Since 1999, the number of new tuberculosis patients in this country has been decreasing but the number of cases of pharyngeal and laryngeal tuberculosis has remained the same. We treated ten cases of laryngeal tuberculosis in our institution from 2011 through 2016. The patients' ages ranged from 30 to 86 years with an average of 67.3±21.7 years (mean±SE) ; four were men and six were women. The most frequent chief complaint was hoarseness (n＝8)．Endoscopic findings were categorized into three types of lesions : granulomatous (n＝6)，perichondritic (n＝3) and ulcerative (n＝1)．Positive rates for tuberculosis diagnosis were 60% with smear speculum tests, 100% with culture tests, and 88% with polymerase chain reaction (PCR)．Abnormal findings were recognized in 70% of cases with chest X-ray and 100% of cases with chest CT. Two of five cases (40.0%) could be diagnosed as tuberculosis by pathological examination. Because the appearance of laryngeal tuberculosis is variable, diagnosis is difficult. Prompt bacteriological examination and pulmonary imaging are important for early diagnosis and to prevent spreading.

Descending necrotizing mediastinitis is a severe life-threatening disease with a high mortality rate resulting from sepsis or other complications. Deep neck infection can spread through the cervical fascial spaces and descend rapidly to the mediastinum. We have treated 9 patients (6 male and 3 female) of descending necrotizing mediastinitis resulting from deep neck infection who underwent cervical and mediastinal drainage between 2012 and 2016 in our hospital. Their mean age was 64 (range : 48-71) . Laboratory data on admission showed a mean white blood cell count of 14830/ µl and a mean C-reactive protein level of 33.5 mg/dl. Duration time from admission to cervical drainage was 0 to 5 days, and duration time from cervical drainage to mediastinal drainage was 0 to 7 days. All patients were admitted to the intensive care unit (ICU) after surgery and received antibiotic therapy, daily wound cleansing and repeated cervicothoracic CT imaging. They also received physical therapy within a few days postoperatively to prevent disuse syndrome. All patients survived to discharge. Mean length of hospital stay was 102 days (range : 32-222 days) and mean length of ICU stay was 34 days (range : 12-126 days) . After swallowing rehabilitation, all patients were able to ingest orally. We concluded that in cases of descending necrotizing mediastinitis, early surgical drainage and postoperative rehabilitation may be critical factors determining prognosis and swallowing function.

In this study we statistically examined patient background, period of hospitalization, effect of primary treatment, completion rate of treatment, overall survival, and frequency of adverse events for 15 cases of cisplatin-radiotherapy (CDDP-RT) and 14 cases of cetuximab-radiotherapy (Cmab-RT) as primary treatment of locally advanced head and neck squamous cell cancer during a period of 3 years from November 2014 to October 2017. In examining patient background, although the Cmab-RT group was often applied to cases with a poor general condition and the period of hospitalization tended to be significantly longer, we did not find any significant differences in treatment completion rate, primary treatment effect, or overall survival rate compared to the CDDP-RT group. Concerning adverse events, the Cmab-RT group showed significantly high rates of frequency of Grade 3 or higher dysphagia and Grade 2 or higher radiation dermatitis. Levels of recommendation suggest that Cmab-RT is often selected for cases with a poor general condition ; however, we believe that if sufficient supportive treatment is provided, Cmab-RT can obtain treatment effect equivalent to that of the CDDP-RT group.

The case was a male child, aged 1 year and 9 months, born at 28 weeks and 3 days, who required 14 days of endotracheal intubation during the neonatal period. The patient presented inspiratory stridor at 1 year and 8 months and conservative treatment yielded no improvement. Contrast-enhanced computed tomography (CT) showed a cyst-like formation in the larynx, and a subglottic tumor was found by flexible laryngoscopy. Because the mass was large, stridor was strong and dyspnea appeared, the patient was urgently transported to our hospital for airway management. After endotracheal intubation, the tumor was tentatively incised, and a white serous fluid was discharged and confirmed to be a subglottic cyst. On the 16th day after the incision, we performed a subglottic cyst fenestration without endotracheal intubation under general anesthesia. We prepared for tracheotomy at any time during the fenestration and sprayed 8% lidocaine pump spray before the surgical operation to prevent laryngeal spasm. As the patient was under deep sedation, muscle relaxant was not used, laryngoscopy was performed without intubation, and the cyst wall was removed as much as possible using a microdebrider. The cyst wall was resected only for the anterior wall ; the posterior wall was preserved to prevent subglottic scarring and adhensions. There was no airway difficulty after surgery, the inspiratory stridor completely disappeared, and there has been no recurrence at 9 months after the fenestration surgery.

We experienced a case of recurrent cervical bronchogenic cystadenocarcinoma on the inner wall of the trachea. The patient is a seventy-one-year-old woman. After total thyroidectomy and anterior neck dissection were performed, the tumor relapsed on the inner wall of the trachea immediately. The tracheal wall cartilage with recurrent tumor was resected. Pieces of rib cartilage and dental impression materials (plastic silicone) were used to reconstruct the tracheal wall. To acquire sufficient structural strength, an outer frame of the trachea was made with pieces of rib cartilage. A rubber medical glove filled with dental impression materials was placed into the tracheal lumen as an inner stent. Three years after operation, there was no evidence of tumor recurrence, and the tracheal wall was reconstructed and retained adequate strength as a respiratory tract. We concluded that dental impression materials are very useful for reconstructing the inner lumen of the trachea.