Introduction: Many patients with laryngeal cancer desire radical cure and preservation of voice and swallowing function. At our institution, patients with locally recurrent laryngeal cancer who have a strong desire for laryngeal preservation are treated with boron neutron capture therapy (BNCT). Objective: To investigate the efficacy of BNCT for locally recurrent laryngeal cancer after radical irradiation. Patients and Methods: We retrospectively examined the local control rate of BNCT, post-treatment for recurrent lesions after BNCT, and efficacy of BNCT by rcT stage in 28 patients who underwent BNCT for locally recurrent laryngeal cancer after irradiation. Results: The efficacy of BNCT for locally recurrent laryngeal cancer at 3 months was 78.6% for CR, 10.7% for PR, 10.7% for SD, and 0% for PD. The 1-year local control rate was 65.9%. CR rates by rcT stage were 75.0% for rcT1, 75.0% for rcT2, 71.4% for rcT3, and 100% for rcT4. Conclusion: BNCT is expected to be a new treatment option to maintain quality of survival in patients with recurrent laryngeal cancer after radiotherapy who strongly desire laryngeal sparing.

Sixteen patients who presented at Kawasaki Medical School Hospital or the School's General Medical Center with a chief complaint of a foreign body in the head and neck region and who required removal under general anesthesia were examined for age, type of foreign body, localization, and length of hospitalization. Eleven were males and five were females, ranging in age from 1 to 90 years, with a median of 8 years, showing a biphasic distribution between children and elderly patients. The types of foreign bodies were fishbones in 12 cases and dentures in 4 cases. Fishbone foreign bodies in children were extracted with forceps after pharyngeal expansion using a Davis-Crowe Mouth Gag, and denture foreign bodies in elderly patients were extracted with forceps after pharyngeal expansion using a direct laryngoscope. Denture foreign bodies with clasps should be treated with special care, and gentle manipulation is necessary when removing them.

Rosai-Dorfman disease (RDD) is a histiocytic disorder of unknown etiology. Symptoms are often associated with cervical lymphadenopathy and extranodal lesions that can occur throughout the body. Although pediatric cases are common among overall RDDs, RDD in the larynx is typically reported in older patients. This is the first pediatric case of laryngeal RDD we have encountered. The patient is a 7-year-old boy who was found to have wheezing and respiratory distress, leading to an emergency tracheotomy and biopsy. During steroid administration, the subglottic mass shrank ; however, as the steroids tapered off, the mass regrew. The patient also developed a moon-like facial appearance. After steroid treatment, the mass continued to grow, but the lesion resected for biopsy showed no recurrence. Microlaryngeal surgery was performed on the remaining lesions, and no recurrence has been observed for 7 months. RDD is a rare disease, and there is no standard treatment. Spontaneous remission occurs in about 40% of patients with nodal lesions, but in only about 20% of those with extranodal lesions. Therefore, RDD with extranodal lesions often requires some form of treatment. In particular, RDD in the larynx has the potential to obstruct the airway, and in some cases it extends into the surrounding cartilage, suggesting the need for aggressive surgical treatment.

Hypopharyngeal pyriform sinus fistula is a relatively rare disease that can cause repeated neck abscesses and acute suppurative thyroiditis in young people. Although hypopharyngeal esophagography is considered useful for diagnosis, in many cases the fistula is not visualized due to stenosis caused by inflammation. In this report, we describe a case of hypopharyngeal pyriform sinus fistula that was identified using 3D reconstruction images (3D-CT) created by CT immediately after fistulography and subsequently removed by transoral surgery. The patient was a 30-year-old woman who visited our hospital for further examination and treatment of a recurrent left neck abscess. An endoscopic examination in the modified Killian position revealed a suspected fistula opening in the left pyriform sinus. A lower pharyngoesophageal contrast study was performed but the fistula could not be visualized. However, contrast medium was injected directly into the fistula using a Varicose Esophageal Vein Puncture Needle^® under laryngoscopy at the same site, and a 3D-CT examination was performed within a few minutes of the injection. The 3D-CT examination revealed a fistula about 12 mm long that ran from the left pyriform sinus to the caudal side, and a diagnosis of left pyriform sinus fistula was made. Under general anesthesia, the fistula was removed using transoral videolaryngoscopic surgery (TOVS). One year has passed since the operation and there has been no recurrence. We considered the possibility of determining whether a fistula could be removed orally by confirming the area suspected of having a fistula under endoscopy, injecting contrast medium directly into it, and then creating a reconstructed image using CT to accurately measure the length of the fistula.

For otolaryngology head and neck surgeons, tracheostomy is a technique that must be performed skillfully to secure the airway, but the degree of difficulty varies greatly from case to case. In this study, we experienced a surgical tracheostomy in a severely obese patient with a BMI over 40 who was difficult to ventilate after craniotomy for cerebral hemorrhage. The fat thickness from the trachea to the skin was 8 cm, and a mid tracheostomy with lipectomy was performed. Postoperative airway management was uneventful, but control of local infection was time-consuming. The patient's severely obese body was susceptible to infection and delayed wound healing, and we reported that postoperative infection should be carefully monitored.

Tracheal stenosis after tracheotomy is a symptom that should be noted as a late complication of tracheotomy, but because it is relatively rare, its clinical characteristics have not been widely recognized. In this study, we report two cases of delayed tracheal stenosis after tracheotomy closure, together with their clinical characteristics. Both cases had a common feature of poor performance status (PS), but the literature also states that cases of tracheal stenosis after tracheotomy often have poor PS. It is important to note that patients with poor PS are less active and therefore less likely to be aware of dyspnea even if they have tracheal stenosis. When deciding on a treatment plan, it is important to place more importance on objective evaluations such as CT scans rather than subjective symptoms. The causes of delayed tracheal stenosis were examined based on intraoperative findings. In case 1, obesity and keloid constitution were thought to be the cause, and in case 2, thyroid enlargement of unknown cause was thought to be the cause. In both cases, airway fenestration was performed. In case 1, fenestration was performed using the trough method. In case 2, the neck could not be extended under local anesthesia, and the thyroid gland was significantly enlarged, so a tracheotomy was performed in conjunction with a cricoid cartilage incision, allowing the airway to be safely opened and the narrowed area relieved. Treatment for tracheal stenosis after tracheotomy differs depending on the cause and the patient's overall condition, so it is important to consider each case individually.

Diffuse aspiration bronchiolitis (DAB) is a chronic inflammation of the bronchioles due to chronic aspiration of foreign objects, with mild symptoms. Repeated aspiration causes inflammation in the alveoli, leading to aspiration pneumonia. We report on two patients who developed DAB after eating regular foods. The patients' swallowing function improved after changing to a diet of food prepared in a blender, administering expectorants, offering swallowing guidance, adjusting food format, providing laryngeal elevation training, and managing aspiration pneumonia. Physical strength was restored, and grip strength and peak flow values were improved. In addition, since hospitalization due to aspiration pneumonia can be avoided, medical costs can be expected to be reduced. DAB was suspected in 41.9% of dysphagia cases.