Introduction: Tracheostomy is a common surgical procedure performed by the otolaryngologist. Tracheostomies may be required not only to treat otolaryngological diseases but also for intubated patients being treated in other departments. Despite the extensive use of tracheostomies, there is no clear consensus on the best timing for a tracheostomy after intubation or the outcomes of long-term oral intubation. Methods: Ninety-eight patients who underwent tracheostomies between April 2017 and July 2019 were retrospectively reviewed. The factors evaluated included the primary disease, department requesting the tracheostomy, indication for the tracheostomy, surgical procedure, and postoperative course. We also analyzed the complication rate and mortality rate, taking into consideration the timing of the tracheostomy in 50 patients with long-term intubation. Results: This study included 71 male and 27 female patients, with an average age of 70 years (range: 17-95 years). Thirty-four of the 98 patients (35%) were from our department; of the remaining patients, more than half were from the internal medicine department. The rate of surgical complications was similar to that reported previously. With respect to mortality rate, out of nine early postoperative deaths, five were found to be due to cardiopulmonary dysfunction associated with the underlying disease. Thirty-two patients from the group with prolonged intubation developed complications associated with long-term intubation, and 22 of these patients died. There was no significant difference in the complication rate or mortality rate between the early and late surgical intervention groups. Conclusion: In patients with long-term intubation, it is important to take into consideration the indication for and timing of the tracheostomy, the general condition of the patient, and the prognosis of the underlying disease.

Because tracheal stenosis is a relatively rare disorder, the number of cases managed at each institution is small, and its treatments have not been adequately investigated. We examined the clinical course of eight cases of tracheal stenosis that developed after tracheal intubation or tracheostomy. Three cases underwent tracheal intubation; two, tracheostomy; and three, tracheal stenosis after both procedures. Those with narrowed lumen due to soft tissue were classified as scar type, and those with invaginated tracheal cartilage were classified as cartilage-buckling type. Steroid therapy was administered in three patients with mild cases, and conditions improved in two of the patients. Tracheoplasty by the trough method was performed in four scar-type cases. In three patients who did not undergo mucosal transplantation, a T-tube was placed as a stent for two months or longer, and the lumen was enlarged. Two patients with the cartilage-buckling type underwent cartilage reposition. A speech cannula was placed as a stent in one patient, and tracheo-cutaneous fistula closure surgery was performed in one complete procedure in the other patient. Since the mechanism of tracheal stenosis varies depending on the cause and time of onset, it is important to select an appropriate treatment method according to the case.

Vascular tumors and vascular malformations have been internationally classified by the ISSVA classification last revised in 2018. In Japan, clinical practice guidelines provide guidance on their diagnosis and treatment. Such tumors and malformations can occur in any part of the body, and those that occur in the pharyngolaryngeal regions require careful management specific to the airways, making it difficult to select a treatment method. From 2017 to 2019, we treated 4 cases of pharyngolaryngeal vascular malformation in our department. Of these, 1 case involved arteriovenous malformation (AVM) of the side wall and anterior wall of the oropharynx, 2 cases were venous malformation (VM) of the larynx and hypopharynx, and 1 case consisted of combined vascular malformation (lymphatic-venous malformation: LVM) of the posterior wall of the hypopharynx. Evaluation of blood flow speed (slow or fast) is particularly important when considering treatment of pharyngolaryngeal vascular malformation. The diagnosis is made mainly by ultrasonography with Doppler method, enhanced MRI, and transnasal endoscopy. The treatment options broadly divide into surgical excision and sclerotherapy, each with its own strengths and weaknesses. The 3 cases of VM and LVM underwent transoral resection, and the case of AVM underwent intravascular embolization and sclerotherapy. In recent years, transoral partial pharyngolaryngectomy surgery methods such as endoscopic laryngo-pharyngeal surgery (ELPS) and transoral videolaryngoscopic surgery (TOVS) have been developed for head and neck cancer, and we postulated that transoral surgery can be applied to patients with localized VM of the pharyngolarynx up to about 4 cm in diameter. With an extremely large fast-flow AVM of the laryngopharynx, however, treatment is difficult because here the aim is to control rather than cure the disease by combining multiple treatments centering on embolization and sclerotherapy.

The balloon method is one of the rehabilitation procedures used for patients with cricopharyngeal dysfunction. We report a case in which severe dysphagia occurred after treatment for tongue cancer and the dysphagia was prolonged for several years, and a good effect was obtained by performing balloon dilatation. The case was a 72-year-old man. Approximately 4 years before the first visit to our hospital, left tongue subtotal resection, neck dissection, free flap reconstruction, tracheostomy, and postoperative radiation chemotherapy were performed at another hospital for tongue cancer. Immediately after the operation, dysphagia was observed, and after the treatment, swallowing became impossible. Later, he improved his swallowing function to the extent that he could enjoy food, but he was referred to our department out of a strong desire for oral intake. Videofluoroscopic examination of swallowing revealed oral disorders involving mastication and bolus feeding, as well as laryngeal elevation failure and cricopharyngeal dysfunction. The main pathological condition of dysphagia was considered a cricopharyngeal dysfunction, and immediate effect was obtained when the balloon intermittent dilatation method was performed under fluoroscopy. Therefore, the patient was admitted to the hospital for rehabilitation at a later date and was instructed on the balloon dilatation method. It became possible to take 3 meals of paste food. These results suggested that there are cases in which functional improvement can be obtained by grasping the pathophysiology of dysphagia and performing therapeutic rehabilitation techniques such as the balloon dilatation method for patients with prolonged dysphagia.

Most laryngeal malignancies are squamous cell carcinomas. Chondrosarcoma has been reported in 0.2% of laryngeal malignancies. Among laryngeal chondrosarcoma cases, cricoid cartilage is the most common primary site (70%). We experienced a laryngeal chondrosarcoma that required total pharyngo-laryngo-esophagectomy. The patient was diagnosed with a chondrosarcoma of the larynx and neck, and we performed a total pharyngo-laryngo-esophagectomy and bilateral neck dissection. The prognosis of laryngeal chondrosarcoma is relatively good, but there are few effective chemotherapies. In many cases, detection is delayed and total laryngectomy is unavoidable. Early detection is the key to maintaining postoperative quality of life, because even a partial laryngectomy can cure the disease if it is detected at an early stage.

The first report of a hyalinizing trabecular tumor, a rare form of thyroid tumor, was made by JA Carney. A problem with cytodiagnosis is the difficulty of differentiating hyalinizing trabecular adenoma from papillary carcinoma or medullar carcinoma. Here, we report a case in which diagnosis of hyalinizing trabecular tumor was possible preoperatively. The patient was a 47-year-old woman. Medical examination suggested the presence of a mass at the right lobe of the thyroid. Neck ultrasonography revealed a solid and well-defined mass sized 9 mm × 14 mm × 16 mm. Fine needle aspiration cytology found follicular epithelial cells containing intranuclear inclusion bodies. However, the cells had partly unclear cytoplasm and were clumped. Such features are not typical of thyroid papillary carcinoma. The patient underwent an operation involving right lobe resection and paratracheal lymph node dissection. Pathological diagnosis pointed to a hyalinizing trabecular adenoma. Determination on whether this tumor is benign or malignant is still inconclusive, and in the 8th edition of “General Rules for the Description of Thyroid Cancer” this case has been classified as “another tumor.” The important points for differentiating tumors are the form of the tumor cells, and the results and locations derived by immunohistochemistry.