A scoring system for mucositis of the head and neck during irradiation was reported by van der Schueren in 1990. However, there has been no such scoring system developed for edema of larynx and hypopharynx. Thus, we present here a new semiquantitative scoring system to evaluate edema of the larynx and hypopharynx. The scoring system consists of five levels for evaluation of arytenoid edema.
The scoring system has been used to evaluate patients with laryngeal or hypopharyngeal cancer undergoing irradiation. The patients were examined during and after the irradiation. The scores during the treatment were associated with the total dose of the irradiation and the square of the irradiation field. On the other hand, the recurrence of their cancer and necrosis of the thyroid cartilage seemed to affect changes in the scores after treatment.
This new scoring system has been proven easy to perform and very useful for follow-up patients after irradiation.

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Histamine has multiple effects on the airways that are mediated by the H1-, H2-, and H3-receptors. Histamine causes bronchoconstriction partly by a direct effect on the H1-receptors in the airway smooth muscle and partly by activating a cholinergic reflex. In the present study, we examined the correlation between airway hyperreactivity and the density of muscarinic acethylcholine receptors. Because histamine causes broncho-constriction partly by activating a cholinergic reflex, it is necessary to confirm the correlation between histamine receptors and hyperreactivity.
Therefore, in this study, we studied the characteristics of the H1 and H2 receptors in guinea pig pulmonary tissues and the following results were obtained.
1) The density of H1 receptors in the lung tissue of OA-sensitized guinea pigs was higher than that in the control group. No difference was obtained between the affinity of the H1-receptors in the OA sensitized lungs and that in the control lungs.
2) The density of H2-receptors in the OA-sensitized lungs was lower than that in the control lungs. There was no difference between the affinity of the H2-receptors in the OA-sensitized lungs and that of the control lungs.
These results indicate that an increased density of H1 receptors and a decreased density of H2-receptors are involved in the pathogenesis of bronchial asthma.

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A statistical study was made of 137 cases of esophageal and 10 cases of tracheobronchial foreign bodies treated in our clinic during the 11 years from 1983 to 1993. The results were as follows:
1) Of the 137 cases of esophageal foreign bodies, 68 were males and 69 were females. There were no year-to-year changes in the incidences and sex distributions.
2) Two peaks were observed in the age distribution of the esophageal foreign bodies, one in infants under 9 years old and the other in adults over 50. These were especially prominent in male infants and female adults.
3) The foreign objects were PTPs (press through pack for medicine, 24%), coins (21%), fish bones (17%), artificial teeth (11%) and others. The most frequent object in the infants was coins; on the other hand, PTPs, fish bones, artificial teeth and pieces of meat were frequently observed in adults.
4) The present results indicate that the incidence of the elderly people over 70 and the percent of PTP foreign bodies of our clinic were higher than reported elsewhere.
5) Of the 10 cases of tracheobronchial foreign bodies, 7 were males and 3 were females. The annual incidence has not changed markedly.
6) Eighty percent of the total tracheobronchial foreign body cases were under 2 years old, and 20 percent were over 70 years old.
7) Beans were the most common tracheobronchial foreign bodies in infants, and false teeth were found in 2 cases of elderly people. Foreign bodies were more often seen in the right bronchus.
8) In order to prevent esophageal and tracheobronchial foreign bodies, it is necessary to emphasize the dangerous features of PTP, fish bones and artificial teeth to elderly people and their families, in addition to the danger of coins and beans to the parents of infants.

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We report the case of a 54-year-old man who showed dyspnea caused by a hypopharyngeal hemangioma. He had had a sense of respiratory distress on exertion and dysphagia since one month prior to visiting our clinic. The hypopharyngeal space was found to be filled with a tumor on fiberscopy, and a tracheostomy was performed on the day of his visit. A T₂ -weighted high intensity area was recognized on MRI. A histological diagnosis could not be obtained by biopsy using an endoscope because of the latter's thick capsule. A lateral pharyngotomy was carried out and the tumor, 5.0×3.5×3.0 cm in size with its pedicle in the bilateral arytenoid and postcricoid region, was totally resected without much bleeding. A histological examination revealed that the tumor was cavernous hemangioma. A recurrence of the tumor has not occurred for 14 months.

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Functional reconstruction after head and neck cancer operations has been developed using the deltopectoral (D-P) flap first reported by Bakamjian, 1965. However, due to problems such as the multi-step procedures required in the D-P operation and its poor quality for reconstruction, myocutaneous flaps, elevated digestive tract, free flaps and so on have become more familiar as materials for head and neck reconstruction recently. The D-P flap, however, requires no special technique and is safe and simple, and thus a reliable method for reconstruction. In addition, D-P flaps can be supported using fibrin tissue adhesive. Actually, in cases where other types of reconstruction have proved to be in vain, D-P is often utilized as a last resort.
Using fibrin tissue adhesive, we made a staged functional reconstruction with a D-P flap for cases of tissue necrosis after total or partial laryngectomy. Though these require relatively more time for completion, the patients who undergo this procedure have re-acquired their major functions at almost the same level as before surgery.
Staged functional reconstruction with a delayed D-P flap is thought to have some advantages of a sure method. Surgeons can modify the procedure during a period of operative therapy, which would not result in satisfaction.

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A case of a large epiglottic cyst is reported. The patient was a 79-year-old man who complained of an abnormal sensation in the larynx during phonation. On examination, he was found to have a massive epiglottic cyst arising from the lingual surface of the epiglottis, displacing it in a posteroinferior direction and almost totally occluding the pharynx. No view of the larynx could be obtained indirectly. The huge cystic mass was an obstacle to conventional intubation for general anesthesia. An endoscopically guided nasal intubation was therefore undertaken using a fiber-optic laryngoscope. The fiber optic laryngoscope was easily maneuvered past the cyst and an anesthetic tube railroaded through the larynx. The cyst was removed using a tonsillectomy snare under direct laryngoscopic observation.
Histopathological examination revealed a lymphoepithelial cyst, whose walls were lined by stratified squamous epithelium accompanied by abundant lymphoid tissue.

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A case of a mucosal bridge of the vocal fold concurrent with polyp is reported. This is the second report of a mucosal bridge in Japan.
The patient was a 62-year-old female who had complained of hoarseness for six months. We diagnosed her illness as polyp of the left vocal fold based on a fiberscopic observation of the larynx. However, an endolaryngeal microscopic observation revealed that her polyp was sessile and located on the middle of the mucosal bridge. We removed the polyp by cutting the anterior and posterior end of the mucosal bridge, and a sulcus of the left vocal fold was recognized. Her hoarseness was not improved after the operation.
Since a mucosal bridge is a minute string-like structure on the vocal fold, endolaryngeal microscopic observation is the only method to correctly diagnose it, and it is one of the laryngeal pathologies probably associated with sulcus vocalis.

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A 61-year-old female was admitted to our hospital complaining of fever and dyspnea. She had been using a humidifier in her home before admission.
A chest X-ray film on admission showed diffuse micronodular shadows in the bilateral lung fields. A transbronchial lung biopsy revealed specific findings of hypersensitivity pneumonitis.
A provocation test using the humidifier was positive, and a diagnosis of humidifier lung was made. The precipitin antibody reaction of the patient's serum to various antigens was negative, but Acremonium and Cladosporium were cultured from water in the humidifier. We therefore speculated that these fungi could be the pathogenic antigens.
However, an inhalative provocation test using these fungi was not performed due to her refusal.

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A fourteen-month-old male with a bronchial foreign body, a peanut, complicated with pneumomediastinum and cervical subcutaneous emphysema was reported. The pneumomediastinun and subcutaneous emphysema was revealed by chest X-ray examination. MRI was found useful for visualizing the trapped foreign body as well as for the diagnosis of the complications. After removal of the foreign body using ventilation bronchoscopy, the pneumomediastinum and subcutaneous emphysema disappeared spontaneously within five days.

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A case of a late fatal hemorrhage following tracheostomy was reported. A 45-year-old male underwent thymoma resection and then radiation therapy 9 yaers ago. Even though he underwent a thymoma resection, he showed dyspnea caused by myasthenia gravis 9 years after the operation. Because of the dyspnea, a tracheostomy was performed and a steroid was administered for the treatment of his myasthenia gravis.
Three months after the tracheostomy, a massive hemorrhage occurred through the tracheostoma because of a tracheo-innominate artery fistula. The fistula was immediately closed using a tracheal tube with an air cuff and thus successfully controlled. Then, an emergency operation was performed under general anesthesia. A fistula was observed in a tracheal wall and in an innominate artery wall. These fistulae were sutured and a patch of the fascia was inserted between them. Bleeding occurred again from the tracheostoma 2 months after the operation and resulted in the patient's death.

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The activities of the intrinsic laryngeal and respiratory muscles were compared during coughing between non-tracheotomized and tracheotomized conditions. In non-tracheotomized and tracheotomized cats, when the peak values of the intratracheal pressure during coughing increased, the EMG amplitudes of the intrinsic laryngeal and respiratory muscles also increased significantly. When the intratracheal pressure peak during coughing increased over 60 cmH₂O, the rectus abdominis muscle in tracheotomized cats suddenly increased its amplitude compared to that of non-tracheotomized cats. These results suggest that the function of the larynx during coughing is to modulate the activities of the respiratory and intrinsic laryngeal muscles.

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