During cordal injection therapy (a kind of laryngomicrosurgery), a patient needs to be kept still and ventilation needs to be maintained at an adequate level. In addition, the vision of the surgical field (particularly the posterior region of the vocal fold) should not be obstructed. Until now, various methods of anesthesia during cordal injection therapy have been assessed; they include local anesthesia, general anesthesia with tracheal intubation, general anesthesia without intubation (e. g., neuroleptanalgesia) and high frequency jet ventilation (HFJV). We have recently tried low frequency jet ventilation (LFJV) for anesthesia during cordal injection surgery under laryngomicroscopy. The use of this technique allowed us to keep the vision of the posterior region of the vocal fold almost unobstructed, to prevent elevation of PaCO₂ while PaO₂ at a sufficiently high level during operation. This method seems to provide an excellent means of anesthesia during this kind of surgery.

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To evaluate swallowing function, we utilize double contrast pharyngography, since barium coating or remaining to the pharyngeal mucosa is always observed in patients with organic or functional dysphagia. Recently, we introduced Computed Radiography (CR) into the above pharyngography and investigated its value for detecting the patients with clinical or subclinical dysphagia. In comparison with the conventional images, CR images offered clearer contour of the hypopharynx in the lesser X-ray doses without giving false negative images. The double contrast pharyngogram using CR is concluded to be a more accurate and useful screening method for detecting clinical or subclinical dysphagia.

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Paradoxical movements and abnormal electromyographical findings of laryngeal muscles following recurrent laryngeal nerve (RLN) injury may reflect quantitative and qualitative defects in the reinnervation process. The purpose of this study was to clarify morphological changes caused by reinnervation after freezing nerve injury.
Hartley guinea pigs weighing 300-400g were anesthetized with pentobarbital. The left RLN was injured by freezing (-80°C) at the level of the 10th tracheal ring. At intervals ranging from 2 weeks to 6 months, animals were reanesthetized and horseradish peroxidase (HRP) was injected into the left posterior cricoarytenoid (PCA) muscle. Animals were fixed by perfusion 48 hours after the HRP injection, and examined for the presence of retrogradely labeled perikarya in the medulla oblongata. Projections to the individual laryngeal muscles, as well as entire RLN, were also recruited as normal controls. On the other hand, we researched the histological degeneration and regeneration process of RLN following freezing injury.
Injection of HRP in normal PCA muscle labeled a well defined area within the ipsilateral nucleus ambiguus. From two to six months after the freezing injury, the number of labeled neurons increased gradually from 11 to 73. In addition, we were able to observe that the area occupied by neurons which project to the PCA muscle expanded, but was confined within the region of perikarya projecting to the normal RLN. Through the light and electron microscopic observations, most axons degenerated within 3 days and showed regenerative sprouting by 7 days after the injury. One of the most striking feature of nerve regeneration after freezing injury is rapid sprouting and maturing of regenerating axons compared to the other injuries. Target specific reinnervation was not accomplished even after freezing injury which produced minimum disorganization to the structure of RLN fibers.

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A case of idiopathic laryngeal granuloma, which was spontaneously expectorated by excessive coughing, is reported. The patient was a 36-year-old house wife complaining of only hoarseness. Under indirect laryngoscopy, a large laryngeal granuloma was observed in the right arytenoid area. She has no history of any possible factors of inducing laryngeal granuloma, such as intubation, inappropriate use of voice, regurgitant esophagitis and so on. Surgical removal of the granuloma was planned, however, it was expectorated by excessive coughing following sudden choking sensation, during preoperative follow-up period. Residual stem of the granuloma was also disappeared in a few weeks after the episode of expectoration without any surgical interventions.

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A case, 46-year-old female, of relapsing polychondritis was experienced. She complained of hoarsness and dyspnea. Under indirect laryngoscope, both falsevocal cords were found swelling and granulomatic stenosis was observed in subglottic space. But mobility of vocal cord was normal. The X-ray examination showed subglottical stenosis and narrow trachea. The collaps of nasal chondro-septum was observed.
As a first aid, tracheostomy was performed for subglottical stenosis. However, dyspnea increased, resulting in necessity of respiratory control with intubation. Pathology of the bronchial cartilage was strongly suspected relapsing polychondritis.
Regardless of tracheostomy and treatment with steroid and Dapsone^®, dyspnea and narrow trachea increased more and more. Total laryngectomy was performed for the purpose of the improvement of dyspnea and the prevention of aspiration pneumonia. Two-three weeks after laryngectomy, narrow trachea was improved and dyspnea disappeared.
We considered that by a dicreasing of compliance in upper respiratory system, the pathological improvement was obtained in main bronchus. A better ventiration promoted normalization of mucous gland of bronchus.
After laryngectomy, she had been alive without dyspnea but one year after died suddenly by acute heart failure. The cause of acute heart failure was suspected to be based on the complication of relapsing polychondritis.

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Tracheo-innominate artery fistula is one of the fetal complication of tracheostomy. It occurs mainly because of continuous compression of a cuff or an elbow of canule to the tracheal wall at the level of the innominate artery.
We treated a 54-year-old male operated on for his hypopharyngeal carcinoma. On the 120th. post operative day, sudden massive hemorrhage occurred through the tracheostoma. The hemorrhage was successfully controlled by inserting an endotracheal tube and hyperinflation of the cuff.
Median sternostomy was carried out and the innominate artery was resected. Three days after the operation, however, the patient died due to respiratory failure.

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A case (5 years and 3 months, female) of a bronchial foreign body is reported. After intubation using jet ventilation under general anesthesia, we found under bronchoscopy (₃C₁₀) a foreign body in the left bronchus and removed it using a Fogarty catheter.

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We reported a case of a cervical esophageal foreign body which had developed an esophageal perforation and a tracheo-esophageal fistula. The patient was 56 years old male and had been in a mental hospital because of mental retardation for 26 years. He misswallowed an artificial tooth, but his chief physician and nurses did not notice it. The esophageal foreign body could not diagnosed for a month. He was introduced to our hospital on the 22th June 1988, we tried to remove the forein body using rigid esophagoscope, but it ate into the esophageal mucosa, so we could not remove it. On the next day, the foreign body was removed by means of lateral neck incision. The esophageal perforation and the tracheo-esophageal fistula were repaired using Latissimus dorsi myocutaneous flap 5 days later. It was fortunate that he did not fall pneumonia or mediastinitis after the operation. The esophagogram three weeks after the operation did not reveal leak of contrast media or stenosis of the esophagus. He had been troubled with misswallowing caused by post-operative r-RLN palalysis, so we tried a percutaneous intracordal injection technique for improvement of glottis closure during swallowing. He was discharged from our hospital 16 weeks after the admission, We feel keenly to need the enlightenment about the danger of the artificial tooth which may be a foreign body of the esophagus.

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