We recently experienced a case of transoral endoscopic thyroidectomy via the trivestibular approach. We identified and preserved all neighboring critical structures during surgery. The patient was discharged on postoperative day 3. There were no complications in thyroid function, vocal cord function, or lower lip sense. Transoral endoscopic thyroidectomy via a trivestibular approach provides a short and direct route to the thyroid and an adequate workspace without a skin incision. Therefore, it is worthwhile to develop and refine the surgical techniques of this promising new surgical approach.

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The causes of vocal cord paralysis include iatrogenic injury during thyroid or cervical surgery, heart and chest surgery, and tumorous lesion such as laryngeal cancer and lung cancer. In addition to these common causes, rarely, cardiovascular disease can also cause vocal fold paralysis. A disease known as Cardiovocal syndrome, or Ortner's syndrome, causes left vocal fold paralysis when the left recurrent laryngeal nerve is compressed by the pulmonary artery and aorta, which is occurred by pulmonary hypertension from heart disease. We report for the first case in Korea the diagnosis of vocal fold paralysis caused by Ortner's syndrome.

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm (MPN) which is characterized by proliferation of red blood cells, white blood cells and platelets. PV is associated with the JAK2 V617F mutation. The presenting symptom of PV is variable. Headache, weakness, fatigue, pruritus, dyspepsia, dizziness, visual disturbances may be seen in PV patients. Severe complications such as stroke, acute myocardial infarction and pulmonary embolisms are attributed to a red blood cells and platelets causing hyperviscosity and thrombosis. Even though hearing loss, tinnitus and dizziness are belong to symptoms of PV, they are very rare initial presentation for patients with PV. We report a 49-year-old man with PV, whose first symptoms of PV were hearing loss, tinnitus and dizziness.

Tracheostomy is considered as a first treatment, when oral intubation seems to be difficult in patient who present severe upper airway obstruction. Generally, tracheostomy is performed in supine position. But if airway obstruction is severe enough to cause dyspnea, low oxygen saturation and inability to maintain supine position, tracheostomy should be performed in sitting position. The authors report a case of successful tracheostomy using high flow nasal cannula which help to maintain stable oxygen saturation and respiration in patients with laryngeal cancer.