Obstructive sleep respiratory disorder (OSRD) is a breathing disorder which occurs during sleep, which includes snoring and the obstructive sleep apnea syndrome.
Sixty-three adult patients who had been diagnosed as having OSRD underwent polysomnographic diagnosis with multiple barosensors to find the site of obstruction. There were four types of OSRD: the soft-palate type, root-of-tongue type, combined type and transfer type. The soft-palate type was shown by 39.7% of cases, the root-of-tongue type 27.0%, the combined type 30.2% and the transfer type 3.2%. The effectiveness of UPPP (uvulopalatopharyngoplasty) had been 50-80%, similar to our data for the soft-palate type. The patients for whom UPPP was not effective perhaps had an obstruction in an area other than the soft palate. Twelve patients whose site of obstruction was at the root of the tongue underwent mid-line glossectomy. Preoperative and postoperative results of polysomnography showed that the absolute mean value of the intraesophageal pressure decreased from 52.5cmH₂O to 27.1cmH₂O, and that the mean value of AHI (apnea hypopnea index) decreased from 56.0 to 29.4.
The correct diagnosis of the obstructed area and the selection of the operative method most appropriate for the area are very important. Mid-line glossectomy is the most effective treatment for the root-of-tongue type of obstruction.

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It has been suggested that the pseudoglottis in tracheoesophageal (TE) and esophageal phonation is formed by the activity of the inferior pharyngeal constrictor muscles. However, the physiology of these muscles has not been entirely investigated in laryngectomized patients. In the present study, the behavior of the pharyngoesophagus in eight TE speakers were investigated during swallowing, phonation and rest. Video-fluoroscopy revealed a single mucosal fold in the posterior wall of the PE segment in the resting state, as well as in phonation, which partially disappeared and dilated the pharyngoesophagus during swallowing. During phonation, the “pseudoglottis” was formed in the upper part of the mucosal fold. On the other hand, the lower part of the fold dilated and did not participate in the formation of the pseudoglottis. Intraluminal pressure-monitoring of the pharyngoesophagus was performed using four subjects. In three of the four subjects examined, the “high pressure zone” was present just below the level of the pseudoglottis at rest, and the pressure was lowered during phonation and swallowing. It was suggested that the pseudoglottis was formed by the activity of the thyropharyngeus muscle, and that the high pressure zone was formed by the constriction of the cricopharyngeus muscle. During phonation, the suppression of the cricopharyngeus muscle activity seemed to be effective for dilating the high pressure zone and lowering the airway resistance.

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Bilateral extended radical neck dissection with upper mediastinal dissection and free jejunum transplantation after pharyngolaryngectomy with esophagotomy was performed for 26 patients with advanced (stages 3 and 4) hypopharyngeal carcinoma. The three-year survival rate as determined by the accumulative method was 64%. Local recurrence occurred in two patients, and neck lymphnode recurrence appeared in two patients. The survival and diseasefree rates of these patients were significantly higher than in 22 patients with advanced hypopharyngeal carcinoma who received staged bilateral neck dissection and DP flap reconstruction. As for complications, two patients died from surgery and pneumonia. Swallowing was severely impaired in five patients. These complications tended to increase in senile patients. The results suggest that extended neck dissection with jejunum transplantation is effective in increasing the survival rate for advanced hypopharyngeal carcinoma, although it increases complications in senile patients.

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Swallowing is made up of a set of complex physiological movements resulting from a series of muscle contractions under precisely controlled neural innervation. Swallowing is thought to be immature immediately after birth. With physical development, swallowing movements become mature. The hypopharyngeal constrictor muscle, which plays an essential role in mature swallowing, consists of two different muscles having diverse functions: the thyropharyngeal muscle (TP), which drives the bolus into the esophagus, and the cricopharyngeal muscle (CP), the constrictor of the upper esophagus at rest. For this paper, the author investigated histochemically the differential pattern of the canine hypopharyngeal constrictor muscle, using the ATPase stain technique, in respect to functional development and the maturity of the TP and CP.
Compairing the proportion of muscle fiber types between two-week-old, two-month-old and adult dogs, the TP showed an earlier differentiation than the CP. As for the mean diameters of the type 1 and 2 fibers, the TP similarly differentiated earlier than the CP muscle.
To determine whether this differential pattern is specific to the hypopharyngeal constrictor muscle or not, the author observed the proportions of the constituent fibers and their diameters at 1, 2, 4, 6 and 9 weeks after birth between the TP, CP, extensor digitorum longus (EDL, type 2 fiber predominant in adult) and flexor digitorum superficialis (FDS, type 1 fiber predominant). The TP appeared to mature earlier than the EDL, while the CP seemed to differentiate later than the FDS.
These findings suggest that the differential pattern of the hypopharyngeal constrictor muscle may be specifically related to the maturity of swallowing movements after birth.

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Non-specific granulomas of the larynx are relatively rare inflammatory tumors. Voice therapy is the most efficacious means of dealing with these tumors. However, surgical removal has been performed frequently for this disorder. At the Keio University Hospital, 79 cases of granuloma have been surgically treated from 1965 to 1986. Such tumors have a great tendency to recur. The recurrence rate in our study was 47.1%.
Beclomethasone dipropionate inhaler (Aldecin^®) were used to treat 49 cases of nonspecific granuloma of the larynx from 1987 to 1991. Aldecin^® was administered by oral spray in two, 50 microgram-per-puff doses, four times daily yielding a total daily dose of 400 micrograms taken over one to fourteen months. In this trial, symptoms and findings improved markedly over the course of six months in 31 cases (63.3%). Two cases of candidiasis of the pharynx as a side effect were noted. We believe that proper voice therapy, or long-term resting of the voice, can be a very important factor in the cure of this disease, but that it may be impractical. In these cases, and as a initial treatment, Aldecin^® is a very usuful therapeutic adjunct for the treatment of non-specific granulomas of the larynx.

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A rare case of a hypopharyngeal foreign body (a fish bone) as long as 4cm accompanied by vocal cord paralysis is reported. A 70-year-old man visited our clinic suffering from dysphagia, swallowing pain and hoarseness. He had eaten “Namabushi” two days before his visit, which is a Japanese dish consisting of half-dried steamed bonito. Left vocal cord paralysis and edema in the left piriform sinus and the arytenoid region were observed, but we could find no foreign body using a laryngeal fiberscope. Roentgenograms and laminagrams revealed a linear, fish bone-like shadow located from the inferior edge of the thyroid cartilage to the left lateral neck area. The fish bone foreign body was removed under general anesthesia. The skin incision was developed on the left lateral neck. The fish bone had entered between the cricoid and thyroid cartilages just 2-3mm medial from the left inferior cornu and had also pierced the sterothyroid and sternohyoid muscles. Its end extended to the subcutaneous region of the neck. Vocal cord paralysis still remained on the 20th postoperative day but had disappeared on the 30th.

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We report a case of surgery for voice restoration in a 33-year old male complaining of breathy voice of 26 years' duration as the result of a traffic accident. He showed a fixed right vocal cord with marked atrophy. The right vocal cord was resected, and a pedicled flap comprising the right lobe of the thyroid gland (thyroid gland flap) was grafted onto the defective part. The grafted tissue was covered by the laryngeal mucosa, and the glottis was satisfactorily reconstructed. Sufficient glottal closure for phonation was obtained, and the post-operative voice quality was satisfactory. A CT scan revealed a well-adapted thyroid flap, and no evidence of atrophy in the grafted tissue was noted 20 months after the operation. We believe that the use of the thyroid gland flap is a very competent surgical technique for phono-surgery in traumatic voice disorders.

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A case of laryngeal papilloma with malignant change in a 84-year-old female was reported.
This patient has suffered from hoarseness since October 1988. She visited a neighboring ENT clinic and was urged to surgical treatment. However, she waited almost two years without undergoing any treatment. In October 1990, she visited us because of severe difficulty in respiration. A laryngoendoscopy revealed a papillomatous tumor occupying the laryngeal cavity. Successively, she underwent laryngomicrosurgery using the CO₂ laser technique. A histopathological study revealed that the tumor was a papilloma with a highly dysplastic change. Unexpectedly, a recurrence was endoscopically found at the right vocal fold in July 1991. Laryngomicrosurgery with a CO₂ laser was immediately performed again. Our histopathological division reported that a squamous cell carcinoma was found in part of the specimen.

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An 20 year-old male was admitted to the authors' hospital for the treatment of tracheal stenosis due to a traffic accident. Complete stenosis was found in the cricoid region. The patient underwent a posterior cricoid split with the removal of scar tissue and granulation in the stenotic portion. The wound was left as a tracheal gutter using a silicon T-tube as a stent.
On the 77th day postoperatively, the authors performed a reconstruction of the anterior wall using hydroxyl apatite as support for the skin flap in the anterior wall. About three months after the first stage of the operation, decannulation was safely performed. The patient was following a favorable course 21 months after the operation.

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The case of a 75-year-old man with squamous cell carcinoma of the thyroid gland invasive to the cervical trachea was reported. Squamous cell carcinoma originating in the thyroid gland is uncommon and is reported to have a poor prognosis. The patient came to our department with complaints of a fever of unknown origin and a large mass in the left anterior neck. He was diagnosed as having squamous cell carcinoma of the thyroid gland from the specimen biopsied through a needle, and it was suspected that the tumor had invaded the tracheal wall. He underwent a radical resection of the thyroid tumor concomitant with a left radical neck dissection and a oval-shape resection of the tracheal wall. Secondary reconstruction of the trachea was performed with a skin flap in which the nasal septal cartilage was implanted. A satisfactory postoperative status was obtained.

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Tracheal carcinoma is very uncommon in diseases of the upper respiratory system and is difficult to diagnose and treat in the early stage. Five patients with tracheal carcinoma have been treated at the Department of Otolaryngology, Niigata University since 1981 and here reviewed. The patients were 4 males and 1 female ranging 48 to 77 years in age. Dyspnea was observed in 3 patients and coughing and hoarseness in the other 2 patients. The tumors were found by a laryngeal fiberscope under local anesthesia. These were located in the upper one-third of the trachea in all of the patients and none were in the early stage. Histologically, 3 patients showed primary carcinoma (2 squamous cell carcinomas and 1 small cell carcinoma), and 2 patients showed metastatic carcinoma from the rectum and thyroid. Total laryngectomy had to be conducted on the patients with primary squamous cell carcinoma. A sleeve resection of the trachea with end-to-end anastomosis was carried out on the metastatic thyroid carcinoma patient. The primary small cell carcinoma patient was sent into reminission by chemotherapy and radiotherapy. The patient with the metastatic rectal carcinoma did not permit a radical operation and later expired.
From the above, it follows that careful attention should be directed to the subglottic region and the tracheal lumen of patients with respiratory complaints using endoscopy so that diagnosis can be made as early as possible.

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We have experienced observed diseases of the larynx using a new type of rhino-larynx electronic endoscope PENTAX PVE VNL-1530 connected to a video processor PENTAX PVE EPM-3300 (Asahi Optical Co., Ltd.). The electronic endoscope differs from the fiberoptic endoscope in that it contains a small, light-sensitive CCD chip which is attached to the tip of the endoscope. This electronic endoscope has a small CCD camera in its tip portion, which is 5.1mm in diameter, and can thus be passed through the nasal passage into the laryngeal cavity. The dynamic image provided by this system is superior to that obtained by a flexible laryngofiberscope in terms of resolution of detail. Several clinical cases were presented using data from this system.

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