Acquired tracheoesophageal fistula (TEF) can occur rarely from various causes. Recently, cuff-related tracheal injury after endotracheal intubation with the orotracheal tube and tracheostomy cannula is the most common etiology of nonmalignant TEF. Since cuff-related TEF is usually preventable with proper selection of the cuffed tube and close monitoring of cuff pressure. Although most patients present increased secretions, recurrent pneumonia, or coughing after swallowing, a high index of suspicion is required in patients at risk for developing a TEF. Surgical correction for the defectis required. In most cases, primary closure of the esophageal defect and tracheal resection and end-to-end anastomosis give the best results.

Background Neoplastic vessels tend to proliferate on the surface of malignant lesions in the aerodigestive tract. So, superficial malignant lesions can be detected earlier by enhancing mucosal vascular clarity. To enhance mucosal vascular clarity on endoscopic image, we developed an image processing algorithm of RGB (red-green-blue) channel substitution image (CSI). Methods Each pixel in original white light image (WLI) has its own value of red, green and blue channel. Various combinations of RGB channel substitution was tried on original WLI. Results To make superficial blood vessels darker than brighter background mucosa, in the CSI algorithm, RGB value in each pixel of WLI is substituted; red value to green one, green value to blue one. There was a good contrast between superficial mucosal vessels and background brighter mucosa in the CSI image. Conclusion By RGB CSI algorithm, WLI could be successfully converted to new images with enhanced mucosal vascular clarity. Using RGB CSI algorithm could provide added vascular visibility on original WLI.

Background and Objectives This study was conducted to gather three dimensional images from computed tomogram in detecting and gaining information about fish bones. Materials and Methods Thirty-nine fish bones and 2 chicken leg bones were used. Bones sandwiched between the cotton sheets were placed into the 3 plastic boxes. Computed tomogram of the bones in the boxes were reconstructed three-dimensionally by Xelis (Infinitt, Korea) to make images of MPR, MIP and VR images. The images were compared with real chicken bones and fish bones as to possibility of detection, finding of location and orientation, and evaluation of shape and calculation of size. Results All 41 bones were detected in all reconstructed images. Distance to the bones from reference point can be measured and orientation can be checked. Shapes were similar between matched images of all real bones. Conclusion The results indicate the usefulness of 3D reconstruction technique in getting informations about fish bones.

Tracheo-innominate artery fistula (TIF) is a rare but catastrophic and almost always fatal complication of tracheostomy. TIF can occur anytime but is commonly present 3 to 24 days after tracheostomy. It can first manifest as massive bleeding around and through the tracheostomy tube, but it can also manifest as a small amount of blood with temporary spontaneous resolution. If TIF is suspicious, airway management and prompt surgical intervention are needed. In an 83-year-old man with CVA history 20 years earlier and who had recurrent aspiration pneumonia, tracheostomy was performed for respiratory management and ventilator support. On day 7 post-tracheostomy, the patient had bleeding from the tracheostoma. Immediate surgical exploration was performed to control the bleeding. A defect was seen at the post wall of the innominate artery. The erosive portion of the artery was sutured, but the patient died three weeks after the surgery due to rebleeding and respiratory failure. We present a patient who developed TIF after tracheostomy, with literature review.

Second branchial cleft cysts are usually present as a fluctuant neck mass along the anterior border of the sternocleidomastoid muscle. When they are found in this typical location, accurate diagnosis on initial presentation is not difficult. Parapharyngeal presence of the branchial cleft cyst is very rare. We report a case of second branchial cleft cyst presenting as a parapharyngeal cystic mass in 51-year-old male. Before coming to our clinic, the patient had been diagnosed as parapharyngeal abscess, resulting in several attempts at removal. However, symptoms and parapharyngeal abscess recurred. We performed complete surgical resection of the parapharyngeal cystic mass via transoral approach only with oropharyngeal incision. The cystic mass was located in the parapharyngeal space and did not have tract-like structure. Histopathologic examination confirmed that the excised cyst was branchial cleft cyst. Patient discharged without any surgical complication and there was no evidence of recurrence for 2 years follow-up.

Bronchogenic cysts are uncommon congenital anomalies and commonly located in the mediastinum or lung parenchyma. Bronchogenic cyst in cervical area is rare and in posterior pharyngeal area is exteremely rare. Clinically, it is usually asymptomatic and incidentally diagnosed. It is pathologically confirmed only when there are bronchial tissues such as pseudostratified ciliated columnar epithelium, smooth muscle cells, mucous gland and/or cartilage. Since it has potential for malignant transformation and complication, complete excision is essential. We report a case of bronchogenic cyst located in the retropharyngeal space with a review of literature.