We conducted a retrospective study in 25 patients (24 males, 1 female ; mean age 66 years) who underwent tracheoesophageal shunt with voice prosthesis placement after total laryngectomy in our department between 2002 and 2023. Long-term outcomes were evaluated by voice acquisition rate and complications. The median observation period was 144 months (range : 1-354 months), and the median duration of voice prosthesis placement was 123 months (1-354 months). The voice acquisition rate was 92% and the voice use rate was 88%, showing favorable outcomes. However, complications occurred in 40% of the patients. Shunt enlargement was observed in 28% of the patients. Tracheoesophageal shunt closure was required in 32% of the patients, mainly due to shunt enlargement, which accounted for 75% of closures. In patients with controlled primary disease and no complications, voice prosthesis speech was possible for a long period of time, with a median duration of 172 months.

Gastro-tracheal fistula is a rare complication following esophagectomy with gastric conduit reconstruction via the posterior mediastinal route, occurring in approximately 0.3% of cases. This report describes two challenging cases of gastro-tracheal fistula and their management experiences. Case I : A 60-year-old male underwent thoracoscopic esophagectomy with posterior mediastinal reconstruction using a narrow gastric conduit for stage I esophageal cancer. Despite a smooth postoperative course, he presented with pneumonia on the 21st day. Diagnostic evaluation revealed a 5 mm gastro-tracheal fistula. Initial attempts at conservative treatment, including nutritional support and endoscopic therapy with polyglycolic acid (PGA) sheet filling, were unsuccessful. Respiratory failure ensued, necessitating intubation. Surgical intervention three months later successfully resolved the fistula. Case II : A woman in her 50s underwent preoperative chemotherapy followed by thoracoscopic esophagectomy with gastric conduit reconstruction for stage III esophageal cancer. She developed fever and cough after meals on the 15th postoperative day, and endoscopic examination confirmed a gastro-tracheal fistula. Despite 5 months of nutritional and endoscopic therapy with PGA sheet filling, the fistula persisted. Additional interventions in another hospital were also unsuccessful. After 18 months, surgical intervention with muscle flap reconstruction achieved fistula closure. Conclusion : Early surgical intervention is advisable even for small gastro-tracheal fistulas. Conservative management may lead to worsening respiratory conditions and pose challenges for subsequent surgery, emphasizing the importance of prompt intervention after esophagectomy with posterior mediastinal route reconstruction.

A woman in her 70's underwent systemic treatment including tracheal intubation for hemorrhagic shock for five days in our emergency ICU. After extubation, she presented with dyspnea with inspiratory wheezing and underwent a tracheostomy. She was then referred to our department for further evaluation and management. Laryngoscopy revealed dysmobility of the right vocal cord. The glottis cavity was found to be clear for breathing and was managed with a speech cannula, but she was found to be in respiratory distress. Microlaryngobronchoscopy (MLB) performed for airway evaluation revealed type III posterior glottic stenosis (PGS) and tracheal stenosis due to adhesions with scar formation at the level just above the tracheal foramen. The scar tissue was removed, and a T-tube was placed. One month later, the T-tube was removed, but the anterior wall of the tracheocutaneous fistula was found to have collapsed. Reconstruction of the anterior tracheal wall was performed using auricular cartilage. The tracheal foramen was closed two months after surgery. Although tracheostomy in the ICU is a common procedure, complications can make it difficult to manage in some patients. We report our measures for safe ICU tracheostomy.

Mediastinal tracheostomy is performed in patients who have undergone extensive tracheal resection during surgery for malignant head and neck tumors and for whom creation of a tracheal foramen in the neck is difficult. The tracheal foramen is usually created in the anterior thoracic region by resecting a portion of the sternum or clavicle, and the dead space is filled using a pectoralis major or latissimus dorsi musculocutaneous flap or other pedicled flap. However, postoperative complications such as tracheal necrosis, disruption of the great vessels due to infection, and tracheo-innominate artery fistula can prove fatal. Our department uses a pedicled pectoralis major myocutaneous flap in combination with mediastinal tracheostomy. We believe that good results can be obtained by paying attention to designing a flap that takes into account the anatomical area receiving blood flow, filling the area around the tracheal stoma with skin, and filling the dead space in the mediastinum.

Descending necrotizing mediastinitis is a life-threatening disease, and the standard treatment is prompt surgical drainage. The conventional treatment is thoracotomy, but recently, less invasive thoracoscopic drainage has been performed. Herein, we report a case of descending necrotizing mediastinitis from a deep neck infection that could be successfully controlled by CT-guided catheter drainage alone. A male in his 60s with diabetes mellitus was admitted to our hospital with a deep neck infection. We immediately performed transcervical drainage and tracheostomy. A contrast-enhanced CT on the fifth day revealed an abscess formation in the superior and lower posterior mediastinum, and a diagnosis of type IIC descending necrotizing mediastinitis was made. Because the abscess was unifocal and localized along the danger zone, we choose the method of less invasive CT-guided catheter drainage. The exudate from the mediastinal drain decreased over time and was removed on day 16. Swallowing rehabilitation was started on postoperative day 7. After one month, drains and tracheal cannula were removed, and the patient was discharged with oral intake. Depending on the shape and location of a mediastinal abscess, minimally invasive CT-guided catheter drainage may be an effective treatment option.

There have been few reports of blunt thyroid injury, and there is no established treatment policy. In treatment, it is important to keep in mind the possibility of thyroid storm, to stop bleeding at the injury site, and to secure the airway to prevent airway obstruction due to hematoma. In the case of blunt injury, delayed airway obstruction may occur despite the presence of few clinical symptoms immediately after injury. We report a case in which a patient was rushed to our department immediately after blunt thyroid injury and developed delayed laryngeal edema during follow-up. The patient was a woman in her 30s. She was being treated for Graves' disease and was taking oral thiamazole. She fell down the stairs at home and struck her anterior neck on a table downstairs, and was rushed to the hospital. One hour after injury, laryngeal findings showed only mild edema in the left arytenoid. Three hours after injury, the edema in the left arytenoid had increased only slightly. We determined that airway management was not necessary, and the patient was admitted to our hospital for follow-up observation. The next morning, 20 hours after the injury, the patient was examined and found to have worsening hoarseness and mild dyspnea, and laryngeal findings showed that edema had spread to the right arytenoid. Airway management was suggested but was refused, so steroids were administered intravenously, and the edema subsided 28 hours after the injury. There was no recurrence of edema, and the patient was discharged on the third day after the injury. Fortunately, no thyroid storm was noted during the patient's hospital stay.