Once the patient's respiratory and general conditions improve after a tracheostomy, we must work to restore the patient's oral intake and speech function. However, these functions may not be restored if the tracheostomy is performed in an inappropriate site and postoperative management is inadequate. Case 1 (83-year-old male) had a tracheostomy tube placed in the cricothyrotomy ligament and was followed up, resulting in failure to elevate the larynx and subglottic stenosis. Case 2 (86-year-old male) had a tracheostomy performed from the right lateral side of the trachea, which resulted in inability to elevate the larynx and paralysis of the right vocal cord. Case 3 (78-year-old female) had a high tracheostomy that injured the cricoid cartilage, resulting in failure of laryngeal elevation and subglottic stenosis. For these three cases we reoperated with the tracheal foramen in the appropriate position. In Case 1, laryngeal elevation and subglottic stenosis were improved and the tracheal foramen was closed. In Case 2, laryngeal elevation and paralysis of the right vocal cord were improved and the tracheal foramen was closed. In Case 3, the anterior surface of the cricoid cartilage was resected and a long vertical tracheal foramen was formed. Although the tracheal foramen was difficult to close, a tracheostomy tube was no longer necessary. In all three cases, oral intake was possible after reoperation to properly position the tracheal foramen. Appropriate tracheostomy is important to improve postoperative swallowing and speech function.

Type 4 thyroplasty (TP4) is a technique for raising speaking fundamental frequency (SFF). Traction sutures increase the tension of the vocal fold by closing the thyroid cartilage and cricoid cartilage, and the sutures are fixed by GORE-TEX^® (GT). However, use of artificial materials sometimes results in infection. Here we report a case of infectious granuloma 13 years after TP4. The case was a 78-year-old male. He was diagnosed with male to female gender identity disorder in 200X. To increase his SFF, he underwent TP4 in 200X＋1. In 200X＋14, he came to us with complaint of an infectious mass, and an infectious granuloma was found on the neck skin. GT was found in the anterior commissure. The patient's voice profiles were G2R2B2, SFF 269 Hz, jitter coefficient 4.43%, shimmer coefficient 7.87%, NHR 19.6 dB, and VHI 63/120. The granuloma, GT, and traction thread sutures were removed under general anesthesia. The thyroid cartilage showed a perforation into the laryngeal lumen, and it was covered with the strap muscles. After the removal operation, the voice profiles did not change and the SFF was not decreased. Over a long time period the cricothyroid joint became fixed after traction sutures removal, the SFF was unchanged. If infection occurs around artificial materials, they should be removed in order to control the infection.

In patients who complain of pharyngolaryngeal discomfort, stuffiness, or sustained swallowing difficulty, esophageal disease may sometimes be found. Here, we report a case of esophageal motility disorder successfully treated by the combined administration of isosorbide dinitrate, a calcium channel blocker, and Chinese herbal medicine (Shakuyaku-kanzo-to). A 62-year-old male had complained of difficulty in swallowing pills for 10 months. He lost about 10 kg in weight in a year. Endoscopic examination of swallowing and upper gastrointestinal endoscopy showed no abnormalities, but videofluorographic examination of swallowing showed insufficient opening of the upper esophageal sphincter during the pharyngeal swallowing stage, peristaltic dysfunction of the thoracic esophagus, and spasticity of the lower esophagus. With these findings, he was diagnosed with primary esophageal motility disorder, and administered isosorbide dinitrate, calcium channel blocker, and Shakuyaku-kanzo-to. Thereafter, his symptoms gradually improved, and dysphagia had almost disappeared at one month later. After 3 months, he gained 7 kg in his weight. Since the causes of dysphagia vary, we wish to stress the need to consider esophageal disease if the symptoms of dysphagia continue or progress for a long period of time.

The case is a female in her 80s. She was referred to our department because she had no subjective symptoms and a foreign body was pointed out by an imaging test. Various examinations suggested that a metallic foreign body had completely invaded the pharyngeal esophageal cavity near the right lobe of the thyroid gland. No inflammatory findings such as abscess were observed. Since the foreign body could not be confirmed endoscopically and could not be removed endoscopically and orally, an extracervical incision was judged to be necessary in order to remove the foreign body. After examining the localization of the foreign body in detail by cervical ultrasonography and 3D-CT, foreign body removal surgery by cervical incision was performed under general anesthesia. Consistent with the preoperative examination, a metal dental foreign body was found outside the pharyngeal cavity and could be removed without damaging the recurrent laryngeal nerve. No problems occurred after the operation. Foreign bodies that have completely entered the pharyngeal esophageal cavity may take some time to be detected if there are no signs of inflammation. Neck incision surgery is often required to remove the foreign body. We believe that it is possible to safely and reliably remove a foreign body after conducting a detailed preoperative examination.