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The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM., (© 2024. The Author(s).)

Purpose: The use of standalone cages (SAC) and anchored cages (AC) in anterior cervical discectomy and fusion surgery (ACDF) has shown advantage of reduced operative time and lower incidence of dysphagia. However, there is limited literature available comparing the clinical and radiological outcomes of SAC and AC., Methods: We conducted a prospective study for patients undergoing ACDF for cervical radiculopathy or myelopathy. Patient were classified based on the cage used into SAC group and the AC group. Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) for myelopathy and Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for radiculopathy. Dysphagia was graded as per Bazaz score. Radiologically, global cervical lordosis, segmental lordosis, cage subsidence, and migration were assessed., Results: We analyzed 31 patients in each group with a minimum two year follow-up. The mean VAS improved from 7.9 to 4.56, mean NDI score improved from 27.6 to 19.8, and mean mJOA improved from 10.8 to 11.7 which were statistically significant (p < 0.05); however, no significant difference was noted between the SAC and AC groups. Mean global lordosis improved from 14.4 to 20.3° and mean segmental lordosis improved from 6 to 10.1° at six months and plateaued to 6.9° at final follow up without any significant difference between the groups. The subsidence was statistically more in 12.9% (4/31) in SAC than 6.4% (2/31) in AC., Conclusion: AC showed of lower rates of subsidence while both SAC and AC had comparable clinical outcomes and radiological alignment outcomes., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Purpose: Anterior cervical discectomy and fusion (ACDF) surgery is commonly performed to treat cervical degenerative disc disease (CDDD). The lost of range of motion (ROM) is also found after ACDF, which contributes to degenerate in adjacent segment disease (ASD). Artificial cervical disc replacement (ACDR), an alternative to ACDF, is developed to preserve the ROM and reduce ASD. This article aims to compare the outcomes between ACDR and ACDF in the short-, mid-, and long-term., Methods: Databases including Cochrane, Embase, PubMed, and Web of Science were searched. Only RCTs were included in this meta-analysis, and the search strategy followed the requirements of the Cochrane Handbook. The strength of evidence was assessed using GRADE. Two reviewers independently assessed the methodological quality of each included study and extracted the relevant data., Results: Thirty prospective RCTs were included. Prolonged operative duration, better overall success, neurological success, and NDI success rates were found in ACDR group in all follow-up periods, with lower dysphagia/dysphonia during short-term follow-up. Moreover, a lower ASD was found in ACDR group during long-term follow-up and overall analysis, with lower reoperation rates in all follow-up periods. Comparable length of hospital stay and blood loss were found in both groups. Moreover, ASD was similar in short- and mid-term follow-ups, while dysphagia/dysphonia incidence was similar in mid- and long-term follow-ups. The incidence of implant events was comparable in all follow-up periods (p > 0.05)., Conclusions: ACDR is as effective as ACDF and superior for some success rates. Disc replacement can reduce the risk of dysphagia/dysphonia, ASD, and re-operation., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

The objectives of this study were to determine if any specific clinical signs, symptoms, or comorbidities could reliably predict underlying feeding difficulty and need for further evaluation (i.e., video swallow study, VSS) in infants with Down syndrome, to establish the prevalence of gastrostomy tube placement (G-tube), and to determine if any clinical signs, symptoms, or comorbidities correlated with a higher risk for needing placement of a G-tube. An electronic medical record retrospective chart review of 73 children with Down syndrome born between January 2013 and March 2017 and seen in Nationwide Children's Hospital's multidisciplinary Down Syndrome Clinic included demographic information, medical history, and results of studies and specialist evaluations. Descriptive statistics were utilized to summarize the data. Comparisons were performed to identify factors which differed between feeding difficulty vs. no feeding difficulty and G-tube placement vs. no G-tube placement. "Feeding difficulty" was the only feeding term established by the AAP guidelines which was consistently noted in charts of children with feeding abnormalities. Infants with feeding difficulty had increased use of medical services and more abnormalities on specialist evaluations and studies. Congenital heart disease, cardiothoracic surgery, obstructive sleep apnea, and hypothyroidism did not differ significantly between the groups assessed. Our cohort had a prevalence of 13.7% for requiring G-tube placement in their first year of life.Conclusion: The currently established clinical tools for determining which patients may benefit from radiographic evaluation lack sufficient sensitivity to detect all individuals with feeding difficulty. Due to the high prevalence of abnormal VSS results and high rate of G-tube placement, universal radiographic screening for individuals with Down syndrome could be considered, even in the absence of obvious clinical signs or symptoms. However, determining how to balance this with cost, availability, and radiation exposure may be difficult.What is Known: • Feeding difficulty in children with Down syndrome can lead to significantly increased morbidity, such as poor weight gain, failure to thrive, aspiration, persistent respiratory symptoms, andrecurrent pneumonia. • The AAP has established a clinical tool regarding which objective signs and symptoms should lead to a radiographic swallowing assessment within their Health Supervision for Children with Down Syndrome Clinical Report.What is New: • A comprehensive assessment of clinical signs, symptoms, and common comorbidities in infants with Down syndrome has not previously been correlated with presence of feeding difficulty nor necessity for gastrostomy tube placement, including whether or not the terms used in the AAP guidelines encompass the sensitivity required to detect all infants with feeding difficulty. • The prevalence of gastrostomy tube placement in children with Down syndrome has not previously been established.

Background: Improvements in surgical techniques have led to a higher percentage of larynx preservations. These do not always include preservation of the swallowing function. This study investigates the prevalence of swallowing disorders after partial laryngectomy and their predictors., Patients and Methods: In a multicenter cross-sectional study with patients who received a partial laryngectomy (n=154) the prevalences of problems related to swallowing and eating were gathered. Additionally, medical and sociodemographic data were obtained as well as information about alcohol and tobacco consumption., Results: Twenty percent of the patients had problems related to swallowing and eating; more specifically, eating solid foods and eating in public. Chances of having swallowing disorders were significantly lower for patients who received laser therapy (OR=0.12; 95% CI: 0.04-0.37; p<0.01), when time since the last laryngeal surgery was longer (OR=0.89; 95% CI: 0.75-0.99; p<0.03) and when patients were non-smokers (OR=3.39; 95% CI: 1.29-8.94; p<0.02)., Conclusion: Swallowing disorders correlate with post-surgery smoking. Physicians and therapists should focus more on the negative side effects of smoking on swallowing during patient consultations.

Tracheotomies are increasingly performed in the pediatric population in the context of long-term treatment. There are specific pediatric aspects that require attention: differences in the pediatric compared to adult anatomy, the necessity for later reconstruction and the negative impact on oral feeding and speech development. Caring for pediatric tracheostomy patients is more challenging compared to adult patients. This needs to be addressed by a dedicated team during both in- and outpatient treatment.

Background and Methods: Based on data obtained in the prospective multicenter observational study on the surgical treatment of gastric cancer "East German Gastric Cancer Study 2002 (EGGCS)", the cohort of patients with gastric cancer who underwent palliative surgical interventions during the study period from 1(st) January to 31(st) December 2002 was investigated., Results: Out of 1,139 documented patients with gastric cancer, 1,031 underwent a surgical intervention (operation rate 90.5%). In 70.4% (n=726) of the patients with surgical interventions, R0 resection status could be achieved whereas in 305 patients (29.6%), only a palliative (R1/2 resection status) result was possible using resection and non-resection procedures in 165 and 140 cases, respectively. The hospital mortality rate was 7.3% (n=53) in the group of curative R0 resection patients and was almost identical with 7.8% (n=13) in the group of R1/2 resection patients. The highest hospital mortality of 14.4% (n=20) was found in subjects who primarily underwent palliative surgical interventions (R2 resection or non-resection procedures). In the subgroup analysis the highest overall morbidity of 57.1% was found in the group of palliative (R2) resection patients. Curatively intended but palliatively operated patients (from the perspective of the final histopathological result) showed a significantly longer overall survival time (11 months) compared with patients who primarily underwent a surgical intervention with palliative intention (6.3 months). Even patients who underwent tumor resection with palliative intention were observed to have a longer survival time of 2.3 months (in total, 6.9 months) compared with patients with non-resection surgical intervention (4.6 months). In the group of R2 resection patients with a preoperatively detected pyloric stenosis/dysphagia, an increased overall morbidity (62.5% with stenosis versus 47.7% without stenosis) and an increased hospital mortality rate (25% versus 11.6%, respectively) were seen. This favors more interventional endoscopic procedures if possible considering the only marginal prolongation in survival time. In contrast, palliative resection in cases without stenosis is associated with an acceptable rate of postoperative complications (47.7%) and mortality (11.6%) resulting in the recommendation of a palliative resection under specific conditions considering the improved oncosurgical long-term outcome., Conclusion: Radical tumor resection with palliative intentions (if possible from a technical point of view) resulted in a prolongation of the median survival time of 3 months with an acceptable postoperative morbidity and mortality compared with non-resection procedures. According to the results of individual analysis of each tumor resection intervention, palliative gastrectomy showed a significant prolongation of survival time of 5 months compared with more limited subtotal resection (6 versus 11 months).

This study aimed to evaluate the presenting symptoms, the effectiveness of imaging methods, and the surgical treatment of vascular rings. Data for 44 patients (32 enrolled prospectively, 12 reviewed retrospectively) over a 10-year period in a tertiary referral center were analyzed. These patients comprised 25 patients with a left aortic arch and an aberrant right subclavian artery, 13 patients with a right aortic arch and a left subclavian artery originating from Kommerell’s diverticulum, 1 patient with a right aortic arch and an aberrant left subclavian artery, 3 patients with a double aortic arch, and 2 patients with a pulmonary sling. Respiratory symptoms were found in 25 patients and dysphagia in 6 patients. Atypical symptoms such as reflex apnea, cyanosis, syncope episodes, and exercise-induced wheezing were noted in five patients. Associated congenital heart defects were detected in 41% of the patients. The diagnostic yield was 95.23% for barium esophagography, 54.54% for echocardiography, and 66.66% for computed tomography. The anatomy could be correctly identified by magnetic resonance imaging (MRI) in 97.43% and by angiography in 90.5% of the patients. Of the 30 patients who underwent surgery, 80% were completely relieved of symptoms during a mean follow-up period of 25 ± 33.5 months. Vascular rings should not be overlooked in infants with atypical symptoms. The authors’ diagnostic procedure of choice is MRI because it is superior to angiography for delineating the relationship between abnormal vascular structures, trachea, and esophagus.

Zenker's diverticulum occurs as a result of impaired relaxation of the cricopharyngeal muscle primarily causing dysphagia. Affected are elderly patients with several comorbidities. By means of endoscopic intervention the septum is divided between the diverticulum and esophagus which allows unobstructed passage of food and liquids to the diverticulum into the esophagus. Advantages of this technique are manifold: usually general anesthesia is not required, the intervention can be performed in an outpatient setting or if necessary, hospital stay is short and the complication rate is low. Therefore, it is a suitable option for multimorbid patients. In approximately 90% of interventions symptoms of dysphagia are improved after the first treatment resulting in excellent effective medium term results in most cases.

In case of Zenker's diverticulum, treatment is indicated as soon as the diagnosis is established. Therapy should aim at the elimination of dysphagia and the symptoms of food retention and should reliably prevent recurrence. Currently, three different therapeutic approaches are applied: the classical option is open transcervical myotomy and diverticulectomy/diverticulopexy and alternatively stapled diverticulostomy with a linear stapler or flexible endoscopic diverticulostomy is propagated. As compared to the surgical (open) approach, rigid or flexible endotherapy is less invasive. However, endotherapy is not always feasible for all types of Zenker's diverticulum and the recurrence rate is high. Accordingly, open diverticulectomy is recommended in patients with an adequate life expectancy and good general operability.

Background: Complications caused by osteosynthetic material after cervical spine surgery are rare., Patient and Method: The case of a 36-year-old patient is reported, who suffered the extrusion of a screw and migration through the hypopharynx after ventral spondylodesis of a cervical spine fracture., Result: Dysphagia occurred shortly after spinal surgery. The lack of one osteosynthesis screw in the spine was detected by X-ray and the material was located in the rectum. The screw had passed through the intestinal tract and was excreted spontaneously. An ENT medical control was carried out because of persisting dysphagia. Endoscopy revealed a cherry-sized granuloma of the posterior hypopharynx wall which was removed surgically. The healing process of the mucosa continued without further complications., Conclusion: X-ray control and endoscopy are required immediately when dysphagia occurs after osteosynthesis of the cervical spine due to possible complications caused by the implanted material. Further therapeutic measures depend on the case-specific constellation.

A 33-year-old, otherwise healthy female nursing student presented to the ear-, nose-, and throat- (ENT) outpatient clinic with a globus sensation that had been progressing for 6 months. Tomographic imaging revealed a neck mass extending from the 4th vertebrum to the subclavicular region and apex of the left lung. A surgical resection with histopathological examination exposed a neurofibroma. Management and differential diagnoses of globus sensation are herein discussed. This case underlines the importance of tomographic imaging, even in common but persisting symptoms such as globus sensation.

Many different causes have been described for dysphagia. An uncommon one is trichobezoars, which are mainly caused by trichotillomania. This may lead to mechanical obstruction and peritonitis due to perforation of the gut. Here we report a case of a giant trichobezoar (30x20x10 cm) in the stomach of a 20-year-old female. The patient presented unclear dysphagia and a palpable tumor in the epigastrium. Computed tomography showed an inhomogeneous tumor spreading from the upper belly to the pelvis. A B1 resection was performed and the patient recovered uneventfully.

Intrathoracic gastric herniation after laparoscopic antireflux surgery is a rare but well known phenomenon. It may occur during the early and late postoperative period. We report on a patient with early onset of dysphagia after surgery due to a tight wrap. Subsequent vomiting and dysphagia increased due to a gastric herniation. After gastroscopy and bougienage, tension pneumothorax developed. The context and relationships are illustrated and discussed referring to the current literature.

Background: Patients with supraglottic laryngectomy often complain about persisting dysphagia because the resection includes the most important protective mechanisms of the airway. The additional resection of parts of the tongue base or the lateral hypopharyngeal wall leads to increasing aspiration problems., Patients and Results: Reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage in extended oro-hypopharyngeal and laryngeal carcinomas was carried out in seven patients from 1997 to 2002. In one patient, the reconstruction was performed in a second stage procedure after extended endoscopic laser resection. In four patients, the temporary tracheostomy was closed, and in five total oral feeding was possible., Conclusions: Preliminary results show that a functional reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage to reconstruct the epiglottis helps to avoid chronic aspiration and to preserve the larynx.

Introduction: As a rule, epiphrenic diverticulum occurs in combination with most diverse forms of dysfunction in the lower esophageal sphincter (LES) and/or in the esophagus itself. The main symptoms are dysphagia, pain, and regurgitation. The operation consists in myotomy, diverticulum resection, and partial fundoplication via abdominal or thoracic approach using conventional or minimally invasive technique. The main risk is postoperative suture dehiscence after diverticular resection. The present study was therefore undertaken to establish whether the operation succeeds in risk patients even without resection of the diverticulum., Patients and Methods: In the period from 1998 to 2001, six patients were investigated preoperatively by means of esophageal manometry, endoscopy, and radiological barium swallow. The four risk patients underwent only myotomy of the LES, if appropriate, in combination with laparoscopic partial fundoplication. Resection of the diverticulum by thoracoscopy or with conventional thoracic technique was also performed in the two patients with normal risk., Results: Three of the four risk patients showed normal postoperative courses after laparoscopic myotomy and rapidly became free of symptoms and were able to eat normally. One patient died perioperatively of pulmonary complications. After thoracic diverticulum resection, both patients developed postoperative suture dehiscence with a complicated course. Altogether, freedom from symptoms with regard to dysphagia and regurgitation could be attained in five out of six patients over a follow-up period of 6 to 25 months., Conclusion: In patients with epiphrenic diverticulum and disorder of LES function, myotomy alone without resection of the diverticulum may be sufficient to relieve or eliminate symptoms. Laparoscopy and the combination with partial fundoplication are the preferred techniques. In our opinion, this method must be considered in order to reduce the surgical risk in multimorbid and elderly patients.

Introduction: According to randomized studies, semifundoplication in the treatment of gastroesophageal reflux disease (GERD) is related to lower postoperative dysphagia rates than with fundoplication in comparable reflux controls. However there is a lack of long-term results. The object of this study was therefore to determine the influence of partial anterior fundoplication on the long-term clinical outcome (>1 year) in patients with GERD., Method: From December 1986 until May 2000, 100 patients suffering from GERD were operated on. Seven of them were not evaluated, four because of revisional surgery, two because of preceding multiple abdominal operations (MEN, colitis ulcerosa), and one because of Nissen fundoplication. In all, the perioperative results of 93 patients (51 men and 42 women aged 21 to 86 years) were evaluated. Fourteen patients died during the follow-up period and two were lost because of changes in address. Thus, 77 patients with a median follow-up of 88 months (range 15-94) were interviewed with a list of standardized questions concerning reflux control and dysphagia., Results: The median operation time was 110 m (range 55-270). In one patient, an esophageal mucosal tear was detected intraoperatively and promptly repaired. Postoperatively, 71.4% (55/77) had no reflux complaints, 85.7% (66/77) had dysphagia, 66.2% took no further medication, and 31.2% (24/77) continued taking medication. The median interval free of symptoms was 25.5 months, and in 40.9% of the patients, symptoms recurred within the first year after operation. Five patients were in need of reoperation. A total of 77.9% of the patients were satisfied with the results of the operation., Conclusions: With regard to reflux control, long-term results of anterior semifundoplication are comparable to those of fundoplication. However, considering postoperative dysphagia, the technically easier anterior semifundoplication is less eventful and therefore a good alternative which in the long run shows good results after laparoscopic intervention.

Madelung's disease, also known as benign symmetrical lipomatosis, is a rare proliferative disorder of unknown etiology that was first mentioned by Brodie in 1846. Characterized by multiple symmetrical deposits of unencapsulated fat in the head and neck region, the disease is most common in middle-aged men with a history of alcohol abuse. The only effective therapy in cases of dyspnea and dysphagia, indicating the necessity of treatment, is the surgical resection of the adipose tissue. The authors report on the evaluation and therapy in a case of giant Madelung's disease.

The basic principle behind the treatment of achalasia consists of alleviating swallowing disorders by reducing resistance in the lower esophageal sphincter without inducing gastroesophageal reflux. Only a few studies are available on long-term results after operative treatment. Fifty-one patients were studied with regard to long-term results after open transabdominal extramucosal myotomy of the distal esophagus along with partial anterior fundoplication (Dor procedure). Clinical data were collected by standardized interviews, and symptoms were assigned a score ranging from 0 to 3 according to severity and frequency. The pre- and postoperative symptoms were comparable in 50 patients. The median duration of follow-up was 88 months (range: 12-160 months). Operative time was a median of 80 min. Two esophageal mucosal tears were recognized intraoperatively and promptly repaired. Postoperative morbidity occurred in two patients (3.9%). Very good or good long-term results after surgical therapy were achieved in 49 patients (96.1%). Forty-seven patients (92.2%) have no or rare dysphagia. The frequency of regurgitation as well as chest pain was also significantly reduced after surgery. Forty-nine patients (96.1%) either maintained or gained weight. Preoperative duration of symptoms, follow-up, age, and gender had no influence on the results (p > 0.05). Two patients (3.9%) mentioned occasional heartburn. Five patients (9.8%) took or still take proton pump inhibitors postoperatively. Severe stage IV symptoms due to peptic stricture and dolichomegaesophagus required reoperation in one patient (2%). The results show that myotomy and the antireflux procedure (semifundoplication) lead to long-term relief of dysphagia without inducing reflux at a low operative risk. Since long-term results are as yet not available for minimally invasive surgery, it remains to be seen if this operative technique will become the primary surgical procedure for this disease.

Background: Denecke developed 1957 a surgical strategy consisting of three or four operative steps for rehabilitation of patients with unilateral paralysis of IXth and Xth cranial nerve. These four steps are the following: myotomy of the cricopharyngeal muscle, resection of the paralyzed pharyngeal wall, medialization of the paralyzed vocal cord and fixation of the soft palate to the posterior pharyngeal wall which can be facultative., Patients and Methods: For the first time we have reviewed patients operated on with the Denecke operation in a retrospective study. The surgical results should be analyzed to deduce some parameters for surgical indication., Results: 16 patients were reviewed in regard to nourishment status, situation of tracheostomy, former pneumonias, classification of Miller and Eliachar for aspiration and subjective evaluation. The follow-up was 21 +/- 16 months postoperatively. In 8 cases surgical intervention was successful. In 2 additional cases the results were partially satisfying., Conclusions: The surgical procedure of Denecke was successful for improving substantially nourishment and aspiration status of considerably reduced patients in about 50% of the reviewed cases. Preoperative cinematography of swallowing, manometry and an interdisciplinary approach are required to clearly define the indications for surgical intervention.

An adult patient with severe scoliosis secondary to familial dysautonomia developed dysphagia and recurrent aspirations. Various imaging studies showed a mechanical obstruction of the esophagus due to compression between the spine and the aorta. The patient underwent a gastrostomy and fundoplication, with a significant decrease in symptoms. The case demonstrates one of the possible long-term consequences of untreated scoliosis.

The percutaneous endoscopic gastrostomy is the procedure of first choice for the creation of a gastrostomy. If that is not possible a laparoscopic access should be preferred to a laparotomy. In tumor patients there seem to be some advantages of the laparoscopic Janeway gastrostomy compared to Kader-Stamm fistulas. We describe the technique and discuss the results of 5 patients without complications referring to current publications. In conclusion the Janeway gastrostomy is a good palliation because it is an effective, safe and simple method with easy handling, and little requirement for nursing care.

A 92-year-old man with dysphagia secondary to squamous cell carcinoma of the esophagus was palliated repeatedly with endoscopic laser therapy and insertion of esophageal stents. During the treatment period of 32 months, the patient could be fed perorally while ingrowth of tumor, development of new stenoses at the edges of the stents, and breakage of one stent were encountered. A tracheosesophageal fistula developed at the upper edge of the first stent. The patient died from aspiration pneumonia. At autopsy, no cancer cells were found in the esophagus. Combined endoscopic laser treatment and stent therapy may keep a patient free from dysphagia during a long period of time and also may result in the complete disappearance of tumor growth in the esophagus.

A case of dysphagia and hoarseness due to external compression by anterior hyperostosis between the third and fourth cervical vertebra is reported. Immediate relief of the symptoms was accomplished by surgical excision of the hyperostosis through an antero-lateral approach. The pathogenesis of the symptoms with reference to literature is discussed.

A rare case of dysphagia caused by leiomyomatosis of the esophagus is presented. Esophageal leiomyomatosis is triggered by diffuse proliferation of smooth muscle cells in the wall of the entire esophagus. Only 1.0% of all tumors of the esophagus are benign lesions; 0.4% of all esophageal neoplasms are leiomyomas. Only a few cases of leiomyomatosis-a special form of diffuse leiomyomas-have been described so far in the literature. Modern diagnostic imaging techniques such as CT and MR are described in esophageal leiomyomatosis.

Diagnostic and therapeutic procedures are presented in a 29-year-old female patient who suffered from severe dysphagia and rapid loss in weight. In the conventional X-ray examination and barium swallow an aberrant right subclavian artery was suspected. MR imaging (MRI) and MR angiography (MRA) were done to plan the surgical correction. Postoperative MRA documented exactly the complex topography after surgical correction and the flow pattern in the implanted Gore-Tex stretch graft prosthesis. Non-invasive MR angiography renders possible the concrete planning of complex corrections of thoracic vessels replacing invasive catheter angiography.

The occurrence of non-recurrent inferior laryngeal nerve is based on a rare embryologic vascular malformation of the aortic arches. Based on three recent cases, we discuss embryology, clinical presentation and operative technique.

Metastatic cancer to the esophagus is unusual. Breast cancer represents one of the most frequent solid tumors metastasizing to the esophagus. Less than 100 histologically confirmed cases were reported up to now. By suggestion of Laforet the entity of postmastectomy-dysphagia was inaugurated as a syndrome, characterized by dysphagia, occurring many years after mastectomy due to metastatic breast cancer. Surgical therapy by means of esophagectomy and esophagogastrostomy is a safe procedure and can provide a survival time of several years in combination with other therapies due to reliable palliation.

Improvements in video endoscopic technique opens a wide spreaded field of indications of thoracoscopic surgery especially in benign tumors of the esophagus. A 58-years old patient presented with dysphagia. Preoperatively a benign, intramural tumor of the esophagus wall was diagnosed. Enucleation of the tumor was performed by right videothoracoscopy. The use of thoracoscopic operative technique implies rapid disappearance of complaints and a reduced time of hospitalisation.

After surgery of advanced larynx and pharynx malignancies, a main problem is reconstruction of swallowing and voice. With microvascular small bowl transplantation, we have been able to use a 30 cm segment of jejunum in a one-stage procedure to reconstruct extended defects of the oropharynx, and total by hypopharynx, as well as to create a speaking-syphon as devised by Ehrenberger. The surgical technique is described and we now report the results achieved in our first five patients. This new method enables pharyngectomized and laryngectomized patients to speak and to eat without any aspiration after about two weeks. This rapid and functionally encouraging rehabilitation means a significant improvement in a patient's quality of life and is further justification for the great effort required in using this method.

In 1989, five patients were treated for a cricopharyngeal dysfunction by cervical myotomy. In the past, due to extremely limited indications for surgery, repeated efforts of conservative treatment had been attempted in patients with idiopathic cricopharyngeal dysfunction and tracheopulmonary aspiration and/or permanent inability of oral nourishment. These patients underwent surgery after an interdisciplinary clinical assessment. Four out of five patients showed immediate improvement of their serious symptoms. Cervical myotomy is not expected to be successful in patients with insufficient oropharyngeal propulsion, as we could see in one female patient with severe upper oesophageal sphincter spasm. According to the literature and to our results, approximately 70 to 90% of the patients with idiopathic dysfunction of the cricopharyngeal muscle, who underwent surgery, showed significant improvement or even recovery. Due to the multifactoral genesis of the cricopharyngeal dysfunction it is understandable, that the surgical result is heavily dependent on the preoperative interdisciplinary diagnosis. In summary, for idiopathic cricopharyngeal dysfunction with complications we recommend the early and technically simple operation.

An elongated styloid process or a calcified stylohyoid ligament may cause dysphagia or craniofacial and cervical pain. Palpation and radiography confirm the diagnosis provided that it is considered. The only effective treatment is surgery. Eleven patients undergoing surgery for elongated styloids or calcified ligaments are reported. In all cases the symptoms disappeared or were relieved. An evaluation of the external versus the transoral approach is presented. The authors recommend the external one, as it provides adequate anatomical exposure of the styloid process and its relationship to the structures of the parapharyngeal space.

The treatment of patients with advanced carcinomas of esophagus and gastric cardia endoscopic palliation should restore the passage for normal oral uptake. We compared the results of two methods: endoscopic neodym-YAG-laser-therapy (group I: 24 patients) and endoscopic perturbation (group II: 56 patients). An initial recanalisation was achieved after 1-4 sessions in group I and after 1-2 sessions in group II. Recurrence of dysphagia caused in median 5 endoscopic interventions in group I and 2 in group II. We observed no complications in group I and 5 complications in group II. The median survival times were not significantly different. The results and the follow-up show no definite superiority of one of the two methods, the selection of treatment modality depends on the technical possibilities and the personal experience of the physicians.

Dysphagia due to upper esophageal sphincter dysfunction is usually diagnosed by cineradiography. If the treatment of an underlying disorder fails to improve swallowing or if the dysfunction is thought to be idiopathic, cricopharyngeal myotomy is considered the treatment of choice. In properly selected cases (i.e. significant dysphagia and radiological proof of pharyngo-esophageal dysfunction) cricopharyngeal myotomy offers complete or at least substantial relief of symptoms for three out of four patients. The use of an operating microscope is strongly advised.

Severe dysphagia is a rare complication of proximal gastric vagotomy. Two of our patients developed severe dysphagia up to complete obstruction. They got symptom-free after 4 or 5 bouginages. It is of greatest importance to avoid operating on those patients who show signs of post-vagotomy dysphagia unless repeated bouginage has been performed. On one patient we used a newly designed bougie which allows dilation by complete endoscopic control.

An operation for the correction of swallowing and voice following paralysis of the vagus nerve is described. The operation is divided into four parts which are performed either in one or two stages. These include: 1. extramucosal myotomy of the pars fundiformis of the cricopharyngeus muscle; 2. correction of vocal cord paralysis by the rotation of the arytenoid cartilage and cartilage implant into the paralyzed vocal cord; 3. resection of the paralyzed wall of the pharynx; 4. fixation of the paralyzed soft palate to the posterior wall of the pharynx. Nineteen years experience with the four different parts of the operation are discussed.

A case of idiopathic chronic fibrous mediastinitis accompanied only by dysphagia is reported. Symptoms, etiology, and differential diagnosis are discussed with reference to the literature reviewed. The various conservative and operative methods of treatment are presented. In this case, attempts to mobilize the oesophagus were unsuccessful. Therefore, the oesophagus was bypassed via the colon.

This study reports two cases of anterior osteophytes that caused dysphagia leading to loss of weight and finally cachexia. The successful ablation of these osteophytes and clearance of the intravertebral spaces with ventral fusion of the cervical spine completely relieved these two patients of their swallowing difficulties.

After pharyngolaryngoesophagectomy had been performed to remove a malignant tumor, a shunt was created between the elevated gastric tube and the trachea for vocal rehabilitation in two patients. By covering the tracheostoma, the patients were able to produce a substituted voice without any reflux. However, strange vibrations of the gastric tube slightly disturbed the intelligibility of the shunt voice.