The ultrastructural changes of subneural apparatus (SA) of neuromuscular junctions in the posterior cricoarytenoid muscle of dog were investigated using a scanning electron microscope. The experiments were carried out under the following three different conditions; 1) section of the recurrent laryngeal nerve, 2) immediate neurorrhaphy after section of the recurrent laryngeal nerve, 3) compression of the recurrent laryngeal nerve. In addition, light microscopic observations of the recurrent laryngeal nerve and evoked electromyographic study were also performed.
1) Nerve section: The primary synaptic cleft became shallower and flattened during six weeks after the section. The slit-like secondary synaptic cleft became round and pit-like form, and its density gradually decreased. These SAs disappeared after twelve weeks.
2) Neurorrhaphy: Molphological restoration of SA was obtained eight weeks after the treatment. The secondary synaptic cleft recovered faster than the primary synaptic cleft. Pararell with morphological recovery, functional restoration of the recurrent laryngeal nerve was proved by evoked electromyography.
3) Nerve compression: From six weeks after the compression, SA recovered morphologically and electromyographically. The course of recovery of SA was similar to that of neurorrhaphy group.
Emphasis was placed on the results that the initiation of morphological restoration of SA was coincided with the functional restoration.

抄録全体を表示

Twelve cases of polypoid vocal folds with severely edematous swelling were successfully treated with laryngomicrosurgical technique by use of a snare.
Postoperative analysis including phoniatric examination revealed that excellent normal voice restoration was obtained in 4 cases, good in 6 cases and fair in 2 cases. It should be emphasized that there was no case in which worse voice than preoperation was resulted in. Postoperative analysis including phoniatric examination revealed that excellent normal voice restoration was obtained in 4 cases, good in 6 cases and fair in 2 cases. It should be emphasized that there was no case in which worse voice than preoperation was resulted in.
It is considered that an excess removal of the mucous membrane and undesirable injury to the elastic conus can be avoided by use of a snare.
In this paper, the method was demonstrated with clinical case reports and discussed from the viewpoint of surgical manipulations which may influence on postoperative results.

抄録全体を表示

Recently, acute suppurative thyroiditis and acute cervical abscess resulting from infection through the piliform sinus branchiogenic fistula have been reported. We presented 4 acute cervical abscess. In this paper, the complete fistulectomy for a parmanent cure were performed for these cases.
The cases were one girl aged 11 years, two women aged 22 and 27 years and one boy aged 12 years. Clinical symptoms were sore throat, fever, and recurrent cervical swelling with severe pain. These cases were diagnosed based on fluororadiography with barium, and fistula originating from the apex of the left piriform sinus were disclosed. All cases underwent fistulectomy after acute inflammation was abated.
From these cases, we suspect that acute cervical abscess without obvious route of infection must have resulted from infection through the piriform sinus fistula and commplete removal of the fistula is essential for a permanent cure.

抄録全体を表示

Seven patients with unilateral recurrent nerve paralysis underwent vocal fold augmentation by intracordal injection of atelocollagen. Injection was done through direct laryngoscopy under general anesthesia. An additional injection was necessary in two cases and was done transcutaneously under local anesthesia. Five patients were followed as long as six months after injection. Four of them received 3. 5% atelocollagen injection and their phonatory function improved dramatically except one patient. The other received 3% atelocollagen injection. But, his vocal fold became again atrophied within a week after injection. Thus 3. 5% atelocollagen should be a choice for vocal fold augmentation. In addition, some physical properties of atelocollagen in the vocal fold was said to be like those of vocal fold itself. Therefore, atelocollagen can be injected into any layer of the vocal fold without specific technical care.

抄録全体を表示

It is true that there is no effective therapeutic method for spastic dysphonia. Patients with spastic dysphonia are mainly treated based upon psychology or voice training.
Since Dedo reported a surgical treatment, to resect the recurrent laryngeal nerve, many laryngologists have followed this method. We think that this method is recommendable for a patient with very severe spastic dysphonia. However, in case of not so severe spastic dysphonia, the hoarse voice caused by unilateral recurrent laryngeal nerve paralysis will anoy the patient on the contrary.
Therefore, we have newly designed a surgical method to resect only the terminal branch of the recurrent laryngeal nerve distributed in the thyroarytenoid muscle. A longitudinal incision from the anterior to posterior is made at the middle part of the vocal fold by use of the laryngomicrosurgical technique. By this incision, the terminal branches will be resected and also muscle fibers of the vocal muscle be resected.
Such a procedure causes a partial reduction of the tension of the thyroarytenoid muscle, resulting in reduction of spastic factors in the voice.

抄録全体を表示

Incidence of esophageal cancer among patients with head and neck cancer was estimated as about 1%. Recently, we had a rare case with double cancer of metachronous multiple tongue cancer and synchronous multiple superficial esophageal cancer.
A 48 year old man admitted the hospital for his tongue ulcer. He had underwent partial resection and irradiation of tongue cancer 4 years before. Further examination revealed epidermoid carcinoma at tongue ulcer and multiple superficial esophageal cancer. The tongue cancer was estimated as metachronous multiple cancer, because the lesion occupied opposite side of the tongue to the former tumor and there suspected no continuity between them. Partial resection of the tongue and total thoracic esophagectomy were carried out. Histological studies on resected specimens disclosed the tongue cancer as T1NO (stage I) and five esophageal cancers as superficial cancer (3 mucosal cancers, and 2 submucosal cancers) . There found only one lymphnode metastasis at para-tracheal node (n=1/98) .
Postoperative chemotherapy was carried out using CDDP 50 mg, MTX 30 mg and BLM 15 mg, and it repeated four times. Post operative course was uneventful.

抄録全体を表示

Two cases of PTP foreign body in the trachea and in the larynx were reported in this paper. The patients in these cases did not complain of severe uncomfortable symptoms compared to patients with PTP foreign body in the esophagus. Therefore, in managing PTP foreign body in the air passage, it is important to pay attention to the attack of cough, dyspnea etc. while obtaining present history.

抄録全体を表示

It is generally accepted that“sucking method or technique”is a very excellent surgical technique for polypoid vocal folds in order to restore normal voice. In sucking method, abnormal substance in the layer of the lamina propria is removed by sucking after making incision on the lateral side of the vocal fold from the anterior to the posterior. After sucking, if the vocal fold membrane is excessive, the membrane should be resected to some extent to obtain a normal shape of the vocal fold.
It can be said that if we could suture the membrane to cover all the wound, wound healing must be accomplished sooner. Hence we have tried to suture the membrane under endoscopic observation by use of a newly designed surgical instrument. In this paper, the instrument is described and the method employed is reported.

抄録全体を表示