Nihon Kikan Shokudoka Gakkai Kaiho

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It has been stated that in some animals foreign bodies are found in the esophagus but not in the tracheo-bronchial tree. In Man foreign bodies in the lower airway are of frequent occurrence. This difference between animals and Man prompted the author to investigate the comparative morphology and the basic principles involved.
In this study domestic animals as horse, dog, ox, pig and sheep were employed in comparison with Man. The results obtained are as follows.
In the animals studied, an elongated soft palate and a big epiglottis are in close contact with each other. In some, these two structures are overlapped so that the normal air tract is shut off from the oral cavity. The palate has lateral palatine fold which also assists in the exclusion of the mouth from nasal passages. In addition, the air and food highways in the animals do not cross at the same plane. These animals, therefore, can with impunity breathe and swallow at the same time.
In Man it is not so. There is a gap of several centimeters between the soft palate and the epiglottis, the former being short and degenerated with uvula as its relic. Thus respiration and deglutition can not be carried out synchronously as during the act of swallowing the breathing mechanism has to cease or vice versa. Moreover, the air and food highways intersect at the same plane in the pharynx. In children, particularly, bronchial foreign body incidence frequently occurs resulting from underdeveloped epicritic sense in the sequential mechanism of respiration and deglutition.
The author discusses other morphologic and functional factors which are attributable to the foreign body aspiration.

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The management of chronic stenosis of the larynx and cervical trachea is usually a difficult task for laryngological surgeons.
The surgical treatment of the established late case of chronic laryngotracheal stenosis depends on the location and the nature of the obstruction. If the cartilaginous framework is not injured, a simple open operation can be adopted to remove cicatricial tissues, granuloma and/or polipi obliterating the airway lumen. The opening fistula is closed after an appropriate period of time when it is apparent that the lumen is well maintained.
More extensive reconstruction of the stenosed larynx or tracheab ecomes necessary when the configuration of the suppooting cartilages is destroyed by trauma or infection and severe concentric obliteration of the lumen is evident. A wide excision of scar tissues followed by placement of a mucosal graft to cover the raw surface of the lumen is indicated. The graft is usually taken from the nasal septum or buccal wall and is supported in place with a silicone mould, which is also preventing the collapse or reobliteration of the airway lumen. Several devices are proposed for surgical closure of the large postoperative fistula in the anterior neck.
It should be stressed that good cooperation between the patient and surgeons is mandatory during the course of long term treatment.

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