Patients with neurodegenerative diseases and children with severe mental and physical disabilities are often managed with tracheostomy tubes due to repeated aspiration pneumonia. Longterm tracheostomy tube placement increases the risk of complications and requires frequent sputum suctions by caregivers, making institutionalization and the introduction of home care difficult. Surgical closure of the larynx is a useful technique that can avoid pneumonia, decrease the frequency of sputum suctions, and provide relief from airway management by tracheostomy tube. We investigated the usefulness and safety of 18 cases of surgical closure of the larynx by removal of cricoid cartilage (Kano's method) performed at our department over a 7-year period from April 2015 to March 2022. Except for one patient with unknown postoperative course, cannula withdrawal was possible in 6 of 6 (100%) patients using tubes who were not on respiratory management, and postoperative complications were limited to one case of fistula formation at the glottis closure site. In addition, 3 of 5 patients who were preoperatively unable to take orally were able to ingest orally postoperatively, and one patient was on alternative nutrition but was able to take oral intake. A survey of caregivers showed a decrease in the frequency of sputum suctions in most cases, and 75% of them expressed satisfaction with the results of the surgery. As a result, we believe this technique is useful and safe for patients with repeated severe aspiration pneumonia in terms of airway management without a tracheostomy tube.

In the head and neck region, schwannomas can arise from nerves other than the optic nerves and olfactory nerves, which lack Schwann cells, but such cases are relatively rare. We report a case of schwannoma arising in the arytenoid. The patient was a 54-year-old woman whose chief complaint was hoarseness, which she had been aware of since around 202X. Laryngoscopy revealed a submucosal tumor in the right arytenoid, which caused glottal insufficiency due to tumor volume. The tumor was removed under general anesthesia, and the patient's symptoms improved. The final pathological diagnosis was schwannoma. Neurilemmoma should be kept in mind as a differential diagnosis for laryngeal tumors. It should also be noted that, although very infrequent, head and neck schwannomas have been reported to be malignant.

We herein report a case of tardive glottic adhesion four months after inhalation burn that improved by amputation of the glottic adhesion. A 51-year-old male was transported by ambulance because of inhalation burn. The patient improved with conservative treatment without tracheal intubation, and was discharged from the hospital a month later. Three months after discharge, however, laryngoscopy showed bilateral cordopexy. We performed an emergency tracheotomy under local anesthesia. Recurrent nerve paralysis was not found and we suspected a glottic adhesion. We performed amputation of the glottic adhesion under general anesthesia to open the glottis and improve vocalization. After the operation, glottic movement and vocalization were improved. Tardive glottic adhesion sometimes occurs in cases of inhalation burn. We should pay attention to respiratory stenosis several months after inhalation burn. We consider amputation of glottic adhesion useful for treatment of patients with tardive glottic adhesion after inhalation burn.

Esophageal neuroendocrine carcinoma (NEC) is a relatively rare esophageal malignancy with high histological grade and poor prognosis. Chemotherapy with or without radiation is recommended because NEC is often detected at an advanced stage and the recurrence rate is relatively high. For esophageal cancer, photodynamic therapy (PDT) is indicated after chemoradiotherapy (CRT), and salvage surgery is rarely performed afterwards. We report here a case in which PDT and salvage surgery were performed for secondary esophageal squamous cell carcinoma after esophageal NEC showed complete response to CRT. Eighteen months before this presentation, a 71-year-old woman underwent CRT for esophageal NEC (cT4b (trachea) N2M0 Stage IV) and no residual lesion was detected. Upper gastrointestinal endoscopy revealed multiple superficial-type squamous cell carcinomas in the esophagus at 25, 26, and 38 cm from the incisors. The lesion 38 cm from the incisors had invaded to the submucosal layer and the others represented in situ carcinomas. PDT was performed twice for all lesions, but residual tumor remained at 38 cm from the incisors. Ivor Lewis esophagectomy was performed because the earlier NEC had invaded to the trachea before CRT. Intraoperative findings included edema and scarring of the esophageal wall. The postoperative course was good and the patient was discharged on postoperative day 23.

In this study, we report two cases of foreign bodies in the hypopharynx and esophagus leading to abscess formation due to delayed diagnosis caused by psychiatric and neurological disorders. Case 1 was a 40-year-old woman with a history of schizophrenia and mental retardation. Six days after the onset of dysphasia, a CT scan revealed a chicken bone in the esophagus, causing abscess formation, and the patient was referred to our hospital. In an emergency operation, the chicken bone lodged from the hypopharynx to the cervical esophagus was removed transorally, and transcervical drainage was performed. After swallowing rehabilitation, the patient was discharged 51 days later. Case 2 was a 75-year-old man with untreated dementia. He had left neck pain after eating boiled sea bream, but his general practitioner made no diagnosis. A CT scan on the fifth day of onset showed that a fish bone had migrated outside the hypopharyngeal cavity. The patient was referred to our hospital, and transoral removal of the fish bone and drainage of the abscess were performed. However, the patient exhibited decreased swallowing function and was transferred to another hospital for rehabilitation. In both of the cited cases, early diagnosis could have prevented abscess formation and prolonged hospitalization. When treating dysphagia with neck pain in patients with psychiatric and neurological disorders, it is necessary to consider the possibility of a foreign body. At the same time, in order to prevent recurrence the patient's family should be educated to avoid giving any foods that may cause a foreign body to lodge.