Laryngeal papilloma is a neoplastic disease of the larynx often showing human papillomavirus (HPV) infection. Although histologically benign, the disease is known to have a high recurrence rate, with malignant transformation occurring in a few percent of cases, making it one of the most intractable diseases. At our hospital, YAG laser cauterization with laryngeal microsurgery is our first choice of treatment. In the present study, we retrospectively reviewed 61 cases of laryngeal papilloma surgically treated at our hospital during the 14-year period from June 2005 to October 2019. The mean age was 51.9±19.7 years, with males dominant: 40 males to 21 females. The average number of treatments was 2.3 (single-occurrence: 1 to 6 times ; multiple-occurrence: 1 to 17 times). The mean follow-up from final treatment was 36±31 weeks. The absence of recurrence after a single treatment occurred in 34 cases and recurrence after the initial treatment occurred in 24 cases. Among the recurrence cases, 6 had residual disease after multiple surgeries. Pathological findings showed 3 cases of malignant transformation. From the results of this study, it is possible that differences in HPV viral types may emerge in refractory cases, suggesting the need for the introduction of viral testing. In addition, there are few reports on the efficacy of adjuvant therapy in Japan, so further evidence needs to be collected.

In advanced pyriform sinus squamous cell carcinoma of the hypopharynx treated with total laryngopharyngectomy, hemithyroidectomy to total thyroidectomy and paratracheal node dissection is recommended. In general, ipsilateral paratracheal neck dissection should be conducted, but there is little evidence for surgical management for the contralateral side. We undertook a retrospective review of 117 patients with pyriform sinus carcinoma who underwent total laryngopharyngectomy for initial treatment between January 2005 and December 2015. We investigated the area of the paratracheal neck dissection, histopathological paratracheal lymph node metastasis, rate of thyroid and parathyroid hormone replacement, and prognosis. The rate of ipsilateral paratracheal lymph node metastasis was 11.1% (13 out of 117) and that of the contralateral side was 4.5% (1 out of 22). Stomal recurrence was observed in one patient. The patient underwent definitive chemoradiation followed by adjuvant chemotherapy and had no recurrence for 13 years after surgery. The rates of thyroid and parathyroid hormone replacement in patients with bilateral paratracheal neck dissection were significantly higher than those in unilateral paratracheal neck dissection. In advanced pyriform sinus squamous cell carcinoma with total laryngopharyngectomy, hemithyroidectomy and ipsilateral paratracheal lymph node dissection can be considered as a treatment option for surgical management around the paratracheal area.

Piriform sinus fistula is a congenital internal fistula and is relatively rare. Surgical treatment is the first choice for piriform sinus fistula and three methods have been reported : fistulotomy through an external neck incision, transoral fistula cautery and transoral videolaryngoscopic surgery (TOVS). A 13-year-old boy presented to our hospital with left anterior neck pain and fever. Ultrasonography revealed acute pyogenic thyroiditis, and the patient was treated with puncture drainage and antibiotics. After the inflammation was improved, hypopharyngeal esophagography revealed a 1 cm fistula tract running from the left piriform, leading to the diagnosis of a piriform fistula. TOVS was performed under general anesthesia. The postoperative course was good and there has been no recurrence to date. TOVS is a less invasive treatment without any skin incision. Moreover, the resected mucosa is sutured and the infection route is closed after resection of the fistula. TOVS is considered to be a highly curative procedure.

Neurofibromatosis type 1 (NF-1) is said to be rarely associated with vascular lesions such as arterial stenosis, aneurysm, arteriovenous fistula, or arteriovenous malformation. These vascular lesions, which are thought to be attributable to vascular fragility, cause fatal complications depending on their location and conditions. We experienced a case of ruptures of the thoracoacromial artery and ascending pharyngeal artery associated with NF-1 whose life was saved by emergency tracheostomy and endovascular treatment. As it is rare for arterial bleeding from two places to occur at the same time and the patient's life is saved, here we report our case together with a review of the literature. The case was a 61-year-old woman with NF-1 brought to our hospital due to rapid swelling after mild cervical irritation. She underwent an emergency tracheostomy for airway stenosis, and significant bleeding from the wound was found. Contrast-enhanced CT performed to search for the source of the bleeding revealed a huge hematoma and leakage of contrast medium in the right neck. She was suspected of having had sudden cervical swelling due to an arterial rupture. Subsequently she underwent angiography and transcatheter arterial embolization (TAE) on the bleeding source, and hemostasis was obtained and her life was saved. In NF-1 cases, bleeding from the neck may require urgent airway management, so otolaryngologists and head and neck surgeons should be familiar with these complications.

We report the case of a 66-year-old man diagnosed with adenocarcinoma at the esophagogastric junction in 2016, with a history of stage IVa middle thoracic esophageal squamous cell carcinoma, diagnosed in 2007, that had a complete response after undergoing chemoradiotherapy (cisplatin/5-fluorouracil plus RT at 60 Gy). Radical resection via a left thoracoabdominal approach was performed including the irradiation field, lower esophagectomy and proximal gastrectomy with jejunal interposition. Postoperatively there was esophagojejunal anastomotic leakage, and a drainage tube was inserted transnasally into the abscess cavity through the site of the suture failure. Through enteral nutrition and intermittent drainage, the abscess cavity gradually narrowed, and the esophagojejunal anastomotic leakage was fully treated. This was an unusual case involving anastomotic leakage completely resolved through conservative drainage at the site of the suture failure. We include a detailed review of the literature.

We report a case of paratracheal air cyst that was thought to be a late complication caused by a tracheostomy performed 20 years earlier. The patient was a 71-year-old man who had undergone a tracheostomy as part of treatment for aortic dissection. After the tracheostomy stoma was closed, he showed no symptoms until 20 years later, when he experienced swelling and anterior neck pain accompanying an upper airway infection. Although the pain was subsequently relieved, the swelling remained. Initially a doctor belonging to a different department detected a cystic lesion in the anterior region of the trachea by CT scan examination, and the patient was referred to our ENT department. After conservative treatment proved ineffective, we performed a cystectomy. Postoperative pathology suggested that there were 2 emphysemas, each of a different histological structure. One had findings consistent with a tracheal diverticulum and the other had the findings of a simple cyst. Based on the pathological findings and a literature review, we postulated that the tracheal lumen mucosa had deviated from an insufficiently closed tracheostomy wound, a tracheal diverticulum had formed, and an upper airway infection caused a tracheal air leak around the diverticulum which caused pseudocysts to form. Although there have been no previous reports of tracheal diverticulum related to an earlier tracheostomy, we presumed that other tracheal diverticula cases might exist but did not show as a result of the postoperative healing process. We concluded that if there is a patient with a history of tracheostomy who shows any symptoms, we should undertake close examination of a cervical-chest CT image and check for the presence of a tracheal diverticulum.