For over a century, circumferential pharyngoesophageal junction reconstruction posed significant surgical challenges. This review aims to provide a narrative history of pharyngoesophageal junction reconstruction from early surgical innovations to the advent of modern free-flap procedures.

The review encompasses three segments: (1) local and/or locoregional flaps, (2) visceral transposition flaps, and (3) free-tissue transfer, focusing on the interplay between pharyngoesophageal junction reconstruction and prevalent surgical trends.

Before 1960, Mikulicz-Radecki's flaps and the Wookey technique prevailed for circumferential pharyngoesophageal junction reconstruction. Gastric pull-up and colonic interposition were favoured visceral techniques in the 1960s–1990s. Concurrently, deltopectoral and pectoralis major flaps were the preferred cutaneous methods. Free flaps (radial forearm, anterolateral thigh) revolutionised reconstructions in the late 1980s, yet gastric pull-up and free jejunal transfer remain in selective use.

Numerous pharyngoesophageal junction reconstructive methods have been trialled in the last century. Despite significant advancements in free-flap reconstruction, some older methods are still in use for challenging clinical situations.

Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches.

This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed.

The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well.

This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patient's history, the nature and location of the foreign body, and associated risks.

A pathological communication between the trachea and oesophagus – a tracheoesophageal fistula – may be congenital or acquired, benign or malignant, necessitating a multidisciplinary approach. Conservative attempts at closure of this abnormal connection are ineffective; the interposition of healthy vascular tissue offers the least chance of recurrence.

Outcomes of an islanded fasciocutaneous internal mammary artery perforator flap applied for tracheoesophageal fistula management were assessed in four radiated patients with laryngeal carcinoma using retrospective records.

Four male patients, with an average age of 60.75 years, underwent tracheoesophageal fistula closure between September 2017 and February 2021. A left-sided second internal mammary artery perforator flap was used in all cases, with an average dimension of 10.5 × 4.5 cm. There were no complications of tracheoesophageal leak, flap issues or donor site morbidity on follow up.

Recent advances in angiosomal territory mapping and microvascular dissection techniques, combined with an understanding of tracheoesophageal fistula pathology, have changed management perspectives in these difficult-to-treat patients.

Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means.

After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction.

This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.

This study presents the incidence of denture impaction in the oesophagus, and discusses the difficulties of managing such cases.

A total of 262 patients with a history of foreign body ingestion (between 1999 and 2010) were reviewed; 46 of these patients had dentures impacted in the oesophagus.

The cervical section of the oesophagus was the commonest site of impaction. Dysphagia and tracheal tenderness were the most consistent features when dentures became impacted in the upper oesophagus. In most cases, rigid oesophagoscopy enabled successful removal of the impacted denture. Locating an impacted denture hidden within the oesophageal mucosal folds sometimes proved difficult.

In cases of impacted dentures in the oesophagus, a positive history helps in the diagnosis, but a high degree of clinical suspicion aids early detection. Conventional radiographs are important but may not always be of assistance. Early intervention reduces complications. Dentures that are poorly maintained and old are more likely to be swallowed accidentally. The inclusion of radiopaque filler within dentures would assist localisation following accidental swallowing.

To report a case of misdiagnosis of an impacted oesophageal button battery in a child, and to describe the associated risk factors for impaction and the management of such cases.

An 18-month-old, otherwise fit and well child with stridulous respiration was initially treated for croup. Medical treatment over the course of three months failed, and appropriate imaging subsequently demonstrated an impacted button battery in the upper oesophagus. This was promptly removed. There were no signs of damage on direct visualisation, or on a follow-up contrast swallow image.

This case highlights the difficulty of diagnosing oesophageal foreign bodies. We also discuss the characteristics of button batteries which confer a greater risk of impaction, and the associated sequelae and complications.

This paper describes and discusses the case of an oesophageal foreign body, in which the patient presented with primarily respiratory clinical signs.

A 17-month-old child, who had ingested a watch battery, presented to emergency services on multiple occasions with upper respiratory tract symptoms. Subsequent radiographs showed the battery in the oesophagus impinging on the trachea. The battery was removed successfully under a general anaesthetic.

Large oesophageal foreign bodies can impinge on the trachea causing upper respiratory tract signs. In such cases, anteroposterior and lateral chest films are imperative to make a correct diagnosis.

The objective of this study was to describe our experience removing esophageal coins from children in a tertiary care pediatric emergency department over a 4-year period.

We retrospectively reviewed a continuous quality improvement data set spanning October 1, 2004, through September 30, 2008.

In 96 of 101 cases (95%), emergency physicians successfully retrieved the coin. The median age of the children was 19 months (interquartile range [IQR] 13–43 months; range 4 months–12.8 years). The median time to removal of coin from initiation of intubation was 8 minutes (IQR 4–14 minutes; range 1–60 minutes). Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley catheter were used in the remainder. Succinylcholine and etomidate were used in almost all cases for rapid sequence intubation prior to coin removal. Complications were identified in 46 cases: minor bleeding (13), lip laceration (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus intubation (1), and other (8).

Emergency physicians successfully removed esophageal coins following rapid sequence intubation in most cases. Our approach may be considered for the management of pediatric esophageal coins, particularly in an academic pediatric emergency department.

We report the rare case of an oesophageal foreign body which lodged above the site of oesophageal compression by a double aortic arch.

Case report and a review of the literature surrounding the classification, embryology, diagnosis and management of vascular rings and slings.

An eight-month-old male infant presented with symptoms of tracheal compression following ingestion of an oesophageal foreign body. Following removal of the oesophageal foreign body, the infant's symptoms improved initially. However, subsequent recurrence of respiratory symptoms lead to a repeat bronchoscopy and the diagnosis of a coexisting double aortic arch, causing tracheal and oesophageal compression.

To our knowledge, this is only the second reported case of a double aortic arch being diagnosed in a patient following removal of an oesophageal foreign body.