Briinings' technique is an effective procedure to get a complete medial approximation of a paralyzed vocal fold by one-shot injection, when the glottic space is not so wide during phonation.
In cases which have severe insufficiency of a glottic closure with marked atrophy of the paralyzed vocal fold, even though a large amount of silicone should be injected to fill up the glottic space, it sometimes fails to obtain a good result because the silicone may disperse into the subglottic area.
We developed a new percutaneous injection for severe dysphonic cases of unilateral vocal fold paralysis. By our newly developed technique, the silicone is injected to the lack of the glottis from the thyroid notch along the medial side of the thyroid cartilage.
By this method, large amount of silicone can be injected into thyroarytenoid muscle to medialize the false vocal fold, ventricle, vocal fold as a whole, so the patient can gain the satisfactory phonation by one injection.
This procedure has another advantage that the patient need not undergo a painful procedure of rigid direct laryngoscopy.
Percutaneous silicone injection is indicated for recovering patients with severe insufficiency of glottic closure caused by post-operative unilateral vocal fold paralysis.

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The vibratory pattern of the vocal fold was observed and analysed using excised canine larynges. X-ray stroboscopy and ultra-high speed cinematography were utilized to clarify the three dimensional movements of the vocal fold vibration. As contrasting media, three lead pellets were inserted into the epithelium of the so-called free edge of the vocal fold with same distance. Their movements during vocal fold vibration were observed and recorded with an X-ray stroboscope and ultra-high speed camera from three dimensional aspects.
The experiments were mainly carried out on normal larynges. In addition, some pathological conditions were artificially produced on the vocal folds used for the same experiment. A small piece of muscle was attached to the vocal fold simulating a vocal polyp. And small amount of glue was injected into the fold to make it stiff.
The trajectory of each point was found almost circular only in frontal plane. On the other hand, their movements were observed to be almost linear in superior and lateral planes.
From these observations, the three-dimensional movement of the vocal fold was considered to be spindle-shaped along the longitudinal line of the folds.
A small mass loaded vocal fold showed almost normal vibratory pattern with larger amount of air flow. However, in stiffened folds only small wave motion was observed. Moreover, if inferior surface of the fold became stiffened, the vibratory pattern was obviously affected. This fact suggests that phonosurgical procedure on the inferior surface of the fold must be carefully carried out as much as possible to avoid undesirable injury on this area.

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The resting pressure and pressure change during swallowing in the pharyngoesophageal high pressure zone (PHPZ) were examined in 35 alaryngeal patients and 8 normal subjects. Twenty five of 35 patients had undergone simple total laryngectomy (TL) because of cancer of the larynx, and the other 10 patients had undergone pharyngolaryngoesophagectomy combined with free jejunal transplants (JT) because of cancer of the hypopharynx. As for the resting pressure, some previous reports describe that the lower resting pressure is more advantageous for the acquisition of esophageal speech. However, in this study, the resting pressure in the PHPZ of a good esophageal speech group was higher than that of a poor esophageal speech group. Seven of 10 JT group showed remarkable low resting pressure in the region of PHPZ. One patient of JT group acquired good esophageal speech who showed relatively high resting pressure. As for the pressure change during swallowing, the author obtained interesting information through the analysis of the swallowing wave. The duration of swallowing wave was more prolonged in the poor esophageal speech group. The pattern of swallowing wave form was classified into four groups, which were the normal pattern, the pattern without relaxation, the spasmodic pattern and the no critical wave pattern. Most of the patients who showed the normal pattern acquired good esophageal speech. On the other hand, all the patients who showed the spasmodic pattern or the no critical wave pattern could not acquire esophageal speech.

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Recurrent laryngeal nerve paralysis is sometimes caused by malignant tumors of the thyroid gland. On the other hand, it is rarely found in preoperative case of any benign thyroid enlargement. During the period from 1974 through 1985, 376 patients with recurrent laryngeal nerve paralysis were examined in our clinic. Among these patients, there were 5 cases in whom the paralysis was considered to be caused by benign thyroid diseases. They consisted of 2 cases of thyroid cysts and each case of thyroid adenoma, subacute thyroiditis and chronic thyroiditis. Two of them including the one with adenoma underwent partial thyroidectomy, and the other 3 were treated conservatively. The follow-up studies were done for all patients except one who was operated on because of thyroid cyst, and revealed that their paralyses of the vocal cord were completely recovered within 6 months after the initiation of therapy. The possible mechanisms of the laryngeal paralysis in the present cases were considered to be compression of the recurrent laryngeal nerve by thyroid cyst or adenoma, or spreading of inflammation to the nerve from thyroiditis. It is suggested that improvement of the vocal cord paralysis can be expected, if it is caused by the benign thyroid disease and properly treated. Such cases must be followed-up for long-term.

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Foreign bodies in air and food passages are occasionally seen during daily practices of medical care or patients' home care. Some cases are considered to be iatrogenic.
We have experienced following cases of bronchial and esophageal foreign bodies; medical and dental instruments, surgical materials, extracted teeth, resected specimen, drugs etc. These foreign bodies seem to be unpredictable to occur. Intense precaution during surgery by physicians involved in upper air way (otolaryngologists, anesthesiologists, dentists, chest surgeons etc.) and constant inspection of medical instruments by operating room staffs could avoid these unhappy accidents.

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A 61-year-old male had weared a silicone T-tube for 54 months because of laryngeal stenosis. The T-tube was replaced with a larger T-tube and finally the stoma was obliterated by using hinge skin flap method. The chemical composition of the tube was examined by infrared absorption technique and found to be stable.

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