An aberrant right subclavian artery represents the most common aortic arch vascular anomaly. Conventional wisdom states that these anomalies do not result in dysphagia, but rather serve as “red herrings”. Clearly, in the vast majority of cases, this holds true. Nonetheless, one should never say never.

Herein, we present a cohort of four children with debilitating dysphagia resulting from an aberrant right subclavian artery. Subclavian reimplantation via a right posterolateral thoracotomy was performed successfully in all cases.

Dysphagia resolved postoperatively, and all patients were able to advance to a normal diet. They were able to gain appropriate weight postoperatively and continue to do well at most recent clinical follow-up.

This case series suggests that aberrant right subclavian artery anatomy should be considered a potential aetiology of dysphagia, albeit rarely. Surgical intervention for select patients can provide dramatic resolution of symptoms.

Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde–retrograde approach.

A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde–retrograde rendezvous technique is advisable.

In cases of complete obstruction of the oesophageal inlet, anterograde–retrograde dilatation represents a safe technique with which to restore enteric continuity.

We present a unique case in which closure of a large tracheoesophageal fistula was achieved with planned conservative management.

The literature was reviewed for other documented cases of spontaneous closure of traumatic tracheoesophageal fistula.

Acquired tracheoesophageal fistula may result secondary to a chemical burn from an alkaline disc battery impacted in the oesophagus, particularly when the presentation, and thus diagnosis, are delayed. This condition is rare. The majority of such cases occur in children, and are conventionally managed with surgical repair. We found only three previously reported cases in which conservative management was attempted.

Non-interventional management should be tried initially for the management of paediatric acquired tracheoesophageal fistula, to permit closure by secondary intention.

A 29-year-old man presented with sudden onset of severe pain in his throat, difficulty breathing and a hoarse voice, following an episode of vomiting.

Initial laboratory tests were normal. The patient underwent fibre-optic nasendoscopy, which demonstrated a haematoma in the piriform fossa. Lateral neck radiography and subsequent computed tomography scanning confirmed a 2 cm, loculated, gas-containing collection at the level of the vallecula in the right posterolateral wall, extending to the false vocal folds and communicating between the right parapharyngeal space and the right carotid sheath. Water-soluble contrast swallow confirmed the diagnosis.

Contained oesophageal perforation.

Conservative treatment was adopted involving nil orally, intravenous antibiotics and nasogastric feeding. The patient made an uneventful recovery.

Patients who have undergone tracheoesophageal puncture for surgical voice restoration often use unnaturally high oesophageal air pressures during speech. This study examined the effect of high oesophageal air pressure on oesophageal body motility, lower oesophageal sphincter function and dyspeptic symptoms.

Cross-sectional study using several investigative tests of oesophageal function.

Sixteen patients who used tracheoesophageal fistula speech underwent several investigations, including: oesophageal manometry, videofluoroscopy, barium swallow, and tracheal pressure measurements during speech. The patients were also asked to complete a dyspepsia questionnaire.

We demonstrated that more than 50 per cent of these patients had subjective or objective disordered oesophageal function. Videofluoroscopy and manometry identified oesophageal dysmotility in the same patients.

Oesophageal function appears to be altered by tracheoesophageal fistula speech. However, our study showed that there is no contraindication to proceeding with tracheoesophageal fistula voicing even in patients with a history of oesophageal dysfunction.

To investigate the effect of urinary flow rate on the urinary bladder temperature, we compared the accuracy and precision of urinary bladder temperature with oesophageal temperature at both high and low urine flow rates.

Twenty-four patients ASA physical status I or II who were undergoing tympanoplasty were randomly assigned to two groups with different intravenous fluid volumes: high (10 mL kg−1 h−1, n = 12) and low (3 mL kg−1 h−1, n = 12). General anaesthesia was induced with propofol and maintained with sevoflurane (1.5–2.5%) in nitrous oxide and oxygen. Urinary bladder temperature was measured using a Foley urinary catheter; distal oesophageal temperature was measured using a stethoscope thermocouple. These temperatures were measured every 5 min during surgery and the accuracy and precision of urinary bladder temperature with oesophageal temperature were determined using regression and Bland and Altman analyses.

The correlation coefficient for oesophageal and urinary bladder temperature was 0.90 in the high urinary volume group and 0.75 in the low urinary volume group. The offset (oesophageal–urinary bladder) was −0.13 ± 0.32°C and −0.46 ± 0.45°C, respectively.

Urinary bladder temperature appears to be more accurate at high urinary flow rates than at low urinary flow rates for clinical use.

To demonstrate the importance of a detailed history when assessing patients with a repeated pattern of foreign body ingestion.

A 19-year-old woman presented to our department following accidental ingestion of a teaspoon. On further questioning, she admitted to a habit of binge-eating followed by self-induced vomiting, in order to avoid weight gain; she blamed this behaviour on a stressful relationship with her partner. She also had one previous episode of accidental ingestion of a plastic spoon, which had been removed by oesophagogastroduodenoscopy. The patient underwent an uneventful rigid oesophagoscopy and foreign body removal. During post-operative recovery, she admitted that she had suffered for years with bulimia and anorexia nervosa. She was discharged home after appropriate psychiatric counselling, and follow up was arranged.

Oesophageal foreign bodies are commonly encountered in otolaryngology practice. Such circumstances are often compounded by pre-existing psychiatric problems such as bulimia and/or anorexia nervosa. Patients with bulimia may often present with a very similar pattern of multiple episodes of ingestion of large foreign bodies. Identification of this eating disorder (especially when there is a recurrent history of large, accidentally ingested foreign bodies) and prompt psychiatric referral is essential for efficient long-term management of this condition.

Secondary tracheoesophageal puncture is sometimes difficult and has a higher complication rate. In the irradiated neck, where neck extension is difficult, the traditional tracheoesophageal puncture method of insertion with a rigid endoscope is not possible. We describe a simple, safe and effective alternative method of tracheoesophageal puncture using curved forceps (Kocher's curved intestinal clamp forceps or Mixter forceps).

The procedure is performed under local or general anaesthesia with equal ease. Maximum neck extension is achieved. The curved intestinal forceps are passed through the mouth into the oesophageal lumen. The instrument tip can easily be seen or felt at the posterior wall of the tracheostoma. A small incision is made in the mucosa to allow the forceps tip to emerge, and a guide wire is passed through this incision out of the mouth. The prosthesis can be guided over the guide wire, in retrograde fashion, to fit the puncture hole.

Secondary tracheoesophageal puncture was performed in five cases with severe neck fibrosis. In all cases, valve insertion was easily achieved after secondary tracheoesophageal puncture, without any peri-operative complications.

This is a safe, simple and effective method for secondary tracheoesophageal puncture. It can be performed easily in any setting and is not associated with any complications.

To demonstrate the importance of two radiological views in the assessment of oesophageal foreign bodies.

The case of a child with multiple oesophageal foreign bodies appearing as a single object on an antero-posterior chest radiograph is used to illustrate the need for two radiological views in the assessment of such cases.

Two radiological views are recommended in the assessment of oesophageal foreign bodies.

We present a rare case of oesophageal perforation following ingestion of over-the-counter ibuprofen capsules.

Case report and literature review of pill oesophagitis.

A previously well, 18-year-old man presented with sudden onset, severe, retrosternal pain, dysphagia and odynophagia following ingestion of over-the-counter ibuprofen capsules. Plain X-ray films and a contrast-enhanced computed tomography scan indicated the diagnosis. The patient was successfully treated with non-operative management.

To our knowledge, this is the first report in the world literature concerning oesophageal perforation with ibuprofen. We discuss pill-induced oesophageal injury and its prevention. Manufacturers, clinicians and patients can all take steps to avoid this potentially life-threatening complication.

We report an extremely rare upper airway complication of oesophageal stent failure.

A 58-year-old woman presented four months after having a covered (anti-reflux valve type) oesophageal stent placed for a benign oesophageal stricture. Abdominal radiography showed a broken fragment at the gastroesophageal junction and another fragment in the rectum. On presentation, the patient had pneumonia with sepsis which required intensive care management. After recovery, she developed sinus symptoms of facial pain, green nasal discharge and bilateral hearing loss. ENT review revealed bilateral otitis media with effusion. Flexible naso-endoscopy found a stent fragment lodged in the nasopharynx. The wire mesh fragment was removed under general anaesthetic and bilateral grommets inserted. The patient's symptoms resolved.

To our knowledge, this is the first report in the world literature of a broken and migrated oesophageal stent presenting with chronic sinusitis and bilateral hearing loss. This case highlights the importance of examining the upper airways in such cases, and the need for further, long term studies of the complications of metallic, expandable stents.

To present a significant complication of pharyngolaryngeal reconstruction, which resulted in diagnostic confusion as it mimicked a second primary tumour of the head and neck.

Case report and review of the world literature.

A 61-year-old man developed a granulomatous foreign body reaction, mimicking a second primary tumour, at the distal end of a salivary bypass tube, following pharyngolaryngectomy and reconstruction using a tubed anterolateral thigh flap. Clinically and radiologically, this was felt to represent a second primary tumour of the oesophagus, but biopsies revealed full thickness inflammation of the mucosa and granulation tissue. Repeat oesophagoscopy two weeks after removal of the tube showed complete resolution.

No record of an oesophageal foreign body reaction to a Montgomery salivary bypass tube has previously been reported in the world literature. This report highlights the potential for such a lesion to cause diagnostic confusion with a second primary tumour.

Tracheoesophageal puncture is recognised as an effective and reliable method for voice restoration following total laryngectomy. Several techniques have been described, ranging from rigid oesophagoscopy under general anaesthesia to more recent endoscopic techniques utilising intravenous sedation or local anaesthetic. We describe our technique for secondary tracheoesophageal puncture utilising unsedated transnasal oesophagoscopy in an office setting.

Retrospective review of all total laryngectomy patients undergoing in-office transnasal oesophagoscopy-assisted tracheoesophageal puncture between October 1 2004 and December 31 2006.

Eleven patients undergoing transnasal oesophagoscopy-guided tracheoesophageal puncture were identified. Successful tracheoesophageal puncture placement was achieved in 10 of 11 patients (91 per cent). In one patient tracheoesophageal puncture could not be performed due to anatomic constraints. One patient had bleeding from the puncture site requiring silver nitrate cautery. All patients tolerated the procedure well. Voice results were satisfactory in all cases.

Transnasal oesophagoscopy-guided tracheoesophageal puncture provides a simple, safe option for secondary voice rehabilitation in laryngectomy patients.