Laryngeal complications of endotracheal intubation include formation of Laryngeal granuloma, glottic and subglottic edema, mucous membrane abrasion, and recurrent laryngeal nerve paralysis.
We report here four cases of arytenoid cartilage dislocation with a history of endotracheal intubations. All our cases were in chronic phase of dislocation. In our series, closed reduction of the dislocation was performed. Three cases were easily reducted without complication by manipulation of the dislocated arytenoid cartilage at direct laryngoscopy under modified NLA. One case, 57-year-old woman with four months' history of dislocation, was not completely reducted. Because the cricoarytenoid joint had already fibrosed and fixed in an unfavorable position. But We have a successful reduction case with five months history of its dislocation.
We suppose the cricoarytenoid joint fibrosis is not consistent but has a considerable variation, and so the closed reduction is worth selecting as a peforming operative procedure.

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Cricopharyngeus muscle specimens taken at the cricopharyngeal myotomy were examined histopathologically. Cases included here were the following diseases: amyotrophic lateral screlosis, oculopharyngeal muscular dystrophy, Kearns-Shy syndrome and “cricopharyngeal achalasia.”
The specimens of amyotrophic lateral screlosis showed a pattern of group muscular atrophy or neurogenic muscular atrophy with slight degeneration of muscle fibers, slight fibrosis but no inflammation. The specimens of oculopharyngeal muscular dystrophy and Kearns-Shy syndrome, on the other hand, showed scattered muscular atrophy, degeneration of muscle fibers with marked fibrosis and myogenic muscular atrophy, while no inflammatory processes were found either.
The specimen of “cricopharyngeal achalasia” showed scattered muscular atrophy, degeneration of muscle fibers, nuclear changes and fibrosis without inflammatory changes. These features resembled myopathic processes found in the specimens of oculopharyngeal muscular dystrophy and Kearns-Shy syndrome.
Recently “cricopharyngeal achalasia” has been defined as dysphagia at the site of cricopharyngeal portion without any already known organic diseases. On the basis of the present study and past reports of several investigators, the authors concluded that “cricopharyngeal achalasia” is caused by myopathic processes in the cricopharyngeus muscle.

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Sintered hydroxyapatite tube implantation following YAG laser irradiation to the tracheal membrane was evaluated.
Pathological changes in the tracheal membrane produced by YAG laser irradiation, which reduces mucus production and accordingly prevents accumulation between the membrane and the prosthesis, were studied in 18 mongrel dogs. A lateral irradiation probe was inserted into the trachea and the inner membrane of the trachea was irradiated circumferentially. The temperature of the membrane was monitored with a thermospot sensor throughout this procedure. The irradiated tissues were examined pathologically with reference to the specific temperature of the membranes. The membranous portion of the trachea showed a higher temperature than the cartilagenous portion with the same laser energy density. Histologically, the grade of destruction was divided into five grades ranging from desquamation to perforation.
The most adequate degree of membrane destruction was confirmed as grade 3 which showed shallow localized ulceration reaching to the submucosal glands and the temperature of the membranous portion was approximately 60°C.
The results obtained from the present study indicated that a hydroxyapatite prosthesis could adhere to the inner wall of the trachea most firmly with pretreatment by YAG laser irradiation to get 60°C of the tissue temperature.

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A study of 31 cases of blunt dissection for esophageal cancer were reviewed. The surgical techniques, prognosis, complications were compaired in each location of esophageal cancer. In 14 of 31 patients, cancer were located in the hypopharynx and cervical esophagus. This group was better in length of survival. In three cases of this group (21%), the metastatic lesions to the lower site of esophagus were found. In 5 of 31 patients, cancers were located in upper and middle part of thoracic esophagus. In this group it was very difficult to use this technique and also the prognosis was poor. In the remaining 12 patients, cancers were located in the lower thoracic esophagus and the abdominal esophagus. In this group, the patients with poor risk were operated using this technique, and the result was satisfactory.

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During 13 years from 1971 to 1983, 211 cases of the foreign bodies in the esophagus were treated in our clinic. Thirty-one cases of the X-ray permeable foreign bodies in the thoracic and abnominal portion of esophagus were studied statisticaly. The result were as follows:
1) The patients were high incidence in sixties (8 cases) and seventies (10 cases).
2) Meats were found in 11 cases, bones in 8 cases, PTP (press-through-pack) in 6 cases as kind of foreign bodies.
3) The foreign bodies were lodged both in the thoracic and abdominal portion of esophagus.
4) There was not a difinite history of foreign body ingestion. The characteristic symptoms were not complained of. The interval from the accident to visiting a hospital was apt to be long. Plain X-ray examination seldom revealed the foreign body shadow.
The roentgen diagnosis of the esophageal foreign body was discussed, and the authors emphasized that it is important to confirm the presence of a foreign body before endoscopic examination.

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This is a report of a patient with sudden hoarseness which was probably caused by mis-inhalation of a commercially-available alkaline disinfectant. The patient was a 27-year-old female who sprayed it in a small room in order to prevent mould. She said she inhaled carelessly much amount of it. Next day, she suffered from hoarseness and strange sensation in her throat and visited our clinic.
The laryngo-fiberscopical observation revealed that there were small masses with smooth suface at the posterior wall of the larynx bilaterally.
The masses were resected under microlaryngoscopy and vaporized completely with a CO₂ laser. A histopathological study revealed that the masses were nonspecific glanulomas.
This disinfectant was one of strong alkalis chiefly consisting of NaOCl and NaOH. The corrosive action of the strong alkali might cause minute injuries around the bilateral vocal processes of the arytenoid cartilages. The granulomatous mass was probably produced by the injuries with secondarily occured bacterial infection.
No recurrence has been found under the mirror-laryngoscopy after the treatment.

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We'd like to report on an extremely unusual case of squamous cell carcinoma of the thyroid gland, of a sixty-eight-year-old male patient that came to our hospital complaining of a bad cough and difficulty in breathing (dyspnea) that started about two months prior to his initial visit for medical consultation.
Our preliminary examination revealed an extremly large thyroid cancer, extensively spread into the larynx and trachea region. Due to the extensive nature of this case our diagnosis was that it was inoperative. Despite both irradiation and chemotherapy treatment the patient died ten months later. This case was pathologically diagnosed as squamous cell carcinoma originating in the thyroid gland.

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We reported a case of bronchial foreign body with pneumomediastium and subcutaneous emphysema.
A 16 months old female was referred to our hospital on the suspicion of bronchial foreign body of peanuts. Before performing bronchoscopy, chest X-p revealed Pneumomediastinum and subcutaneous emphysema. Careful Bronchoscopy was done under general anesthesia, and four pieces of peanut were removed. Pneumomediastinum and subcutaneous emphysema disappered after five days of operation, and her clinical course was pretty excellent. We emphasized that careful clinical observations were necessary before bronchoscopy for avoiding many medical and social troubles as the bronchial foreign body could cause pneumomediastinum and subcutaneous emphysema.

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Patients with laryngeal cancer generally visit a specialist in relatively early stage because of the horseness as a primary symptom. On the other hand, we see ocasionally the patients in advanced stage who need to have an emergency tracheostomy on the first visit. A part of such patients should be treated by the mediastinal dissection in addition to the routine radical neck dissection.
We report here two cases with stomal recurrences and one case with skin defect and esophageal fistula formation due to the radiotherapy after the laryngectomy.
They were operated on by the mediastinal dissection and esophageal stripping. The esophagus was successfully reconstructed by using the stomach.

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As the esophagus of the children is slender, it is difficult to remove a press-through-package from their esophagus without causing a perforation. We experienced a twelve-old-year girl who swallowed a press-through-package, and succeeded in removing it by bending its narrower base back. The way mentioned above is recommended, especially to the children.

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