Triple M syndrome is a rare and life-threatening overlap presentation of myocarditis, myositis and myasthenia gravis, secondary to immune checkpoint inhibition. We report a case of an 80-year-old female with metastatic cholangiocarcinoma, presenting with progressive asthenia, ptosis and dysphagia, following completion of six cycles of combination chemotherapy and immunotherapy, durvalumab. Her symptoms emerged 2 weeks after the commencement of maintenance therapy with immune checkpoint inhibitor, durvalumab, and poly(ADP-ribose) polymerase inhibitor, olaparib. Biochemical investigations were suspicious for myocarditis, myositis and type 2 respiratory failure due to myasthenic crisis. Clinical findings supported the diagnosis of triple M syndrome, and she was treated with high-dose steroids, intravenous immunoglobulin and supported with non-invasive ventilation. The patient initially improved; however, her admission was complicated by a fatal retroperitoneal haemorrhage. Our case highlights the need to consider serious immune-related adverse events and escalate prompt management for overlap syndromes in the context of immunotherapy and poly(ADP-ribose) polymerase inhibitors.

Esophageal reconstruction is one of the most challenging procedures in gastrointestinal surgery. While conventional therapeutic approaches, such as gastric pull-up and intestinal interposition, can restore continuity, they often fail to replicate native physiology. This limitation frequently leads to long-term complications, including dysphagia, stricture, and reflux, which can significantly affect the patients' quality of life. Tissue engineering approaches offer promising alternatives aimed at developing esophageal constructs that restore both structure and function, addressing the shortcomings of current treatment methods. 
This review highlights recent progress in esophageal tissue engineering (ETE), focusing on the requirements for ideal ETE scaffolds and examining available biomaterials, including natural, synthetic, and hybrid. We discuss advances in fabrication techniques and various cell-based approaches, such as primary cells, stem cells, and organoids. Furthermore, we also review the steps necessary to transition ETE constructs from the laboratory to clinical settings (ongoing human trials), including preclinical studies conducted on rodent, rabbit, canine, and porcine models with the expected functional outcomes and regeneration capabilities.
Early translational efforts in ETE are addressed, along with the regulatory and ethical considerations regarding Good Manufacturing Practice (GMP) compliance, traceability, and long-term surveillance. While significant advancements in ETE have been made in preclinical models, the review also discusses the challenges of moving to clinical studies. Potential strategies to address these challenges, such as 4-Dimensional printing, smart materials, Artificial Intelligence (AI)-driven scaffold optimization, and organoid-based models, are introduced to help bridge the gap from preclinical research to successful clinical trials. 
In summary, ETE is transitioning from an experimental advancement to a translational reality by integrating significant achievements in biomaterials, fabrication technologies, and cell biology while following health regulatory standards. These efforts aim to provide regenerative solutions that overcome the limitations of current therapeutic approaches in clinical settings, ultimately facilitating healing and improving the patients' quality of life.

Tetanus is a rare but potentially fatal infectious disease caused by Clostridium tetani, characterized by muscle rigidity, trismus, and dysphagia. We report a case of tetanus mimicking post-radiotherapy dysphagia in a 68-year-old male with a history of hypopharyngeal and esophageal cancers treated with chemoradiotherapy. The patient presented with acute-onset dysphagia and speech difficulty, which were initially attributed to radiation-induced sequelae. Because dysphagia and pharyngeal discomfort are common complaints in post-chemoradiotherapy patients, and laryngoscopic findings were unchanged from his recent baseline, multiple physicians-including head and neck cancer specialists-did not suspect tetanus on the initial visit. Detailed history-taking on the following day revealed a preceding hand injury, leading to a diagnosis of tetanus. Clinical examination revealed trismus with an interincisal distance of 20 mm. The patient required endotracheal intubation due to hypercapnia and anticipated airway compromise from progressive trismus, and subsequently underwent tracheostomy, but eventually recovered full oral intake (Functional Outcome Swallowing Scale Grade 0) after intensive swallowing rehabilitation. Additionally, we reviewed eight tetanus cases treated at our institution over the past decade. Of these, 87.5% required endotracheal intubation, 75.0% underwent tracheostomy, and 50.0% had persistent dysphagia at discharge. This case underscores the importance of obtaining a thorough trauma history in head and neck cancer survivors presenting with rapidly progressive dysphagia, as tetanus-induced symptoms can closely resemble post-radiation sequelae.

Surgical resection remains the primary treatment modality for well-differentiated thyroid carcinoma. However, hypoglossal nerve injury following thyroidectomy represents a rare complication. We report a case of bilateral hypoglossal nerve palsy in a 57-year-old female patient who underwent bilateral total thyroidectomy with neck dissection and thyroglossal duct cyst excision under general anesthesia. Comprehensive imaging and electrophysiological studies confirmed bilateral hypoglossal nerve dysfunction, although surgical re-exploration revealed anatomically intact nerves. Despite empirical steroid treatment, neurological improvement was limited. The patient subsequently underwent intensive, multidisciplinary neurorehabilitation. Over the following months, swallowing function gradually improved, allowing a return to oral intake, although mild dysarthria persisted. This case presents a complex and rare neurological complication following thyroid surgery. Although thyroidectomy techniques are well-established, preoperative assessment should carefully consider the potential risk factors for hypoglossal nerve injury to optimize surgical outcomes.

The San Diego Consensus for Laryngopharyngeal Symptoms (LPS) and Laryngopharyngeal Reflux Disease (LRPD) describes a broad-based multidisciplinary management paradigm that focuses on mechanisms underlying symptoms to improve treatment outcomes.

Herpes simplex virus (HSV) esophagitis is classically associated with immunocompromised states and is rare in immunocompetent patients, making the presentation of HSV esophagitis in an immunocompetent patient challenging to diagnose. We present the case of a 64-year-old immunocompetent male with a history of gastroesophageal reflux disease (GERD) who developed severe HSV esophagitis. The patient presented initially with severe retrosternal burning and inability to tolerate oral intake. Esophagogastroduodenoscopy revealed severe esophagitis, and biopsy confirmed herpes simplex virus infection. He was treated with acyclovir administered intravenously, followed by oral acyclovir therapy, along with proton pump inhibitor treatment, which resulted in rapid clinical improvement. This case highlights the importance of keeping viral etiologies on the differential for refractory esophageal symptoms, even in the absence of a history of immunocompromise, and underscores the role of endoscopy and biopsy in diagnostic evaluation. Early antiviral therapy was effective, demonstrating the need for prompt recognition and intervention for optimal outcomes. Increasing awareness of such cases can improve understanding and management of this uncommon condition.

Dysphagia resulting from bilateral cerebellar and brainstem infarction represents one of the most severe and challenging subtypes of post-stroke dysphagia in clinical practice. This study reports a case involving the application of cerebellar repetitive transcranial magnetic stimulation (rTMS) combined with modified proprioceptive neuromuscular facilitation (PNF)-guided balloon dilation therapy for dysphagia in a patient with bilateral cerebellar and brainstem infarction. The patient resumed full oral intake for all three daily meals and was able to drink fluids independently. A three-month follow-up confirmed sustained normal swallowing function with no signs of recurrence. The innovative "central-peripheral" combined therapeutic approach proposed in this study may represent a promising therapeutic option for the management of severe dysphagia following infratentorial stroke. This study aimed to detail the swallowing function recovery process in a patient with severe post-stroke dysphagia (PSD) resulting from bilateral posterior cerebellar lobe infarction combined with brainstem infarction, following comprehensive intervention integrating cerebellar rTMS (central neuromodulation) and modified PNF-synchronized catheter balloon dilation (peripheral functional remodeling). Through this case, we seek to explore the feasibility, safety, and potential therapeutic efficacy of this combined regimen for such complex PSD. It is intended to provide novel clinical insights and practical evidence for developing individualized and precise swallowing rehabilitation strategies in the future.