Aspiration of saliva and a late stenosis of the shunt are not infrequent among laryngectomized patients who had undergone surgery for vocal rehabilitation.
A new technique for neoglottic reconstruction was developed to overcome these complications.
A neoglottis is created from the upper three tracheal rings and the upper esophagus. A permanent tracheostoma is created at the level of the fourth and fifth tracheal rings. The larynx is removed through cutting the trachea off at the upper margin of the first tracheal ring. After removal of V-shaped portions from the anterior and posterior tracheal walls, the tracheal walls are reapproximated to create the neoglottis. The anterior wall of the esophagus with 1 cm vertical incision is pulled in through the tracheal opening, and is fixed on the internal surface of the tracheal ring to form a neoglottis without raw surface. The esophageal wall around the neoglottis is anchored at the level of 1 cm below the neoglottis. These procedures make the neoglottis not to collapse and to prevent aspiration.
This technique has been performed on five patients. Four of them are speaking well without aspiration one year after surgery. Their speech exceeds esophageal speech when measured against the parameters of duration and intelligibility. In one patient however, the neoglottis had to be closed because of aspiration.

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In order to avoid the vertebral image obscuring the routine A-P view of the laryngeal region, a technique of pantomography using TOSLAYER TR-840 (Toshiba) was applied for the examination of the larynx and hypopharynx. A preliminary study on an excised human larynx revealed that the laryngeal image was exposed on a laminographic plane of an elliptic shape. In the case of living human subjects, the vertebra appeared on the marginal portion of the film, the pyriform sinus in the median and the glottis in the center. The exposure dosage was estimated by the TLD method (KYOKKO). Taking the exposure dosage for 10 slices of conventional laryngeal tomography as 100, the dosage for a single exposure of pantomography (rotatory angle 270°, 20 second) was 18 on the cervical skin surface and 16 at the orbit.

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We report eight cases of laryngeal tuberculosis treated during the period from 1968 to 1982 at Shikoku Cancer Center Hospital. This disease has been rarely seen in Japan recently. The mean age of the patients was 53.5 (range 45-83). Seven out of the 8 patients did not show any remarkable symptoms of pulmonary tuberculosis, although tuberculosis was considered to be in active state. Chief complaints were limited to local symptoms such as hoarseness and soreness in swallowing.
We have to be cautious in differential diagnosis of tuberculosis from laryngeal malignancy because the age distribution of patients is shifted to older age and the laryngoscopic findings of tuberculosis are similar to those of malignancy in some cases.

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Eight patients who underwent total laryngectomy during the period from October 1961 to June 1977 were subjected to precise ventilatory function tests including respiratory resistance, flowvolume curve and closing volume test before and after inhalation of bronchial dilator repeatedly with an interval of more than two years.
The second test results obtained from March to April 1980 were compared with those of the first obtained from July 1976 to December 1977.
In general, laryngectomized subjects were found to present abnormal test results as compared with normal subjects in the same age range.
It was revealed that there were significant changes in %VC and CV/VC%, but no significant difference was found between the first and second test results in terms of FEV1.0%, respiratory resistance, or flow-volume curve. No significant difference was found in the data between the pre- and post-administration stages of a brochodilator. The results suggest that hyperinflation induced by relatively light expiratory obstruction existed in the lower air passage following long-term tracheal respiration after laryngectomy, but serious disturbances such as pulmonary emphysema asscciated with structural damage of lungs were not elicited.

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The lower airway hypersensitivity in 58 patients with nasal allergy (pollinosis) and without bronchial asthma was studied by the methacholine inhalation test using respiratory resistance measured with a rhinograph.
The results obtained are as follows:
1) An increase in the lower airway hypersensitivity was observed in 53 of the patients (91.4%).
2) The threshold of sensitivity to methacholine was 25, 000μg in 21 patients (36.2%), 12, 500 μg in 19 (32.8%), 1, 560μg in six (10.3%), and 195-Eg in seven (12.1%).

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Hypopharyngeal and cervical esophageal cancer is one of unfavorable tumors in the head and neck region. The therapeutic results of 48 patients who received treatment at the Kyoto Prefectural University of Medicine during the period of ten years from 1972 through 1982 (Group 1), were compared with those of 53 patients treated before 1972 (Group 2) in this paper. The one-year, three-year and five-year cumulative survival rates in Group 1, which were 85.4%, 53.6% and 40%, respectively, were better than those of Group 2, which were 36%, 14.6% and 11.1%, respectively. The great stride of these survival rates resulted from the progress in reconstructive surgery and radiation therapy.
It was concluded that the resection of the primary tumor with over 2 cm margin, prophylactic neck dissection in No case, and the combination of chemotherapy and irradiation to neck metastases with neck dissection should be mandatory for improving the therapeutic result.

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Use of a specially designed cup for double-contrast esophagography is reported. Using this cup, an adequate amount of air is taken with contrast medium for expanding the esophageal lumen to give an ideal double-contrast image throughout the entire portion of the esophagus.

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Esophageal endoscopy by nasopharyngolaryngo-fiberscope (ENF type LB, Olympus Co., Ltd.) can be performed handy and remarkably less uncomfortable to the patients. The fiberscope has a channel for biopsy. This instrument is used for the esophageal diseases or the routine laryngeal fiberscopy. However, when the observation is insufficient or a lesion is further distal, an additional endoscopy by gastrointestinal fiberscope is performed. Two cases were diagnosed as acute esophageal ulcer by this method. Their clinical courses were discussed.

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The authors experienced three prisoners who intentionally swallowed foreign bodies for attempting suicide and/or escape from prison. Case 1: a 32-year-old man in prison intentionally swallowed a piece of wood rail, 13 cm in length. On esophagography, the foreign body was found in the esophagus. Esophagoscopy revealed that the foreign body had already dropped into the stomach, and it was removed through a transabdominal operation. Case 2: a 42-year-old man in prison intentionally swallowed a ball-point pen, the lid of a chopstick case, a nail and his molar tooth. On X-ray examination of the chest and abdomen, the foreign bodies except the nail were found in the esophagus, while the latter was in the stomach. The foreign bodies were removed endoscopically. Case 3: a 37-year-old man in prison intentionally swallowed a key hole of a window and a handle of a desk a year and a half prior to examination. Later X-ray examination showed spontaneous extrication of the latter.
In general, prisoners, mentally deranged persons and attempters of suicide, swallow various types of foreign bodies intentionally, and multiple foreign bodies are often found in the upper alimentary tract. The authors emphasized that the preoperative detailed X-ray examination is necessary for diagnosis and choice of treatments.

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