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Background This multi‐institutional retrospective study focused on the clinical outcome of carbon‐ion radiotherapy (C‐ion RT) for non‐squamous cell malignant tumors of the nasopharynx. Methods The Japan Carbon‐ion Radiation Oncology Study Group collected and analyzed data for 43 patients with non‐squamous cell malignant tumors of the nasopharynx treated with C‐ion RT at four institutions in Japan. Results Twenty‐nine patients had adenoid cystic carcinomas, seven had malignant melanomas, three had adenocarcinomas, two had mucoepidermoid carcinomas, and two had other pathologies. Twenty‐six of the 43 patients (61%) had T4 tumors. The most common dose‐fractionation schedule was 64 Gy (relative biological effectiveness) in 16 fractions. The median follow‐up period was 30 months. The 2‐year local control (LC) and overall survival (OS) rates were 88% and 84%, respectively. For late toxicity, one patient developed grade 4 optic nerve disorder and two developed grade 5 pharyngeal hemorrhage. Actual incidence of grade 3 or higher late adverse events was 19%, and included cranial nerve dysfunction, jaw bone necrosis, central nervous system necrosis, and ear inflammation. Conclusions C‐ion RT provided good LC and OS rates with acceptable toxicity for treatment of non‐squamous cell malignant tumors of the nasopharynx.

Background Long-term nasogastric tubes are uncomfortable and associated with complications such as impairment with speech and swallowing, septum trauma, epistaxis, alar necrosis, and intubation of the trachea among others. Pharyngostomy tubes (PTs) are an alternative for prolonged enteral feeding, transluminal drainage of collections, and gastric decompression in patients with an intestinal obstruction and an inoperable abdomen. Patients and Methods This is a retrospective analysis of patients who had a PT placed at our institution from May 2005 to March 2015. The primary end point of the study was to establish the type and rate of complications and aspiration events related to PT use. Results During the specified period, a total of 84 PTs were placed. The most common indication for PT placement was enteric decompression in 65 (77.4%), followed by transluminal collection drainage in 12 (14.3%), and enteral access for nutrition in 7 (8.3%) patients. The mean time to tube removal was 17.8 days ± 17.1 (range, 2–119). We encountered 10 (11.2%) complications related to PT placement, including 7 cases of cellulitis, 2 superficial abscesses, and 1 patient with pharyngeal hemorrhage. Conclusion PTs are a relatively simple, safe, and straightforward approach to achieve long-term enteral decompression, access for feeding or transluminal drainage, avoiding the complications associated with prolonged nasogastric tube placement. The complication rate is low and patient satisfaction and compliance appear to be higher than with nasogastric tubes. Modern surgeons should be familiar with the procedure and technique. PTs should be part of every surgeon's armamentarium.

A 44-year-old man presented to our emergency department with a pharyngeal hemorrhage, 6 weeks after a total laryngectomy and extensive neck dissection. Immediate surgical intervention was necessary to stop massive arterial hemorrhage from the pharynx. The head and neck surgeon successfully ligated the common carotid artery during this procedure. We describe the anesthetic strategy and the thromboelastometry (ROTEM®)-guided massive transfusion protocol.

A fetus of 23-weeks gestation presented with polyhydramnios, and was found on sonography to have a large anterior cervical teratoma. At 26 weeks the mother went into premature labor and the membranes ruptured; at this time the uterus was of 32-weeks size secondary to polyhydramnios. A cesarean section was performed through a low transverse uterine incision, and the fetal head and shoulders were delivered with the cord intact. An endotracheal tube was placed, and the cord was then divided. The baby was taken to the neonatal intensive care unit for stabilization prior to planned resection, but suffered pharyngeal hemorrhage followed by endotracheal tube dislodgement several hours after birth, and expired. Despite an unfortunate outcome, this case illustrates the feasibility and potential value of in utero airway access in cases of prenatally diagnosed tracheal obstruction.

Thorium dioxide, a producer of alpha particle radiation, was used in the United States from 1930 to 1950 for carotid and cerebral angiography. Cervical thorium dioxide granuloma is a well-recognized sequela of extravasation of this material near the carotid bifurcation. Radical neck dissection to remove the granuloma for aesthetic and functional reasons may lead to massive postoperative hemorrhage if a patent, but radiation-weakened, carotid artery is present. Additionally, hemorrhage may occur spontaneously because of pharyngeal necrosis or following infection of a pharyngeal biopsy site. The case described illustrates that life-threatening, thorium-dioxide--induced pharyngeal hemorrhage may occur even with an occluded carotid system. The bleeding site may go unrecognized, and laryngopharyngectomy with radical neck debridement may be required for hemostasis. Extension of an infection into the retroesophageal space and thoracic inlet requires exteriorization of the entire neck wound to prevent placing the great vessels of the superior mediastinum at risk for rupture. Spontaneous rupture of the aorta may occur due to thorium-dioxide--induced necrosis of its wall.