchair posted better results than patients unable to drive on their own.

Locomotive ability and stable sitting position are important factors for forecasting prognoses of dysphagia. Physical therapy and operation are useful in the treatment of dysphagia, but their indications remain unclear. In patients over 16 years of age, patients whose dysphagia was attributable to CVD, BT or INMD showed more successful results than poor results, and these are therefore thought to be good material for discussing indications of physical therapy and operations.

Swallowing disorder associated with reduction of cognitive function is considered to be due to impairment of the anticipatory and preparatory stages, but multiple factors of swallowing disorder, such as reductions of activity of daily life (ADL) and cardiopulmonary function, overlap in many elderly individuals. Only a few studies have closely investigated whether only the anticipatory and preparatory stages are impaired. In this study, we investigated the relationship between cognitive and swallowing functions in elderly subjects with relatively stable ADL. Cognitive function was evaluated using the Hasegawa Dementia Scale-Revised (HDS-R) and Mini-Mental State Examination (MMSE), while swallowing function was evaluated using videoendoscopy (VE) and videofluorography (VF).

The subjects were classified into two groups: patients with low and high HDS-R and MMSE scores, respectively. Using VE, scores were compared between the two groups. Using VF, the position of the contrast agent at the time of swallowing reflex initiation, delay time of laryngeal elevation (LEDT), relative laryngeal elevation at P point (%LE(p)), and the distance of laryngeal elevation were compared between the groups. Significant differences were noted only for parameters that reflect swallowing reflex inducibility. This finding suggests that reduction of cognitive function influences only swallowing reflex inducibility; it does not influence other swallowing functions.

Anorexia and weight loss as a consequence of chemoradiotherapy (CRT) is a common problem in patients with head and neck squamous cell carcinoma. Weight loss during treatment is a prognostic indicator for overall survival. This study investigates the association between anorexia during CRT and ghrelin, which is known to increase appetite. This observational study focused on patients with oropharyngeal, hypopharyngeal or laryngeal cancer who underwent cisplatin-based chemoradiotherapy. Twenty-one patients were enrolled in this study (oropharynx 5, hypopharynx 10, and larynx 6). A prospective analysis was performed to compare plasma ghrelin concentrations before and after CRT. Mean acylghrelin was significantly lower after treatment (mean=7.2 fmol/ml, SD=7.8) than before CRT (mean=21.0 fmol/ml, SD=38.5, p=0.049). Levels of acylghrelin decreased progressively during treatment with cisplatin-based CRT. Appetite measurements were taken before and two weeks after CRT. Mean ratings for prospective consumption after CRT decreased compared with the baseline. There was a significant correlation between the adverse event of anorexia and plasma ghrelin after CRT. The increase in acylghrelin after administration of cisplatin and radiation mucositis are likely to be a compensatory response to anorexia.

Chondrosarcoma of the larynx is a rare disease accounting for less than 1% of all laryngeal malignancies. We report a case of chondrosarcoma in a 50-year-old male who presented with a one-year history of dyspnea originally diagnosed as asthma. Immediate histopathological examination revealed chondrosarcoma. A total laryngectomy was performed on this advanced malignancy with severe destruction of the cricoid cartilage. Histopathology of the excised tumor revealed binucleation, hyperchromasia, nuclear atypia, and hypercellularity, with indication of the coexistence of grade I and grade II chondrosarcoma. No evidence of recurrence has been observed during 6 years since surgery.

In infants, even a small cyst frequently causes snoring, sleep apnea or stridor, and occasionally it can cause cyanosis or dyspnea because infants' upper respiratory tract is narrow and undeveloped. In this article, we present three cases of congenital cysts in infants with upper airway stenosis and a sucking disorder. The first case was of a laryngeal saccular cyst in a 5-month-old infant. The cyst was asymptomatic and was detected along with an upper respiratory infection. The cyst originated from the right laryngeal ventricle and covered the glottic chink. Laryngomicrosurgery was performed, and the whole cyst was transorally resected. The second case was also of a laryngeal cyst, in a 1-month-old infant, with stridor as the presenting symptom. The cyst was located around the right arytenoid and pyriform sinus and was completely resected by transoral surgery. The third case was of a cyst at the base of the tongue in a 1-month-old infant, which caused a sucking disorder and stridor. Microscopic marsupialization was performed because the cyst extended to the hyoid bone. In all three infants, postoperative recurrent nerve palsy did not occur and cyst recurrence was not observed. Although the ideal treatment for such cysts is complete resection, microscopic marsupialization is also appropriate dependent on the size of the cyst and its invasiveness.

A mediastinal abscess developing from a deep cervical abscess is an emergent disease having a high mortality rate which requires treatment including immediate drainage. In this study, we report on our experience regarding a case involving an esophageal submucosal abscess requiring differentiation from a mediastinal abscess.

The subject was a 65-year-old female patient with chief complaints of a sore throat and cervical swelling. Obstruction of the airway was observed and endotracheal intubation was carried out as an ambulatory service. CT revealed a left peritonsillar abscess and deep cervical abscess, along with an abscessed lesion developing continuously in the mediastinal direction up to the bifurcation of the trachea. A cervical incision and drainage were conducted the same day. The mediastinal abscess remained, however. Despite conducting another cervical incision, we could not achieve drainage from the mediastinum. During the course of the operation, the abscess further enlarged and the general condition of the patient deteriorated. An esophageal intramural abscess was suspected from the findings. Upon consultation with the Department of Gastrointestinal Surgery, an esophageal submucosal abscess was suspected. We then made an incision under endoscopy, resulting in a large amount of drainage, after which the general condition of the patient rapidly improved.

Contrast-enhanced CT is effective for distinguishing an esophageal submucosal abscess from a mediastinal abscess. In the case of a mediastinal abscess, the abscess cavity can be identified as having developed into the surrounding tissue, while in the case of an esophageal submucosal abscess, a localized abscess cavity is formed in sharp contrast with the surroundings of the abscess. If in doubt, upper endoscopy should be performed. This is a relatively rare disease reported here together with a review of the pertinent literature.