Laryngeal paralysis is occasionally associated with other cranial neuropathies. Associated laryngeal paralysis, as the disease is then called, is thought to be caused by viral infections and is often difficult to diagnose in its early stages. In this study, we reviewed 6 cases of associated laryngeal paralysis believed to be due to reactivation of varicella zoster virus (VZV) or herpes simplex virus (HSV) which we observed between November 2013 and October 2019. Our review showed that dysphagia was present in all 6 cases, facial nerve paralysis in 5 cases, curtain signs in 3 cases, and vestibulocochlear dysfunction such as hearing loss in 4 cases. One case was clinically diagnosed with Ramsay Hunt syndrome, 4 cases were diagnosed with viral reactivation by VZV, and 1 case was diagnosed with idiopathic or viral reactivation by HSV. All patients were treated with corticosteroid and anti-viral therapy. After treatment, the laryngeal paralysis improved in 5 of the 6 cases. Dysphagia, facial nerve paralysis and vestibulocochlear dysfunction improved in all cases. Early diagnosis of viral-associated laryngeal paralysis is difficult when it lacks any of the three characteristics of Ramsay Hunt syndrome : skin rash, facial nerve palsy, and inner ear nerve palsy. At the same time, laryngeal paralysis has a poor prognosis. For these reasons, early therapeutic intervention is needed and otolaryngologists should perform early treatment for patients with associated laryngeal paralysis thought to be due to reactivation of VZV or HSV, in order to improve their prognosis.

Object: Knowing the dimensions of the human larynx is useful for performing framework surgery and surgery to treat laryngeal trauma. The aim of this study was to perform anatomical measurements of the laryngeal cartilage and to compare such measurements between men and women. Materials and Methods: Laryngeal images of 40 adult patients 19 years of age and older were obtained by ultra-high-resolution computed tomography. Three-dimensional reconstructions were made and the parameters of the laryngeal cartilage were measured : height of thyroid (from thyroid notch to inferior thyroid border at midline), width of thyroid cartilage (from anterior commissure to posterior border of thyroid cartilage at the vocal fold level)，angle between the thyroid laminae at the vocal fold level, superior-inferior height of the anterior arch and posterior wall of the cricoid cartilage, inside diameter (anterior-posterior and left to right), and the angle between the superior border and inferior border of the cricoid cartilage. Results: The majority of the laryngeal measurements obtained in this study were higher in males than females, and the angle between the thyroid laminae at the vocal fold level was smaller in men than in women. In addition, the inside diameter anterior to posterior of the cricoid cartilage was significantly larger than the inside diameter left to right. The inferior shape of the cricoid cartilage was oval. Conclusion: Sex is an important factor to define laryngeal morphometrics. There was approximately a 17° gender-related difference in the average angle between the thyroid laminae, with the larynges of men showing a smaller angle than those of women. Our results produced a more acute angle than reported previously. We need to evaluate individual images carefully before performing laryngeal surgery.

We conducted a retrospective review of 41 patients with COVID-19 who underwent tracheostomy at Kobe City Medical Center General Hospital. The 41 patients were classified into four groups : pre-fourth wave, fourth wave, surgical tracheostomy, and percutaneous tracheostomy. Clinical characteristics, days from intubation to tracheostomy, hospital death rate, and days from tracheostomy to death in fatal cases were evaluated, and comparisons were made between the four groups. In the fourth wave group, body mass index (BMI) was significantly higher than in the pre-fourth wave group, so obesity was considered to be one of the risks of severe COVID-19. In the fourth wave group, tracheostomy was performed earlier, but the hospital death rate worsened in both surgical tracheostomy cases and percutaneous tracheostomy cases. These results revealed that early surgical tracheostomy in COVID-19 cases did not contribute to improvement of patients' survival outcome. We concluded, however, that early tracheostomy was necessary to save medical resources, such as beds in intensive care units, and ultimately to promote normal medical care for patients other than those directly impacted by COVID-19.

An 81-year-old male came to our hospital presenting with a chief complaint of odynophagia, and his previous doctor had pointed out an irregular mucosal lesion on the epiglottis by laryngeal endoscopy. We suspected it to be a malignant tumor, but a laryngeal biopsy showed only necrotic erosion and chronic inflammatory findings. Chest X-ray showed a ground-glass appearance in the upper left lung field, so we suspected tuberculosis disease, but the result of interferon-gamma release assay T-SPOT was intermediate. We tried a second laryngeal biopsy under general anesthesia, but an acid-fast bacillus smear test and Ziehl-Neelsen staining were negative. Tuberculosis polymerase chain reaction (PCR) could not be performed due to insufficient sample volume. As there were no tumor cells in the sample, we were unable to make a definitive diagnosis. However, during the follow-up period after discharge, Mycobacterium tuberculosis complex was reported in the third week of the cultivation test. Ultimately, the definitive diagnosis of laryngeal tuberculosis took about 2 months. Diagnosis of tuberculosis requires a combination of various tests, and time consumed for diagnosis increases the risk of secondary infection to the surrounding area. It is known that the interferon-gamma release assay, which has high sensitivity and specificity, is also affected by the weakened immunity of the elderly, and its sensitivity is reduced. For cases in which tuberculosis is suspected, it is important to carry out various tests in a one-stage and comprehensive manner.

Type 2 thyroplasty (TP2) is a surgery for adductor spasmodic dysphonia (AdSD), and the effectiveness of the surgery depends on the width of cartilage separation and fixation of that width. We experienced a case of breathy hoarseness after initial surgery, and revision surgery was performed and the voice improved. The patient was a 41-year-old woman who was diagnosed with AdSD. To begin, voice therapy was performed, but there was no improvement. Next, TP2 was performed. The thyroid cartilage was split on the midline and two 3.0 mm wide titanium bridges (TBs) were placed on the thyroid cartilage. However, breathy hoarseness appeared after the primary surgery. One month after the first surgery, revision surgery was performed to improve the breathy hoarseness. The two TBs were removed completely, and one 2.0 mm wide TB was placed onto the lower part of the thyroid cartilage. The voice improved to G1R0B1A0S0 and the mora method was 0/21. In TP2, it is important to adjust the width of the cartilage split. If it is too narrow, a spasmodic voice remains, and if it is too wide, the voice becomes breathy. In this case, the voice became breathy after the first surgery, but the revision surgery salvaged the breathy voice. We reconfirmed that TP2 is a reversible surgery and discuss the causes of reoperation and preventive measures.

Tracheoesophageal speech with a voice prosthesis is the preferred technique for vocal rehabilitation after total laryngectomy. One of the most inconvenient complications of voice prosthesis usage is periprosthetic leakage of fluids inducing aspiration. Periprosthetic leakage mainly occurs when the fistula is too wide because of atrophy of the periprosthetic tissues. In some cases, definitive closure of the tracheoesophageal shunt is required to prevent persistent pneumonia. We report two cases of patients with periprosthetic leakage managed using surgical methods. One case was managed only with shrinkage, while the other case required shrinkage with ligament tissue graft. In Japan, expanding adoption of voice prostheses will lead to an increase in cases with periprosthetic leakage. Therefore, highly effective therapeutic methods should be established to manage this condition.

Introduction: In recent years, there have been increasing numbers of esophageal cancer patients who previously underwent gastrectomy for gastric cancer. In these patients, a pattern of abdominal lymph nodes metastasizing from esophageal cancer may conceivably be reduced when lymphadenectomy is performed for the gastric cancer. Especially with total gastrectomy, very few cases have been reported of the possible influence of esophageal cancer spreading to the abdomen. Case presentation: A 70-year-old man who had undergone a previous total gastrectomy for gastric cancer was diagnosed with middle thoracic esophageal squamous cell carcinoma in his postoperative follow-up. After receiving two cycles of a twice-weekly DCF regimen of neoadjuvant chemotherapy, he underwent thoracoscopic subtotal esophagectomy with three-field radical lymph node dissection. We detected and resected lymph node metastasis in the elevated jejunum mesentery during the patient's subtotal esophagectomy. He was diagnosed with esophageal squamous cell carcinoma pT3N2M0 pStage IIIB or pT3N2M1 pStage IV, depending on whether meso-jejunum lymph node metastasis was defined as regional or distant. Conclusion: The possible effects of jejunal mesenteric lymph node dissection on esophageal squamous cell carcinoma after total gastrectomy have not been clarified. To collect cases, it may be beneficial to examine the site carefully in images before surgery and to perform samplings of the applicable lymph node during surgery.