We performed a clinical study through a chart review of patients who underwent Ejnell’s operation for bilateral vocal fold immobility in our department between 2005 and 2018. A total of 21 cases (12 men, 9 women) were examined, with the average age at the first operation being 55 years. The most frequent cause of bilateral vocal fold immobility was postoperative paralysis due to injury to the bilateral recurrent nerves in the operative field, in 8 cases (38％). Among these, thyroid operation (total thyroidectomy for thyroid cancer) was the most frequent cause, in 6 cases (29％). In the initial operation, the operation side was right in 2 cases, and left in 19 cases. In 12 cases, sufficient glottal space was secured after the initial operation and the tracheostoma was closed. Of the remaining 9 cases, 7 cases had insufficient vocal fold abduction and 2 cases had infections of the thyroid cartilage puncture site. Ultimately, it was possible to close the tracheostoma in 4 of these cases after additional operations. As a result, the tracheostoma could be closed in a total of 16 of the 21 cases (76％). In 4 of the 5 cases in which the tracheostoma ultimately could not be closed, this may be due to organic abnormalities of the vocal folds, arytenoids, or cricoarytenoid joints. We should pay extra-close attention and exercise greater caution towards adaptations.
Conventionally, cricopharyngeal myotomy has been performed by collar incision. We performed endoscopic trans-oral cricopharyngeal myotomies on three cases：cricopharyngeal dilatation insufficiency, Wallenberg syndrome and sporadic inclusion body myositis. Laryngeal elevation and pharyngoplasty were added in the Wallenberg syndrome case. In all cases, there were no serious complications, and the swallowing disorder improved. Compared with the conventional cricopharyngeal myotomy by collar incision, endoscopic trans-oral cricopharyngeal myotomy is less invasive and useful, especially when treating elderly cases. Further adoption and verification of this method are eagerly awaited.
Pharyngo-esophageal perforation is encountered rarely in routine clinical practice and can sometimes be complicated by severe deep neck infection or acute mediastinitis. Combined surgical procedures involving the neck and chest via sternotomy generally tend to be avoided because of risk of mediastinitis immediately postoperatively. We encountered a case of pharyngo-esophageal perforation by dental implant ingestion immediately after thoracic surgery via sternotomy. The patient was a 66-year-old woman with a chief complaint of a foreign body postoperatively. The foreign body was found around the cervical esophagus. Open neck surgery for removal of the foreign body and closure of the perforation was performed immediately. The foreign body was identified as a dental crown with a sharp metallic top and edge. In this case, no severe complications occurred despite the ingestion being immediately after thoracic surgery. This is likely because the patient was fit and stable enough to undergo open neck surgery under general anesthesia, and the foreign body was found and removed promptly. A tracheal stoma was not created so as to avoid contamination.
Recently, there have been case reports on the usefulness of transoral removal procedures with a curved rigid laryngoscope for foreign body removal from the pharynx and esophagus. However, no case series have yet been performed on this topic. We treated four patients using this device in the last four years. This study aimed to investigate the clinical features of our cases and previously reported cases. In addition, we showed one representative case of fish bone swallowing into the hypopharynx. A 63-year-old woman presented with a complaint of pharyngeal discomfort after eating fish of the species Seriola quinqueradiata (Japanese amberjack). A fish bone was lodged between the bilateral piriform sinuses, and both its ends were penetrating the mucous membrane. We divided this fish bone at the center, and removed the two pieces with no further damage to the mucous membrane. To date, there have been 6 reports (7 cases) of foreign body removal from the pharynx and esophagus utilizing this technique. We investigated the clinical features of 11 cases including ours. The average age of the patients was 72.5 years old. The most common foreign body was a fish bone. Almost all foreign bodies were located between the hypopharynx and cervical esophagus. Unlike other devices used for removal purposes, a curved rigid laryngoscope enables a wide surgical view, thus providing a wide operating field and workspace. In all our cases, and in previously reported cases also, it was possible to easily divide the foreign body and apply traction or incise the mucous membrane surrounding it. Thus, we believe transoral foreign body removal with a curved rigid laryngoscope is a useful technique in cases of hypopharyngeal and cervical esophageal foreign bodies.
Castleman’s disease (CD), a lymphoproliferative disorder, was first reported by Castleman, a pathologist, and his colleagues in 1954 as thymoma-like lymphoid hyperplasia localizing to the mediastinum associated with chronic progressive fever and muscle weakness. Clinically, CD has been categorized into “local” unicentric CD and “systemic” multicentric CD. Histopathologically, Keller et al. divided CD into a hyaline-vascular type and plasma cell type. Here, in addition to presenting a literature review, we report our experience of a case in which a CD patient underwent follow-up care after diagnosis of a benign neck tumor.
Carcinoma metastasis to the thyroid is uncommon, and has a poor prognosis. We report the case of a 77-year-old man with thyroid metastasis from hepatocellular carcinoma (HCC) with invasion of the larynx. He presented difficulty in swallowing and a tumor on the neck. Computed tomography revealed a tumor in the right lobe of the thyroid with invasion of the larynx. Ultrasound-guided fine needle aspiration (US-FNA) suggested the tumor was a poorly differentiated carcinoma or papillary carcinoma. Although the patient had a metastatic carcinoma from HCC in the lung, he wanted to continue eating orally until he died. A thyroidectomy and total laryngectomy were performed. Histopathological examination revealed a diagnosis of carcinoma metastasis to the thyroid from HCC. Despite use of molecularly targeted therapy, the patient is doing well one year and a half after surgery. Operative therapy may also be useful even for patients with an uncontrollable disease, in order to prevent respiratory and swallowing problems caused by carcinoma metastasis to the thyroid.