A 36-year-old man who presented with the chief complaint of sore throat was diagnosed as having laryngeal edema due to acute tonsillitis. Emergency tracheotomy was performed to establish an airway, and antibiotic therapy was prescribed with bed rest. Emphysema was observed just after the operation because the patient had a very strong cough reflex, and a subsequent chest x-ray confirmed the presence of air around the greater pectoral muscles and expansion of the mediastinum. A few days later, the laryngeal edema and the subcutaneous emphysema improved, and the tracheal cannula was removed. However, the emphysema recurred in spite of continued treatment, gradually spreading out from his face to the chest. The chest circumference increased to 129 cm, therefore, we reinserted the tracheal cannula to prevent air from penetrating into the subcutaneous tissues. On the 29th postoperative day, a CT scan revealed disappearance of the mediastinal emphysema without relapse.

Although tracheotomy for upper airway obstruction caused by acute inflammatory diseases is one of the most basic procedures for otolaryngologists, it is crucial for otolaryngologists to bear in mind the possibility of occurrence of severe complications when performing tracheotomy.

Although traumatic injuries caused by crossbows are rare in Japan, some of these may be life-threatening. We describe herein a-22-year-old man who attempted to commit suicide with a crossbow. The patient shot himself in the neck with a crossbow and was taken to hospital by ambulance. Computed tomography (CT) scans revealed a crossbow bolt entering anterior border of the sternocleidomastoid muscle, involving the carotid space, and passing through the posterior region of the neck. The crossbow bolt had been shot into the neck, penetrated the internal jugular vein and worked as a tamponade so that further bleeding was prevented. We successfully removed the crossbow bolt using the purse-string suture technique and reconstructed the internal jugular vein. The postoperative course was uneventful other than a temporary vocal cord paralysis. In cases of neck injuries, careful evaluations of the vascular structures are indispensable to prevent unexpected bleeding.

We herein on report a case of a resected thrombosed venous aneurysm in the external jugular vein of an 81-year-old woman who noticed swelling of a soft mass with no pain in the left side of her neck. Physical and computed tomography findings did not suggest a thrombosed venous aneurysm. However, at a 3-month follow-up, the woman complained of pain in the mass, and magnetic resonance imaging and ultrasonography findings suggested a thrombosed venous aneurysm. Complete surgical resection under general anesthesia was performed successfully with no complications. Histopathologically, the aneurysm had thrombosed. The postoperative course has remained uneventful. We consider a thrombosed venous aneurysm in the external jugular vein merits aggressive surgical indications. Even if a venous a neurysm is not thrombosed at the time of its identification, regular follow-up is important, taking the possibility of thrombus formation occurring in the future.