Coronavirus disease 2019 (COVID-19), being highly contagious, has made the tracheotomy a high-risk procedure. From the viewpoint of preventing infection and ensuring safety, it is desirable to perform this surgery in an operating room having a negative-pressure environment. This is difficult to achieve, however, because of various limitations at most medical facilities. We have performed tracheotomies on 8 patients with COVID-19. Here, we discuss how to perform a tracheotomy on patients with COVID-19 safely when medical resources are limited. As our operating theater, we use a room for seriously ill patients within an isolation ward. We transfer the patient from the bed to a stretcher which serves as the operating table. This allows the surgeon to maintain a natural vertical posture near the patient, and also facilitates placing the patient in a position with the neck lengthened. We arrange the operating instruments in a manner identical with that adopted for a tracheotomy performed in an operating room. We also include Luer bone rongeurs in the tracheotomy set to enable a change in surgical procedure from tracheotomy to tracheostomaplasty by partial resection of the cricoid cartilage, when deemed necessary. In addition, safety and convenience are provided by using a portable shadowless LED light, preparing a cannula, and confirming the flow line between the staff by the previous day.

It is still unclear whether the Hyodo score of an initial videoendoscopic swallowing study (VE) is useful for predicting whether elderly patients with dysphagia will be able to intake orally at discharge. We reviewed the medical records of a regional acute care hospital retrospectively for 50 hospitalized patients (65-94 years old, median 85 years old) who needed swallowing evaluation. The incidence of aspiration-related events and the functional oral intake scale (FOIS) at hospital discharge were examined according to the severity of the Hyodo score at the initial evaluation. Aspiration-related events occurred in 16% of all patients (17% mild, 9% moderate, 27% severe). Oral intake was possible (FOIS ≥ 4) at discharge in 83% of patients with mild disease (0-3 points), 74% with moderate disease (4-7 points), and 20% with severe disease (8-12 points). When the score was < 7, almost 80% of patients could take sufficient nutrition orally at discharge. These results suggest that the initial Hyodo score can predict the prognosis of swallowing function in elderly inpatients at discharge.

As a treatment for female menopausal disorder, the patient underwent fixed-dose male and follicle-stimulating hormone injection therapy. As side effects, her speaking fundamental frequency (SFF) became lower and her vocal range narrowed. In addition, she developed functional dysphonia, which made it difficult for her to speak freely. Voice therapy (VT) for functional dysphonia enabled her to speak freely, and laryngeal stroboscopy enabled confirmation of vocal cord mucosal waves recovery. However, as the lowered SFF and narrowed vocal range did not improve, type 4 thyroplasty (TP4) was performed. In addition, starting from before the operation, physical therapy (PT) was performed by a physical therapist for respiratory muscle group activation, transversus abdominis muscle activation, and neck massage. The vocal cords, which had undergone organic changes, were extended by TP4, and VT was continued while vocal cord muscle tone was maintained, allowing the voice range to expand as well as pitch match, enabling singing of nursery rhymes with little inflection. Irreversible organic changes may have occurred not only in the vocal muscle group but also in the respiratory muscle group. Combined use of VT, PT, and TP4 was effective.

The patient, who was diagnosed with male-to-female gender identity disorder (MTF/GID) underwent type 4 thyroplasty (TP4) performed by her previous doctor. Four years later, she concluded that she was still male and came to our hospital in order to reverse the TP4. Her speaking fundamental frequency (SFF) was not expected to change to a low pitch, and the removal surgery was planned. In the surgery, the Gore-Tex bolster and traction sutures were removed, but the thyroid cartilage and cricoid cartilage were not returned to their previous condition, and her SFF did not decrease. A TP4 becomes irreversible with the passage of a long period of time.

Deep cervical abscesses have been reported to cause dysphagia in about 20% of cases after acute treatment. Here we report a case of successful surgery for improvement of deglutition to treat dysphagia after treatment of a widespread abscess from the neck to the mediastinum. A 64-year-old female had a cervical abscess and uncontrolled diabetes and was given antibiotics and glycemic control. However, the abscess continued to increase in size and was subsequently drained. After inflammation had subsided, she exhibited a decrease in ADL and severe dysphagia. Rehabilitation did not result in any significant improvement and oral intake became difficult. Following surgical treatment, swallowing function markedly improved. We discuss and report on dysphagia after deep cervical abscess and the effectiveness of surgery for improvement of deglutition.

Soft tissue sarcoma in the head and neck region is a very rare disease among all head and neck tumors, among which liposarcoma is the most common. When it occurs in the neck, it is difficult to remove completely at the time of recurrence from the anatomical point of view, and the prognosis is relatively poor. In this report, we describe a case of a large liposarcoma that required extensive resection to the deep lateral neck, beyond the scope of neck dissections handled by head and neck surgeons, in order to achieve a complete resection. The case was a 50-year-old male. He had undergone tumor resection seven times for an upper back lipoma, but recurrence repeated. The seventh surgical specimen was histopathologically diagnosed as well-differentiated liposarcoma, and the patient was referred to our department. The tumor extended from the left cervical region to the posterior cervical region and the back. The head and neck department performed radical neck dissection, and the tumor was resected beyond the deep cervical myocardium by orthopedic surgery. After resection of the tumor, it was reconstructed by plastic surgery using a latissimus dorsi stem flap. Although a marginal resection may be acceptable for highly differentiated liposarcomas, there is said to be a risk of distant metastasis when dedifferentiated. Extensive resection is necessary for a complete resection in cases of repeated recurrence or cases occurring in areas with a high risk of reoperation, such as the head and neck region. In general, salvage surgery is often difficult, and a well-planned resection strategy is important from the initial treatment.