The treatments for patients with severe dysphagia and misdeglutition are very difficult. Some cases must have total laryngectomy or tracheo-esophageal separation to control their severe misdeglutition and prevent serious respiratory distress. However, in such cases, the phonatory function has to be sacrificed, resulting in a poor quality of life.
In order to overcome this conflict between deglutition and phonation, we have developed an “artificial pharynx.” The artificial pharynx consists of a soft balloon and a plastic tube. The soft balloon is attached to a tube with an inlet hole. The whole assembly can be inserted through the patient's nose. The tip of the tube remains in the stomach and the balloon is inflated at the level of the pharynx to seal the airway. Our patient could breathe through a tracheal stoma which was created prior to using the artificial pharynx. The bolus was introduced through the inlet hole into the tube and moved down to the stomach by gravity. When the balloon was deflated, the patient could breathe and phonate with a speech valve of the cannula.
We treated a patient using an artificial pharynx. He was a 62 years old male diagnosed as having terminal myotonic dystrophy and suffering from severe dysphagia. Because of his poor general condition, any surgical intervention for dysphagia and misdeglutition could not be performed without a tracheotomy. But, since he yearned to take some drinks and to preserve his phonatory function, the artificial pharynx was utilized with some success.

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This study included 614 patients who complained of a dyssensation in pharynx and larynx at their first visit to the Department of Otorhinolaryngology, Tokyo Women's Medical College Daini Hospital between January 1993 and December 1995.
1) The number of female patients having organic disease was not significantly different from that of the male patients.
2) The number of female patients not having organic disease was twice that of the male patients.
3) Irrespective of the presence or absence of organic disease, the frequency of complaints of a sensation of “something in the throat” was greatest among the patients between 40 and 50 years of age.
4) Of the male and female patients who chiefly complained of feeling “something in the throat, ” 60% and 50%, respectively, had organic disease.
5) Many patients having disease of the esophagus or cervical spine had symptoms involving swallowing.
6) The organic diseases encountered most frequently involved the oropharynx.
7) The organic diseases were largely inflammatory in nature.
8) Patients complaining of a sensation of a foreign body in the throat when swallowing a solid substance required a complete medical examination of the hypopharynx and esophagus.
9) Patients complaining of a lump sensation in the throat on swallowing and no other local specific symtoms required an endoscopic examination.

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Coronal laryngeal tomograms have been regarded as clinically useful in observing vertically structural deformities of the paralyzed vocal-fold, inclusive of decreased thickness of the vocal-fold, enlargement of the ventricle, and the level difference between healthy and paralyzed vocal-folds during phonation. Similarly, pathological displacement of the paralyzed arytenoid body may be appreciated in frontal tomograms of the larynx pre- and post-operatively.
Successful identifications of the arytenoid body taken during both inspiration and phonation were obtained only in 6 out of our 38 cases, with unilateral vocal-fold paralysis who all underwent lateral cricoarytenoid muscle (LCA) pull-surgery at the Mitsui Memorial Hospital, Tokyo. The paralyzed arytenoid body was seen to be not only immobile but also inclined downwards and laterally preoperatively on the tomograms. After the LCA-pull operation, however, the arytenoid body on the operated side was pointed upwards and rotated medially to secondarily invite the smooth medialization of the entire membranous portion of the paralyzed vocal-fold, thereby disclosing satisfactory glottal closure when voicing and swallowing.
Thus, critical evaluation of the LCA pull-surgery for the 6 cases with unilateral vocal-fold paralysis were possible simply by comparing the lateral and downward tilting of the arytenoid body seen preoperatively with the same arytenoid sitting upward and inward post-operatively on the frontal laryngeal tomograms.

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Glassy eosinophilic material is abundant in most vocal fold polyps and has been proved to be fibrin by electrical microscopy. Most of this material exists in the extravascular space, apart from the thrombus. Fresh surgical specimens of 11 human vocal fold polyps were divided into two pieces. One piece was preserved in a 0.5ml saline solution of tissue plasminogen activator (TPA, 50, 000U), with the other piece in 0.5ml saline as a control. After eight hours, the specimens were examined under a light microscope. Glassy eosinophilic material existed in eight control specimens but was scarcely observed in the TPA solution group. This study demonstrates that extravascular fibrin in vocal fold polyps can undergo fibrinolysis by TPA.

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Injury caused by cuff pressure and regeneration in rat tracheal mucosa were examined immunohistochemically using BrdU and electron microscopy. Epithelial defects were observed in almost the whole circumference of the tracheal wall, while the partial existence of the epithelium was recognized in the membranous wall of the trachea. The submucosal layer showed severe edema, bleeding and thrombi. The BrdU labeling indices (L. I.) of the epithelial and submucosal layers started to increase at 12 and 24 hours after treatment, respectively, and reached their peak values in a similar manner at 36 hours. They then drastically decreased until the third and fifth days, respectively, after treatment. The changes in the mitotic indices showed a 12-hour delay compared with those in L. I. Migrating epithelial cells were observed in the area of the regenerating epithelial cells, composed of basal cell-like cells, from 6 to 48 hours after intubation.

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The standard surgical treatment for achalasia of the esophagus is myotomy of the lower esophageal sphincter combined with an antireflux repair.
During the years 1958-1994, 124 patients with esophageal achalasia were treated at our clinic. A modified Girard's method has been successfully performed, as well as transabdominal and transthoracic approaches, and a laparoscopic approach has also been recently used. We have performed this operation through the latter laparoscopic approach with four patients to date.
Here we report a comparison of laparotomy with the laparoscopic approach. The clinical, radiological and manometric results confirmed that, at least in the short-term follow-up, the minimally invasive approach is safe and effective.

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The case of a 25-year-old woman with a left pyriform sinus fistula was presented. She had repeated swelling and abscess formation in the left anterior neck region from childhood. When she was 14 and 18 years old she had operations on a congenital neck cyst.
Thereafter, she repeated the abscess formation three times in the left anterior neck area. A congenital fistula of the pyriform sinus was suspected. Fluoroscopy with barium was performed, which revealed a fistula originating from the apex of the left pyriform sinus. Complete removal of the fistula was performed for a permanent cure.

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We report the case of a 63-year-old female with a branchial cleft cyst of the hypopharynx. The tumor was found incidentally when she was given a fiberscopic examination of the upper digestive tract. Fiberscopic endoscopy, esophagogram, and MRI all revealed a smooth-surfaced tumor in the left piriform sinus. The patient underwent laryngomicrosurgery under general anesthesia, and the tumor was removed from the postero-lateral wall of the left piriform sinus. The histopathological diagnosis was of a lymphoepithelial cyst.
To our knowledge, this is the fourth report in the Japanese literature on a branchial cleft cyst of the hypopharynx.

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Small cell carcinoma of the larynx as a primary lesion is extremely rare. Only about 90 cases have been reported since 1972. A 69-year-old man presented with hoarseness and a right neck mass. A biopsy from his larynx showed small cell carcinoma, and no other foci were detected in his entire body. A complete remission was induced with intensive chemotherapy and radiotherapy. Surgery was not indicated because past cases had shown that surgical therapy significantly shortened the median survival time. Half a year later, however, liver and bone metastases appeared, and this patient died of severe liver dysfunction 17 months after the diagnosis. The clinical course of this case and recent advances in diagnosis and treatment are discussed.

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A child with mental retardation, who could not report to subjective symptoms, came to our institute because of failure to gain weight. A foreign body shadow of a safety-pin was found accidentally in his chest with a plain X-ray.
This patient was a 16-month-old male, and the foreign body shadow of an open safety-pin was found at the first cervical constriction of the esophagus. The sharp end of the safety pin was upwards.
He was admitted to emergency, and we attempted to remove the safety-pin by direct esophagoscopy under general anesthesia. However, the pin was buried in the wall of the esophagus, and we gave up because of the danger involved. The next day we performed an incision of the neck and removed the safety-pin.

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We investigated the relationship between tracheobronchial involvement in esophageal cancer and bronchoscopic findings in 27 patients. The bronchoscopic findings were classified into five types. Tracheobronchial involvement was confirmed in cases with endobronchial tumor, with protrusion and abnormal mucosa. In cases without protrusion, the absence of involvement was confirmed. Since a judgment of tracheobronchial involvement is difficult in cases with protrusion but an otherwise normal mucosa, use of CT and MRI, where an assessment of the thickness of the esophageal cancer may be made, is important for detecting involvement.

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