This paper discusses twenty patients with radiation-induced cancers of the head and neck treated in the Department of Otorhinolaryngology, the Center for Adult Diseases, Osaka, from January 1979 to December 1985. The most common site of radiation-induced cancers was the hypopharynx and cervical esophagus (70%), we found synchronus double cancers in 2 out of the 20 patients (10%). One patient had hypopharyngeal cancer and thyroid cancer, and the other had oropharyngeal cancer and thyroid cancer. All of the laryngeal cancers were in the supraglottic area. Cancer of the hypopharynx and cervical esophagus occurred more frequently in females (1: 3.7 males-females ratio). Half of the patients (10/20) had received irradiation for tuberculous cervical adenitis and 8 patients had been irradiated for malignant tumors. The averaged latent period in the patients who had irradiated for benign conditions was 37.4 years, and that for malignant diseases was 16.0 years. Therefore the latent period of the former was 2.3 times as long as that of the latter. The incidence of radiation-induced cancers in all the patients who had the cancer of the hypopharynx and cervical esophagus was 9% and that of the laryngeal cancer was 0.7%. The incidence of radiation-induced cancers in the hypopharynx and cervical esophagus remarkably differed from that in the larynx. However, it was suggested that the larynx was as resistant to radiation induction as the hypopharynx. Six of the 20 patients (30%) had radiation-induced thyroid tumors. Among them, the incidence of cancers was 33%.

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Three cases of children with retropharyngeal absess, mediastinitis, and retropharyngeal emphysema are reported.
Case 1, a one year and seven months old girl, stuck a toothbrush into her left tonsil. She developed a big absess and emphysema in the retropharyngeal space and mediastinitis in the following 10 days.
Case 2, a 2-year and 2-month-old girl, also stuck a toothbrush into her right tonsil and developed an emphysema in the retropharyngeal space and the mediastinum.
Case 3, a 1-year and 6-month-old girl, stuck a piece of toy into her posterior wall of the oropharynx and showed retropharyngeal absess.
We often observe that small children fall with something sharp-pointed (a pen, a pensil, chopsticks, a toy, etc.) in their mouth and injure the oropharyngeal region. Some times such an accident could be followed by the deep neck absess, emphysema, and mediastinitis. The clinical significance of this kind of trauma, often called “pencil injury, ” is emphasized.

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Piriform sinus fistulae usually manifest as acute suppurative thyroiditis or abscess of the neck. In this paper, we reported a case of piriform sinus fistula with a chief complaint of foreign body sensation in the neck. The patient, 25-year-old female, was seen to our clinic on October 20th, 1987 complaining of foreign body sensation in the neck deviated to the left side with about two months duration. She had neither a history of acute suppurative thyroiditis or abscess of the neck. The indirect laryngoscopy revealed no abnormality of piriform sinus of both sides, but the hypopharyngo-esophagography demonstrated the abnormal shadow arising from the left piriform sinus. She was diagnosed as the piriform sinus fistula. The resection of the fistular canal was performed successfully under general anesthesia on July 26th, 1988. Histological examinations revealed that the lumen of the fistular canal was lined by the normal squamous cell epithelia. Inflammatory cell infiltration of moderate degree was observed in the subepithelial layer at the proximal portion of the canal. However, the canal was obliterated with the inflammatory granulation tissue at the distal end. These findings indicated the existence of the masked infection of the fistular canal that could be the cause of foreign body sensation in the neck. There have been no reports on piriform sinus fistula with a chief complaint of foreign body sensation in the neck.

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A case of an endoscopic removal of a tracheal foreign body using the Fogarty balloon catheter is described. A 19-month-old child was admitted in our clinic following aspiration of peanut, complaining of cough, stridor and respiratory distress. Although physically the chest showed no abnormal findings, X-ray examination of neck portion revealed the foreign body shadow in the trachea. Under the diagnosis of the tracheal foreign body, endoscopy was performed under general anesthesia without endotracheal intubation. The foreign body was tighly lodged in the trachea just beneath the vocal cord, and could not be removed by any foreign body forceps. A Fogarty balloon catheter was then introduced through the small gap between the foreign body and the tracheal wall and then the balloon was inflated. The foreign body was then removed smoothly with withdrawal of the catheter.
It was suggested that the balloon catheter is helpful during endoscopic removal of foreign body which could not be removed by the usual procedure.

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The patient was a ten-year-old boy who was buried under pebbly soil and suffered from marked airway obstruction.
He was transferred from a docter by an ambulance with oxygen inhalation. On arrival, he was nearly apneic and unconscious. Arterial blood gas analysis revealed pH 6.581, PaO₂ 400.2Torr, PaCO₂ 162.0Torr. Tracheotomy was done and most foreign bodies had been removed under bronchoscopy and by airway washing. Nine hours after removal, his consciousness was recovered. The pebbles in the right subsegmental bronchus B⁸_b were removed using bronchofiberscope later on. The tracheal stoma was obliterated four days later. He was discharged from the hospital after fifteen days' stay without any complications, e. g., pneumonia, emphysema, tetanus nor sequelae.
Foreign bodies, in this case, were mixture of soil and pebbles of various sizes, and were removed effectively by different maneuver, i. e., soil by airway washing, pebbles in bronchi by bronchoscopy and pebbles in peripheral bronchus by bronchofiberscopy. Needle insertion into the airway through cricothyroid membrane seemed to be of crucial efficacy for the initial respiratory resuscitation.

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1. We reported a case (44 years old woman) who had esophageal perforation after having swallowed a long curtain rail intentionally.
2. A balloon catheter was inserted to reach beneath the foreign body. Contrast medium was injected into the balloon under fluoroscopy and the balloon was inflated for removal of the foreign body.
3. A review was also made on cases of esophageal perforation due to foreign bodies reported in literature for the past 16 years in Japan.

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Chronic aspiration is a serious condition causing life-threatening pneumonia. Various surgical procedures, such as tracheostomy, tracheo-esophageal anastomosis, supraglottic closure (epiglottic flap), glottic closure, and laryngectomy, have been performed in the treatment of aspiration. The reversibility of the air-way will be necessary when the patient recovers from underlying disorder. The epiglottic flap operation was considered to have such reversibility. We modified this technique and could obtain excellent results.
The surgical procedure was as follows: The mucosa of the edges of both the epiglottis and the aryepiglottic folds were removed to create a raw surface. The free edges of bilateral aryepiglottic folds were closed medially in layers with interrupted absorbable sutures. Then epiglottic edge was also sutured. At the top of epiglottis, epiglottic cartilage was resected properly and the membrane was sutured in layers. This technique was performed on two patients who were suffered from chronic aspiration and eliminated aspiration.

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In order to reduce the airway resistance in a bilateral vocal cord paralysis case, several operations have been proposed. In 1984, Ejnell discribed a simple surgical procedure, we performed Ejnell's operation on two patients, one male and one female, who complained of dyspnea due to bilateral vocal cord paralysis. The etiology of the paralysis was thyroid gland surgery in both cases. One patient had improved dyspnea after Ejnell's operation, in the other patient her tracheostoma could not be obliterated postoperatively, even the dyspnea was improved slightly subjectively. No postoperative complications, such as granulation or necrosis, were seen. From these experiences it can be concluded that Ejnell's technique is a simple and effective operation to improve the airway.

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This report is concerned with diet for dysphagic patients. Oral intake of foods was very important as rehabilitation training for dysphagia. However, some foods which are difficult to swallow for patients might cause air way obstruction and pneumonia. Therefore the choice of suitable diet was essential for the rehabilitation of dysphagia. Though adequate foods for dysphagic patients were slightly different, case by case. They are generally wet, easy to masticate and favorite of the patients. On the contrary, unsuitable diet, is dry and spicy. The foods containing too much water and unfavorite ones of the patients are not adequate for dysphagic patients. A program of diet for dysphagic patients were proposed and tried on a patient of dysphagia. Oral feeding was begun with soft and wet foods such as pudding, yoghurt and “chawan-mushi” as the first step and baby foods were chosen in the next step. In the third step, well-boiled soft vegetables or “toufu” (bean curd) were added to foods of the second step. In the forth step, gruel were added to the previous step. The foods should be chosen according to the improvement of the dysphagia. The diet program for dysphagic patients should be established.

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