Major complications of tracheotomy tube placement in children include the formation of suprastomal granulation and suprastomal tracheal collapse, with subsequent unsuccessful decannulation. Surgical treatment, tracheostomaplasty, is usually conducted in these children; however, there are no reports regarding these cases. We therefore researched the targeted development factors of 48 cases with successful decannulation over the past five years. The operations included 27 cases (11 for granuloma only, 9 for collapse only, and 7 for granuloma and collapse). There were no significant differences between the operated group and the non-operated group regarding the tracheotomy tube placement period and the age at which the tracheotomy tube was placed. However, there was a significant difference regarding the age of decannulation. An operation was needed so that the patient would be young when decannulation was attempted. There was also a significant difference regarding the material of the cannula. Cases in which a cannula made of harder polyvinyl chloride was used tended to need an operation more than cases in which a cannula made of silicon was used. Also, the development rate of granulation was high among aspirationprone patients. We report these cases including the treatment protocol and operation method used at our hospital.
This report describes the treatment results of 14 patients with dysphagia after resection of primary brain tumor. All patients required a feeding tube before treatment of dysphagia. Eight patients had limb paralysis and/or ataxia. We performed physical therapy and/or operation for dysphagia on all patients, operating on those who could not achieve successful results by physical therapy. The operations were cricopharyngeal myotomy and laryngeal suspension, thyroplasty type 1, arytenoid adduction, oral corner retraction and pharyngeal reefing.
One of the 14 patients presented with postoperative meningioma in the temporal lobe, and the other 13 had infratentorial tumors. One of the 13 showed a tumor with unclear pathological diagnosis, while the other 12 patients with infratentorial tumors consisted of 3 meningiomas and 3 neurinomas in the CP angle, 2 hemangioblastomas in the medulla, 2 hemangioblastomas in the cerebellum, and 2 ependymomas in the fourth ventricle. Six of the 14 were low frequency tumors in the infratentorial region, such as hemangioblastoma and ependymoma.
We performed physical therapy on all patients, but 10 were unable to take the therapy orally. One of the 10 was inoperable because of poor condition, and another did not want the operation. The remaining 8 of the 10 underwent surgical therapy. Seven of the 8 operated became able to take the therapy orally. One patient, who suffered from hemiplegia, bilateral hearing disturbance, facial hyposensitivity and unilateral facial palsy after resection of CP angle meningioma, was unable to take the therapy orally even after surgical treatment.
Thyroplasty type I (TP I)uses an artificial material to medialize the paralyzed vocal fold. There have been reports of prolapse of artificial materials as a late complication. We report two cases of GORE-TEX deviating into the pharynx after TP I. Case 1 was a 69-year-old man who underwent arytenoid adduction and TP I for vocal cord paralysis after surgery for esophageal cancer. Three years later, throat discomfort appeared, and GORE-TEX protruding from the piriform sinus into the hypopharynx was observed. It was orally removed under general anesthesia. Case 2 was a 67-year-old man who underwent TP I for vocal fold paralysis caused by a traffic accident. Six months after the operation, GORE-TEX was visible in the piriform sinus. At 11 months after the operation, it was orally removed under general anesthesia. In the original TP I method, the general rule is to preserve the cartilage piece of the window and the inner perichondrial membrane. However, in order to medialize the posterior portion of the vocal fold, the inner perichondrial membrane may be ruptured and the thyroarytenoid muscle or the arytenoid cartilage itself may be moved inward or rotated. The risk of the artificial material escaping to the pharynx should be kept in mind when artificial material is translocated across the inner perichondrial membrane in TP I.
Laryngotracheal separation surgery is a minimally invasive procedure among surgical treatments for intractable aspiration. Postoperative laryngocutaneous fistula is the most frequent complication of this surgery. However, to date there have been few reports of useful treatment for the fistula. Here we report a case in which a laryngocutaneous fistula was reconstructed to compensate for suture failure after laryngotracheal separation surgery, and partial resection of the cricoid cartilage by the Kano method was performed to close it. A 59-year-old man with dysphasia caused by cerebral infarction was referred to our hospital. Laryngotracheal separation surgery was performed to prevent aspiration. At the 14th day after surgery, anastomotic leakage and bleeding occurred and surgical treatment for these complications was performed. The laryngocutaneous fistula was reconstructed because it was difficult to suture the anastomotic leakage at the time. After the wound healed, surgical closure of the fistula by the Kano method was performed and the patient had a good postoperative course. Surgical closure of the larynx by the Kano method is a useful procedure to close a fistula complication after laryngotracheal separation surgery.
Various disorders can cause stenosis of the upper esophageal orifice, including mucous membrane pemphigoid, epidermolysis bullosa, Plummer-Vinson syndrome, Behcet's disease, and the aftereffects of chemoradiation treatment of head and neck cancer. We experienced a case of stenosis of the upper esophageal orifice discovered by inability to perform upper gastrointestinal endoscopy through the constricted orifice. Reports of stenosis of the upper esophageal orifice complicated with Sjögren' s syndrome, as we found in this case, are rare. To treat mucous stenosis of the esophageal orifice, we performed surgery to open and enlarge the esophageal orifice. This enabled proper passage of an endoscope into the upper part of the gastrointestinal tract. In everyday medical practice, the physician should keep in mind that dysphagia can be caused by a rare disorder which is difficult to observe, such as stenosis of the esophageal orifice.
We report a case of nasopharyngeal stenosis as a late complication of transoral resection and postoperative radiation therapy for oropharyngeal cancer which was successfully treated by Y-V palatopharyngoplasty (Y-V PPP). Y-V plasty is commonly used in plastic surgery for releasing scar contracture. A 60-year-old woman with oropharyngeal cancer (left posterior wall, squamous cell carcinoma, cT2N1M0 stage III) was treated with transoral resection, left selective neck dissection and postoperative radiotherapy (70 Gy/35 Fr). The soft palate and oropharyngeal posterior wall became constricted by cicatrical contracture 11 months after surgery, and she complained of nasal congestion, hyporhinolalia and slurping movement disorder. Since the nasopharyngeal stenosis worsened, at 5 years after the surgery we performed Y-V PPP under general anesthesia. We opened the patient's mouth with a Davis-Meyer mouth opener. Both outer sides of the uvula were incised in a Y shape, and the apex of the V-shaped flap was sutured to the lower end of the Yshaped cut line. Operation time was 89 minutes. After Y-V PPP, nasal congestion hyporhinolalia and slurping movement disorder soon recovered. Her Voice Handicap Index improved from 106 (before surgery) to 21 (4 months after surgery). Nasopharyngeal endoscopy showed good nasopharyngeal closure. No nasopharyngeal reflux occurred during oral intake. Although cases of postoperative nasopharyngeal stenosis may increase as transoral resection becomes more prevalent, the treatment has not yet been developed. Y-V PPP is minimally invasive and technically easy to learn for head and neck surgeons, so it can be one of the treatment options for nasopharyngeal stenosis.
Summary and Background: We report a case that took 18 months for a complete recovery from surgery, bronchial occlusion by Endobronchial Watanabe Spigot (EWS), and pleurodesis to treat lung fistulas due to empyema. Case: A 78-year-old woman was referred to our hospital for treatment of tuberculosis and pneumothorax. She had undergone video-assisted thoracic surgery at the former hospital, and tuberculosis was detected from pleural effusion at the time of operation and from sputum after the operation. We started continuous chest drainage and anti-tuberculosis therapy. After 2 months, no tuberculosis was found in her sputum culture and pleural effusion but lung leakage did not improve, and re-surgery was performed 3 months after hospital transfer. In the operation, two different lung fistulas were found to be firmly adhered to the chest wall, so the operation was performed by fixing a polyglycolic acid (PGA) sheet to the fistulas. After the operation, the patient was treated with EWS occlusion therapy and repeated pleurodesis. She was discharged from the hospital with chest tube drainage 12 months after the initial operation. She suffered from empyema 2 months after discharge and underwent antibiotic therapy. The leakage was stopped after the therapy and the drain was removed 4 months later. No recurrence was observed 19 months after the removal of the chest drain. Conclusion: Patients with high risk from pneumothorax and tuberculosis can be treated by combining various treatments for a long period while maintaining ADL.
This report presents a case of descending necrotizing mediastinitis (DNM) that was effectively treated by means of a transcervical drainage approach. The patient was an 81-year-old female. She visited our hospital with cold-like symptoms, such as a high fever and a sore throat. We suspected that she might have DNM based on the findings of both a chest X-ray and computed tomography. An abscess was also observed on her neck, and therefore we diagnosed the patient to have DNM. We performed antibiotic therapy and surgical drainage by means of a transcervical approach. The treatment proved to be effective and she was discharged two weeks after the operation.
Thyroid cancer generally carries a good prognosis and appropriate operation allows long-term survival. However, advanced thyroid carcinoma which causes stenosis and compression of the airway occasionally makes ventilation and intubation difficult. When performing surgery in such cases, airway management should be considered preoperatively. We report a case of thyroid carcinoma with severe tracheal stenosis in which we undertook intubation and thyroidectomy with VV (veno-venous)-ECMO (extracorporeal membrane oxygenation). VV-ECMO is useful for airway management in patients who exhibit a thyroid tumor with severe airway stenosis.