Glottal insufficiency caused by unilateral vocal cord paralysis leads to hoarseness and dysphagia, conditions which decrease quality of life for patients. Injection laryngoplasty is one of the surgical treatments for glottal insufficiency. In our department, we use calcium phosphate cement (CPC, BIOPEX-R) as the injectable material. For patients in poor general condition due to advanced cancer or disuse, we perform percutaneous injection laryngoplasty with CPC under local anesthesia. In this study, we retrospectively collected cases of injection laryngoplasty with CPC under local anesthesia, and investigated the outcomes and safety of the procedure. Sixteen cases were included in this study. Dysphonia and dysphasia were evaluated in terms of maximum phonation time (MPT), GRBAS scale, Dysphasia Severity Scale (DSS) and Five-Point Choking Frequency Scale, and in all of these metrics statistically significant improvement was seen after surgery. There were no obvious postoperative complications. These results indicate that injection laryngoplasty with CPC under local anesthesia for patients with unilateral vocal cord paralysis in poor general condition is an effective and safe surgical method for improvement of dysphonia and dysphagia.

Laryngeal lymphoma is a rare occurrence. Here, we report a case of extranodal NK/T-cell lymphoma, nasal type (ENKL) which occurred in the larynx. A 65-year-old man presenting with hoarseness and a sore throat was referred to our hospital. Endoscopic examination revealed a tumor with plaques in the right supraglottic to pyriform sinus ; biopsy confirmed the diagnosis of ENKL. Radiotherapy with concurrent chemotherapy (DeVIC) was performed and a complete response was obtained. A 2-year follow-up has revealed no evidence of recurrent disease. In some ENKL cases, it is difficult to diagnose the disease accurately. Recently, the prognosis of ENKL has been improved by an established treatment. Therefore, it is important to consider ENKL as a differential diagnosis of massive lesions in order to provide treatment without delay.

A 76-year-old man was undergoing treatment for stage IV right lower lobe lung cancer. He had esophageal stenosis due to mediastinal lymph node metastasis and underwent esophageal stenting in the department of internal medicine. After the procedure, abdominal pain appeared and abdominal CT revealed that the esophageal stent had perforated into the abdominal cavity, and emergency surgery was performed on the same day. The esophageal stent had perforated into the abdominal cavity at the abdominal esophagus. Owing to the difficulty of removing the stent, an additional incision was made on the lesser curvature side of the gastric wall from the perforation site, and the perforated stent was guided directly into the stomach. The postoperative course was good, and the patient started oral intake on the seventh postoperative day without any problems. Perforation of the abdominal esophagus is rare, with the thoracic esophagus accounting for 70.2%, the cervical esophagus 15.6%, and the abdominal esophagus 12.2%. There have been no case reports about perforation of the abdominal esophagus due to esophageal stent which was treated surgically without removing the stent.

Aspiration prevention surgery is performed for severe dysphagia. When performing the surgery, it is important that the airway and esophagus be securely separated, that the surgery be minimally invasive, and that there be few surgical complications. In our hospital, subglottic laryngeal closure has been performed since 2021 as aspiration prevention surgery. Six patients who underwent subglottic laryngeal closure from January 2021 to July 2022 were included in the study. The primary diseases were neuromuscular disease in five patients and cerebral infarction in one patient. Three patients had undergone tracheostomy prior to surgery. The other three patients were able to make slight utterances but were unable to speak. Three patients had already undergone gastrostomy and had received nutritional supplements through the gastrostomy before surgery. Five patients underwent surgery under general anesthesia and one patient under local anesthesia. There was no postoperative anastomotic leak in any of the patients. Postoperative nutritional routes were oral intake only in two cases, gastrostomy nutrition combined with oral intake in one case, and gastrostomy only and nasal feeding only in one case each ; one patient was transferred early to another hospital and details were unknown. Two cases did not require tracheal cannula. All others required ventilator support and had no problems with the tracheal stoma. There are several procedures to prevent intractable aspiration, and among them subglottic laryngeal closure is a useful technique.

Background and Objectives : Ischemic stroke is a well-known disease occurring in patients that is variously caused by hypertension, diabetes metabolism, hyperlipidemia, alcohol, smoking, etc. However, the hyoid bone has not been recognized among the possible causes. Materials and Methods : Two patients who presented with ischemic stroke due to mechanical stimulation of the hyoid bone were included in this study. One patient (69 years old, male) had a recurrent brain infarction, and the other (71 years old, male) suffered from hypertension and hypercholesterolemia. Both patients were diagnosed with ischemic stroke caused by mechanical stimulation of the hyoid bone, based on a combination of several imaging studies such as neck ultrasound, computed tomography, computed tomographic angiography, magnetic resonance imaging and angiography. Simultaneously with surgical treatment by a neurosurgeon, the greater horn of hyoid and superior cornu of the thyroid cartilage on the affected side were resected by otolaryngologists. In both cases, the patients had no new cerebral infarctions postoperatively. Conclusions : Hyoid bone-related carotid artery injury is a rare etiology of a stroke which is unknown to many doctors. Carotid artery impingement with compression by the hyoid bone seems to be extremely uncommon and a diagnosis of exclusion. Imaging studies with provocative maneuvers are helpful for making a diagnosis.

Chordoma is a rare malignant tumor that originates from the remnant tissue of the chord during embryonic development and can occur anywhere along the cranium or spine. The skull base and sacrum are the most common sites, while very few cases of chordoma arising in the thoracic spine have been reported. In this paper, we report an extremely rare case of chordoma in the thoracic spine resected by cervical approach. A woman in her 50s with a 1-month history of a mass on her right neck was referred to our hospital. On physical examination, an elastic hard mass was palpated on the right supraclavicular area with poor mobility. Computed tomography and magnetic resonance imaging showed a neoplastic lesion extending from the lower pole of the right thyroid gland to the superior mediastinum. On the basis of fine needle aspiration cytological findings, a tumor derived from a salivary gland or non-epithelial tumor such as schwannoma was suspected. The patient underwent surgical resection of the mass by cervical approach. Intraoperative findings showed the tumor was contiguous with the anterior vertebrae, suggesting that the tumor originated from the anterior aspect of the thoracic spine. Histopathological examination revealed that the tumor cells with eosinophilic cytoplasm proliferated with a cord-like structure on a background of mucinous substrate. Immunohistochemical staining showed that neoplastic cells were diffusely positive for AE1/AE3, and focally positive for EMA and S-100 protein. The final histopathological diagnosis was chordoma. The surgical margin was positive, and postoperative proton beam therapy was performed. No recurrence or metastatic disease has been observed during a follow-up of 9 years. Although the effectiveness of surgical resection and postoperative proton beam therapy for chordoma has been reported, close follow-up after treatment is required since recurrence and late complications associated with irradiation can occur.