There are only a few case reports of arytenoid dislocation, which is one of the complications of intratracheal intubation.
We studied the symptoms and other findings of 17 patients, who underwent closed reduction at our clinic because of suspected arytenoid dislocation from 1997 to September, 2000. As previous operations, there were 5 patients who had had cardiac surgery, 2 patients with large vascular surgery, one patient with lung surgery, 8 patients with gastrointestinal surgery, and one patient with liver surgery.
As symptoms, most patients had dysphagia accompanied by discomfort in swallowing in addition to a voice disorder. After closed reduction, the symptoms of 16 patients dramatically improved. Only the one patient who had had left lung surgery did not improved. In this case, a swallowing disorder appeared in addition to a voice disorder, and both disorders had remissions and exacerbation afterwards. This patient was regarded as having recurrent nerve paralysis.
As for the laryngeal findings, 8 patients had both sides affected, 2 patients had the right side affected, and 7 patients had left side affected. The mobility of the vocal cord of the affected side was insufficient. Movement of the vocal process and movement of the corniculate cartilage did not cooperate with 0, and it seemed that movement of the former was insufficient, and that movement of the latter was good.
If we pay attention to swallowing disorders with discomfort and to the movemnt of the vocal process and corniculate cartilage, there is little chance that an arytenoid dislocation will be wrongly diagnosed as recurrent nerve paralysis. We conclude that closed reduction should be peformed given our success rate.

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Eighteen patients with transient true cord paralysis after operations conducted under endo-tracheal general anesthesia were investigated. In 13 patients, the recurrent nerve and true cords were not toutched during the operations. In these patients, we suspected that endo-tracheal intubation induced their paralysis. In all 13 patients, recovery from paralysis was observed within 37.7 days, on average, after the operations. In these patients, endo-tracheal intubation was continued for a long time after operation, and every patients did not received monitoring of the cuff pressure of the intubation tubes during and after their operation. A high doses of ATP (maximum 360 mg/day for 2 weeks) were administrated in 9 patients, and a watch and wait therapy was performed the other 4 patients. No significant difference was observed in the duration from each operation to the recovery period between the ATP therapy group and the watch and wait therapy group. The authors concluded that the administration of high doses of ATP is not necessary for patients with post-operative true cord paralysis whose recurrent nerves or true cords are not damaged.

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Although microlaryngoscopy using a direct laryngoscope is very useful for precise observation of the larynx and surgical maneuvers, it has some technical problems such as a limitation in the visual field. In order to remove this limitation, we attempted to use different rigid telescopes during microlaryngosurgery. The instruments used were a 2.7 mm rigid telescope with a tip bent at 70°(MACHIDA Co.) and two 4 mm rigid telescopes for nasal surgery, one with a straight tip (0°) and one with a tip bent at 70°(MACHIDA Co. and Storz Co., respectively). With the introduction of these telescopes, direct visualization and a direct surgical approach to the subglottic region, the inferior surface of the vocal fold and inside the ventricle became possible. When we combined the telescopic view on a monitor screen with the direct microlaryngoscopic view, we could even observe the surgical field three-dimensionally. Thus, the use of a telescope was considered to be very effective as a supporting technique for microlaryngosurgery.

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During the 5-year period from September 1995 to September 2000, 38 cases (males : females = 29 : 9) with organic lesions at the posterior glottis were seen at the Voice Clinic of Tokyo Senbai Hospital. Their final diagnoses were granuloma in 30, cyst in 4, papilloma in 2 and carcinoma in 2. Three of the 4 cases with cyst, and 1 of the 2 cases with carcinoma were diagnosed as granuloma on first visit. Administration of PPI was effective in 4 out of the 9 cases with granuloma who were tentatively diagnosed as having gastroesophageal reflex disease (GERD). Stroboscopic examination was often incapable of diagnosing organic lesions at the posterior glottis, while biopsy was the most reliable method for a final diagnosis. Treatment with GERD was effective for selected cases with granulomatous lesions at the posterior glottis.

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Based on informed consents, most patients with hypopharyngeal cancer select radiotherapy as a curative treatment. In 53 patients without double cancer, distant metastasis were mainly treated with radiotherapy from 1986, 9 to 1999, 12. The 5-year cause-specific survival rate was 100% (10 patients) in stages I and II, and 80% (7 patients) in stage III. In stage IV, the cause-specific survival rate was 24.9% (36 patients). The stage IV cause-specific survival rate was worse than that of stages I, II and III. After primary treatment using radiotherapy, twelve patients relapsed at primary sites. Four patients were salvaged by operation, two patients survived, but one patient died because of a distant metastasis, and one patient died because of an other disease. Five patients relapsed at the neck, four patients were salvaged by operation, two patients survived, but two patients died because of distant metastasis. The rate of laryngeal preservation was 60% in stages I and II, and 23.7% in stages III and IV. Radiotherapy for stages I and II hypopharyngeal cancer had a clear benefit in terms of clinical outcome and laryngeal preservation. However, the treatment for advanced hypopharyngeal cancer must be investigated in terms of prognosis and laryngeal preservation.

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Tracheotomies are commonly preformed in medical institution. In general, the tracheotomized stoma spontaneously closes after removal of the tracheostomy tube. However, surgical closure is necessary in some cases. The procedures for stoma closure are not well documented. We describe our method in this report.
Seven tracheotomies (3 males and 4 females, mean age ; 56.8 years) performed between 1996 and 2000 were analyzed. The stoma did not close spontaneously even 5 months or more after removal of the tracheostomy tube in these cases. MRSA was detected from the culture collected from the stoma in all of these cases.
Stoma closure was conducted under local anesthesia. Three skin flaps were prepared including two hinge flap, one on the right and the other on the left side of the stoma, and a skin flap to cover the skin defect. Stenosis of the trachea did not occur in any of the cases, which was confirmed by postoperative endoscopy.
The advantages of our method include 1) minimal surgical invasion, 2) minimal chance of stenosis of the lumen ; and 3) low risk of associated infection. Its shortcomings are 1) it may not be suitable for tracheotomies in head and neck malignancy cases or after irradiation ; and 2) the scar may inhibit laryngeal elevation, and thus may cause aspiration.

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To determine the effectiveness of surgery in treating obstructive sleep apnea hypopnea syndrome (OSAHS) in children, oxyhemoglobin saturation was measured transcutaneously before and after tonsillectomy or adenotonsillectomy in 22 patients (3-11 years old : 13 males and 9 females) who presented at our clinic from January 1993 to October 2000. An oxygen desaturation index (ODI)> 5/h or minimal oxygen saturation (min SaO₂)<90% were the defining criteria for OSAHS.
After tonsillectomy, the mean ODI dicreased from 13.3/h to 1.4/h and the mean minimal SaO₂ increased from 79.9% to 88.3%. Both changes were significant (p<0.01 paired t-test). Thus, all patients improved after tonsillectomy.

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Neurogenic tumor is not common among the laryngeal benign tumors. A case of Schwannoma of the larynx is reported. A 74-year-old man had complained of hoarseness for about 7 years. Clinical observation using laryngofiberscopy revealed a smooth submocosal mass localized in the right false cord of the larynx, but right vocal cord palsy was not seen. CT scan showed a mass lesion from the right supraglottic area to the glottic area of the larynx. The tumor was removed by laryngofissure, and the diagnosis was confirmed pathologically. When the tumor was extirpated, the origin of the nerves was undetectable. Although it is reported that most tumors which develop in the larynx are involved in the arytenoid or aryepiglottic fold, the tumor we report here was localized in the glottic area. The origin of such tumors is thought to be in the internal branch of the superior laryngeal nerve in most cases. In this case, the mobility of the right vocal cord was impaired after surgery. Therefore, the possibility that the tumor originated in the recurrent laryngeal nerve branch is discussed.

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A case of subglottic stenosis due to postintubation granuloma was reported. A 60-year-old male visited our hospital with paresthesia in the throat after an operation for mitral insufficiency, tricuspid insufficiency and angina pectoris. Fiberscopic examination revealed a reddish tumor with a smooth surface in the subglottic region. Vocal cord mobility was normal.
After a period of conservative treatment, the patient developed dyspnea. Therefore, a surgical removal of the tumor was performed. We resected the subglottic tumor by laryngomicrosurgery after tracheotomy under local anesthesia. During the operation, the base of the tumor was cauterized with a CO₂ LASER.
The histopathological diagnosis of the tumor was unspecific granuloma. A follow-up 26 months after the operation showed no evidence of recurrence.

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A case of a fish bone stuck in the pharynx and reaching the retropharyngeal space was reported. The patient was a 51-year-old female. An endoscopic examination was performed to detect the fish bone but failed to find it. A CT scan showed the fish bone in the retropharyngeal space. The patient underwent surgery to remove the bone by external incision. After the operation, we found the fish bone preoperatively with plain cervical radiology.

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Inspiratory stridor is a sign of severe upper airway obstruction. The cause of inspiratory stridor is usually organic, and emergent procedures including intubation or tracheostomy are often needed. Functional stridor is a non-organic stridor caused by the paradoxical adduction of the true and false vocal cords throughout the respiratory cycle. It is often diagnosed as asthma or vocal cord paralysis, and unnecessary treatments including the administration of corticosteroids, intubation, and tracheostomy are sometimes performed.
We report a case of functional stridor in an 18-year-old female who developed severe inspiratory stridor and dyspnea after a mild asthmatic attack.

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Digestive tract anisakiasis is contracted by eating raw seafood and is mostly stomach anisakiasis. A 54-year-old woman visited our hospital with a complaint of dysphagia. There was no remarkable finding to indicate dysphagia in the pharyngolarynx. Though central dysphagia was also suspected, upward movement of the palate and motion of the vocal cord, etc. were normal. There was no other symptom except for the dysphagia. Esophagogastroscopy was performed to rule out foreign bodies or organic abnormality. However, endoscopy revealed an anisakis larva invading into the esophago-gastric junction. Right after the extraction of the anisakis larva, the dysphagia disappeared.

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