We herein report five cases of squamous cell carcinoma of the thyroid gland whose pathogenesis and clinical characteristics were examined in our department between 1979 and 2010. Direct transition from papillary carcinoma was responsible for the pathogenesis of the disease in 4 patients, and an ectopic squamous epithelium or remaining fetal tissue was suspected in 1 patient. Squamous cell carcinoma of the thyroid gland shows a rapid progression and a poor prognosis, and it is similar to anaplastic carcinoma. Although the local control of the cases completely cured by surgery is good, the possibility for subsequent occurrence of multiple cancers needs attention. In addition, it is necessary to always consider the possibility of direct invasion and metastases from multiple organs and to carry out a thorough examination of the entire body.

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We herein report 5 cases that were diagnosed with acute epipharyngitis : 1 case of uncomplicated acute epipharyngitis with no evidence of infection in the oropharynx and 4 cases of acute epipharyngitis associated with oropharyngitis. All 4 cases of acute epipharyngitis associated with oropharyngitis presented with pharyngeal pain of sudden onset involving the whole throat. Bacteriological testing revealed the same bacteria that were sensitive to the same drugs in both the epipharynx and the oropharynx. These findings suggest the possibility that patients with acute epipharyngitis associated with oropharyngitis may sometimes develop an infection due to the same bacteria simultaneously in the epipharynx and oropharynx.

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We herein report a case of recurrent laryngeal cancer invading the trachea. Mediastinal tracheostomas are associated with poor tissue separating the tracheal skin suturing area and the mediastinum, and therefore, infection occurring in the suture area readily extends to the mediastinum. In addition, there is a risk of rupture of the brachiocephalic artery due to mediastinitis or tracheal necrosis. To avoid these postoperative complications, we have developed a new surgical technique in which the anterior mediastinal tracheostoma and the surrounding area are covered using a pectoralis major muscle flap for separation of the tracheostoma from the mediastinal major blood vessels following a total laryngectomy.

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We herein report our experience with a case of huge lipoma in the neck which originated in a subclavicular lesion. The patient was a 57-year-old male with a chief complaint of a left neck tumor. A mobile 15 × 10 cm tumor was noted by palpation. A CT study revealed a huge mass which measured around 15cm in diameter in the anterior-posterior neck. An MRI study showed that the signal intensities of the mass were high both on T1 images and T2 images. From the CT and MRI studies, a lipoma was considered to be the most probable cause of the mass, however liposarcoma could not be ruled out. Because the tumor extended to the subclavicular region, 3-D CT angiography was planned to confirm the extension of the tumor and its relationship with the clavicle. The operation was performed safely, due to the pre-operative examinations. The tumor was confirmed to be a lipoma on pathological examination. The patient's postoperative course has been good after the operation.

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We performed voice therapy before and after microlaryngeal phonosurgery, and obtained good results for 12 out of 13 patients. Only one patient with a laryngeal cyst developed a recurrence. These results showed that voice therapy before and after microlaryngeal phonosurgery was able to reduce voice overwork and avoid recurrence.

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Arytenoid cartilage dislocation has been reported to occur following injury to the neck or complications of endotracheal intubation. We experienced a case of arytenoid cartilage dislocation in a 42-year-old male who undergone aortic valve replacement surgery under general anesthesia and complained of postoperative hoarseness. An endoscopic examination showed the presence of glottic insufficiency due to the fixation of the left vocal cord. Under the diagnosis of recurrent laryngeal nerve paralysis caused by the operation, observation was continued, but the paralysis was not improved. During a 3D-CT examination done 11 months after the surgery, a left arytenoid cartilage dislocation was suspected, and a laryngeal electromyogram which showed normal muscular units on the left side thyroarytenoid muscle during phonation also confirmed the presence of left side arytenoid cartilage dislocation. As an initial treatment, noninvasive reduction of dislocated arytenoid cartilage using forceps under endolaryngeal microsurgery was performed. Although the voice function, as well as the fibrotic findings, improved temporarily, his voice again became hoarse three weeks later. To prevent the recurrence of the dislocation, we performed laryngeal framework surgery for arytenoid adduction with thyroplasty type I, and both the voice and glottal insufficiency were improved after the surgery. This case report indicates that laryngeal framework surgery is a useful treatment in patients in whom therapy for arytenoid cartilage dislocation has been prolonged.

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We herein report the case of a 7-year-old female suffering from a laryngeal granuloma. She had a supra-glottic tumor at birth, and her severe hoarseness had continued ever since. A fiber-optic examination showed the presence of a large mass in the left glottis, with no structure of the vocal fold, the false cord or the ventricle being observed. We performed microsurgery under direct laryngoscopy to reduce the mass, and adjusted the edge of the glottis to the right vocal fold. The operation was successful, and her hoarseness almost disappeared. The mass was diagnosed as chronic granulation histopathologically. We speculate that it was a congenital laryngeal cyst or laryngocele. These conditions might have caused changes in the granulation tissue due to the inflammation, thus resulting in the development of a large mass.

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Needle cannulation kits for the cricothyroid membrane have been utilized more frequently to provide an emergency airway. The cannula is recommended because it allows for management of the airway and aspiration of sputum, although it is not applicable for artificially-ventilated patients. However, some patients have been reported to experience subglottic stenosis after needle cannulation. This is not only sometimes very difficult to treat, but also detracts from the patient's QOL. Subglottic stenosis must therefore be avoided in clinical practice. We experienced two cases with subglottic stenosis due to granulation after needle cannulation. The common points of two cases were 1) the needle cannula was inserted from the lateral side, not the median, and 2) they had been not managed periodically after needle cannulation. In the first case, using fiberscopy, we confirmed granulation at the subglottic space at six days after needle cannulation. Our cases suggest that clinicians should puncture the median of the cricothyroid membrane by using a needle cannula to save the airway and should check the airway using a fiberscope within a week after puncture to prevent stenosis. Our cases shed light on the significance of using an appropriate aspiration techniques and periodical management.

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We examined the voice quality of patients with laryngeal carcinoma after oral laser surgery on the basis of the classification proposed by the European Laryngological Society. The classification is defined from Type I to Type V according to the extent of laser resection. The present study included Type I-Type III cases. The parameters of voice function were MPT, PPQ, APQ, and NHR. At the time of this review, the number of cases is still small, but the overall voice function gradually improved. The voice function of Type I and Type II patients improved for almost 3 months after the operation, but Type III cases tended to take a longer time after the operation for the voice to improve.

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