Dual motor innervation by the bilateral recurrent laryngeal nerves has been demonstrated in the human arytenoid muscle as a whole muscle, but whether every individual muscle fiber of the arytenoid muscle receives single or dual motor innervation has not been made clear yet. The authors observed the side of innervation on the every individual muscle fiber of the intrinsic laryngeal muscles with the glycogen depletion technique in the arytenoid muscles of the monkey, the guinea pig and the dog.
After prolonged repetitive suprathreshold stimulation of the unilateral recurrent laryngeal nerve, the intrinsic laryngeal muscle fibers innervated by it are depleted of glycogen and are thereby identifiable in a PAS-stained section as unstained fibers (PAS (-)).
In the monkey and the guinea pig, the shape of arytenoid muscles is of the unpaired type similar to that of man, about one half of the arytenoid muscle fibers was PAS (-), and they were distributed in a random mosaic pattern. Therefore, arytenoid muscles of the monkey and the guinea pig are innervated equally by the bilateral recurrent laryngeal nerves as a whole muscle, but every individual muscle fiber is innervated by a unilateral recurrent laryngeal nerve from either side.
In the dog, the ventricular muscle and the transverse arytenoid muscle, whose shapes are paired type, received ipsilaterally dominant dual innervation, while the smaller interarytenoid muscle, whose shape is unpaired type, received dual innervation similar to the arytenoid muscles of the monkey and the guinea pig.
This study suggests that the glycogen depletion technique is a useful method in neurolaryngology and it can possibly supply new information about the physiological features of the intrinsic laryngeal muscles under various conditions of electrical stimulation; however, it is necessary to take the fundamental problems of this method into consideration.

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By conventional surgical methods for treating Reinke's edema, it was impossible to predict what sort of voice the patient would have after the operation. However, every individual has an expectation in regard to what sort of voice one would like to have postoperatively, so with this in mind we studied surgical methods. It was possible for both male and female patients to acquire the anticipated postoperative voice based on the amount of mucous membrane excised from the superior lateral region of the vocal folds, and the amount of contents excised from Reinke's space.

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A statistical study was made of cases of esophageal foreign bodies encountered in our clinic during the years from 1979 to 1988 and in selected institutions in western Japan in 1989. The results were as follows.
1) Esophageal foreign bodies were found more often in females than in males in both patient groups. Two peaks were observed in the age distribution; one in children below the age 10 years and the other in the people above 60 years in both patient groups. 2) Coins were the most numerous type of foreign body in the cases at our clinic, while fish bones were prominent in the other area of western Japan. 3) Coins were the most numerous type in children below the age 10 years, whereas PTPs and fish bones were numerous in patients above the age 10 years. 4) Most of the foreign bodies were lodged at the esophageal orifice. 5) Most of the foreign bodies were removed with a rigid esophagoscope. A majority of the cases were treated under general anesthesia. 6) The most common esophageal foreign bodies were PTPs in large cities such as Osaka and Kobe, but fish bones in the other area of western Japan.

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We evaluated a swallowing pressure in two cases of mitochondrial myopathy of oculopharyngeal muscle atrophy type (case 1) and facio-scapulo-humeral atrophy type (case 2). A catheter with three diode transducers each 5 cm apart was swallowed through the nose into the upper esophagus. Firstly a patient was requested to drink 1 ml of water at about five-second intervals, and swallowing pressures were recorded under the condition that the speed of paper recording and catheter pull-through was the same 1 mm/sec. Secondly swallowing pressures were recorded under the condition that the middle transducer was fixed at the level of the upper esophageal sphincter and the speed of paper recording was 5 mm/sec. Thirdly resting pressure of the upper esophageal sphincter was recorded under the same condition of the first recording. The results were as follows: 1) swallowing pressure in the pharynx was low in case 1 and lower in case 2, 2) relaxation of the upper esophageal sphincter was complete in case 2 and incomplete in case 1, 3) resting pressure of the upper esophageal sphincter was rather low in two cases. And the degree of subjective dysphagia was higher in case 1 than case 2. These facts lead to the conclusion that relaxation of the upper esophageal sphincter was more important than peristaltic movement of the pharynx at swallowing.

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過去約30年間 (1963～1988) に中国武漢同済医科大学附属協和病院において経験した食道穿孔症例9例と, 同時期 (1960～1990) に日本で報告された症例87例について, 疫学的検討, 臨床的特徴, ならびに治療と予後について比較を行い検討した。
1) 食道穿孔の原因は, 中国例および日本での報告例ともに, 食道異物によるものが最も多く (42.7%/中国例9例中6例, 日本の報告例87例中35例), 次いで医原性損傷 (36.5%/中国例9例中1例, 日本の報告例87例中34例), 特発性食道破裂 (17.7%/中国例1例, 日本例16例) の順であった。
2) 穿孔部位は, 中国例では頸部食道4例, 胸部食道3例, 腹部食道1例, 部位不明1例で, 日本例では頸部食道31例, 胸部食道38例, 腹部食道14例, 部位不明4例であった。穿孔の原因が異物や医原性であったものは, 穿孔部位が第1狭窄か第2狭窄, あるいは第1狭窄から第2狭窄までの間に集中していた (中国例7例中6例, 日本例69例中50例, 計76例中56例, 73.7%)。特発性食道破裂の穿孔部位は, 17例 (中国例1例, 日本例16例) 中15例 (88.2%) が, 第3狭窄, あるいは第2狭窄から第3狭窄までの間であった。
3) 臨床症状は, 突発性の激しい嚥下痛, 嚥下障害, 頸部あるいは胸部, 腹部の激痛および頸部皮下気腫などが特徴的であった。頸部皮下気腫および縦隔気腫は頸部食道・胸部食道穿孔例だけではなく, 腹部食道穿孔例においてもみられた。
4) 診断にはガストログラフィンを用いた食道造影, 頸部および胸部CTと単純X線撮影が有用であった。特に食道造影では, 食道穿孔の有無に加えて, 穿孔部位と大きさに関する情報も得られた。
5) 治療は, 外科的治療が原則で, 特に胸部食道穿孔例や穿孔が大きい場合, 臨床症状が激しい場合は早期手術が必要である。

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Laryngomalacia is usually a benign condition which occurs soon after birth, and is resolved by 2 years of age. A 12-year-old female, with a history of nasal allergy, had complained of inspiratory stridor and cough. Laryngoscopy revealed a flaccidity of all the supraglottic structures. The arytenoids and aryepiglottic folds were fluttering during inspiration. The stridor was improved after resecting the excess tissue with a CO2 laser. A barking cough appeared about 10 days after the operation and placebos were effected to it. We suggest that she had a tendency to inspiratory laryngeal collapse and that her symptoms might have been triggered by allergic and/or psychological factors.

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We present a 28-year-old woman, gravida 2, with subglottic hemangioma occurring during pregnancy. She had complained of cough since the 28th week, with clots of blood at the 35th week and difficulty in phonation since the 37th week of pregnancy. She was admitted to the hospital as an emergency with wheezing and dyspnea and delivered of a child by Caesarean section at the 38th week of pregnancy. The next day laryngeal fiberscopic examination revealed a subglottic mass with size of 10 mm in diameter and pedicle at 4 mm below the anterior commissure. She underwent laryngomicrosurgery with Nd-YAG laser. The lesion was removed with little bleeding. Histological examination revealed a capillary hemangioma. This is a rare case since the great majority of adult laryngeal hemangiomas tend to be supraglottic whilst those in infants are subglottic. The growth of this hemangioma may be related to pregnancy, because the symptoms in this case were gradually worsened during pregnancy.

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It is generally known that chemotherapy and radiotherapy are not so effective to thyroid carcinoma, so surgical resection of the tumor should be a main treatment.
Thyroid carcinoma sometimes invades the upper respiratory tract, such as larynx and/or trachea. In such cases the resection of a part of the respiratory tract and its subsequent reconstraction are necessitated.
Recently we experienced two cases of thyroid carcinoma which invaded the upper respiratory tract. After the resection we reconstructed the trachea with D-P flap and cervical flap. They had a fine clinical course.
There are several techniques for reconstructing the upper respiratory tract, but we recommend to use skin or myocutaneous flaps considering the safety and the accuracy.

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A 46-year-old woman presented with short history of dyspnea. Five months before the onset of symptom, the patient had a mild wheezing. She had no history of smoking. Physical examination suggested primary tracheal tumor. The patient underwent a V-shaped resection of 3.5 cm of the trachea followed by reconstraction with the trough method. Histological examination revealed adenoid cystic carcinoma. Adjuvant chemotherapy was indicated with 50 mg of adriamycin postoperatively. The patient has done well for 8.5 years with no further treatment.

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We experienced three cases of esophageal foreign bodies, removal of which had failed with flexible esophagoscope by well trained gastroenterologists in other hospitals because of large size and sharp shape. Finally we removed them with a rigid esophagoscope under general anesthesia.
Based on our experiences, we discussed the limitation of flexible esophagoscopy for the removal of esophageal foreign bodies.
In a case of a large or sharp foreign body which seems impossible to pass through the cricopharyngeal pinchcock with the flexible endoscope, it might be the indication of the removal with a rigid scope or with an external approach under general anesthesia.

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A 14-month-old female infant who ingested‘something’was brought to our emergency department, crying severely. PA and lateral chest X-rays showed a coin-shaped foreign body lodged in the esophagus at the thoracic inlet. Three hours after ingestion, the foreign body was removed by esophagoscopy under general anesthesia. On removal, the foreign body proved to be a lithium battery, measured 20mm in diameter, but not a coin. The case of the battery was not perforated. Abundant black debris was found around the lodged battery, and the esophageal mucosa was eroded. The infant was treated with intravenous antibiotics and steroids. After two weeks, she was discharged without any sequelae.
Button batteries can cause esophageal necrosis by sodium hydroxide produced from local direct current. Therefore, unlike coin foreign bodies, button batteries should be removed as soon as possible if lodged somewhere in the esophagus. We suggested two points of differential diagnosis of button batteries from coins: (1) double contour in the PA X-ray; (2) continuous pain, especially manifested by crying in children.

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