Patients with total laryngectomy lose the ability to breathe through the nose and develop a smelling disorder. I compared the effect of olfaction rehabilitation for a group of laryngectomy patients before and after treatment. The subjects consisted of eleven laryngectomized persons who had been treated at our hospital. I evaluated the olfactory state using a T&T olfactometer before and after the intervention. The training was delivered as the NAIM method. The detective threshold for the sense of smell improved significantly after the training, and the cognitive threshold showed a trend toward improvement. In addition, a significantly inverse correlation was observed between the postoperative period and the improvement level after undergoing olfactory rehabilitation. The patients' sense of smell substantially improved after undergoing olfactory rehabilitation. As a result, olfactory rehabilitation should be started as early as possible after laryngectomy from the viewpoint of olfactory maintenance.

Mucoepidermoid carcinomas originating in the oropharynx are rare. Despite the fact that they are considered to be malignancies, the clinical course of mucoepidermoid carcinoma is heterogeneous. This has various pathological subtypes, which show very little agreement with the prognosis. For instance, the prognosis can be influenced by the differentiation of the area of squamous cell carcinoma or by the degree of invasion throughout the malignant tissue. Consequently, it is thought that the precise pathological diagnosis of the subtype and the selection of the most suitable treatment (based on the diagnosis) are the most important factors for the prognosis. We experienced a case of mucoepidermoid carcinoma occurring in the oropharynx. It was considered highly probable that this tumor was based on the anterior wall or tonsil. Even though our case showed a progressive state and was classified as stage IV, which are factors that are associated with a poor prognosis, he remains alive without recurrence at approximately seven years after surgery. The extensive resection that was performed in the first operation and the suppression of metastasis to the cervical lymph nodes by radiotherapy before and after surgery are thought to be the reasons for the good outcome.

We have experienced 3 cases of vocal nodule in athletes. In Case 1, since the illness period was short, the vocal nodule disappeared with voice therapy within a short period of time. In Cases 2 & 3, the illness period was longer and the patients repeatedly experienced the exacerbation/remission of their vocal nodules. In Case 2, the vocal nodule did not improve with voice therapy, and we have been following the patient's progress with the administration of oral steroids and nebulized steroids when an exacerbation occurs. In Case 3, treatment with oral steroids is not possible as the patient is planning to participate in an official Kendo competition and the administration of oral steroids might lead to a doping violation. For this reason, the patient will continuously receive voice therapy without other treatments until the competition. It was considered that surgical treatment may be necessary for the treatment of vocal nodules in athletes in cases in which voice therapy is not successful.

A 56-year-old man suffered a bruise to his larynx during a scuffle and presented with hoarseness 1.5 months later. Laryngoscopy revealed a slight intralaryngeal hematoma and decreased tension of the vocal folds without any immobilization. Three-dimensional computed tomography (3D-CT) showed fracture lines near the midline of the thyroid cartilage and in the left cricoid cartilage. Two and a half months after the injury, rigid internal fixation of the thyroid cartilage fracture was performed using titanium miniplates and cyanoacrylate glue under local anesthesia. The fixation was successfully performed, and an improvement in his voice was confirmed during the surgery. Laryngoscopy, 3D-CT, and an acoustic analysis showed that the improved voice and well-fixed cartilage were maintained even after at one year after the surgery. Laryngeal fixation using titanium miniplates and cyanoacrylate glue can facilitate the fixation procedure and contribute to the long-term outcomes.

We herein report a case of bilateral vocal cord paralysis in which the traction thread broke 11 years after Ejnell's operation. A woman with bilateral vocal cord paralysis after total thyroidectomy underwent Ejnell's operation at 61 years of age. The left vocal cord was pulled outward with a 3-0 nylon thread and the thread was ligated onto the thyroid cartilage. After the operation, the glottis was widened and the tracheostoma was closed. The patient at 72 years of age visited our clinic 11 years after the operation owing to breathing difficulty and wheezing upon exertion. The left vocal cord was almost in the median position. It was speculated that the traction thread broke or became loose. While waiting for re-operation, she complained of throat irritation and developed a cough. The stump end of the nylon thread protruded into the glottis endoscopically ; therefore, it was removed with endoscopic biopsy forceps. After tracheotomy, left partial submucosal arytenoidectomy was performed, and the posterior glottis was widened. When following up a patient who underwent Ejnell's operation, it is necessary to inform the patient of the possibility that the traction thread may break even several years after the operation.

A resection of the trachea is sometimes required because of the malignancies or stenosis due to traumas or inflammatory diseases. The consequent tracheal defect causes cosmetic and functional problems, and thus early closure of the stoma is usually expected. However, the closure of a huge stoma is still challenging. In order to establish a safe and easy procedure for tracheal reconstruction, we have developed an artificial trachea over the past few decades. Our in situ regeneration-inducible artificial trachea composed of a porcine collagen sponge and polypropylene framework has been proven to have a long-term safety and efficacy by previous non-clinical studies. Further, a clinical study using the artificial trachea conducted under an approval of institutional review board has achieved a successful outcome of tracheal reconstruction. Now, we are running a multi-institutional, investigator initiated clinical trial of tracheal reconstruction using our in situ regeneration-inducible artificial trachea intending to investigate its safety and efficacy. The patients with a stoma unable to be reconstructed with existing treatment options, or with malignancies affecting no less than a half of the tracheal cartilage as well as three tracheal rings will be included in this trial. With results of this trial, we are expecting to have an approval of the artificial trachea as a new medical device under Japan's Pharmaceutical and Medical Device Law.