From 1986 to 2000, 86 patients with T1 and T2 laryngeal cancer were treated at our department. Eighty-one patients received initial radiation therapy, and salvage laryngectomy was performed for 8 patients who had residual tumor after 40 Gy radiotherapy. Four patients with glottic cancer had a resection of the true vocal cord with an Nd-YAG LASER under the microsopic observation and only one patients had with partial laryngectomy (front-lateral-laryngectomy) as an initial treatment. Five-year survival rates were 88.4% in T1, and 81.2% in T2. Five-year larynx preservation rates were 94.7% in T1, and 45.1% in T2. In T2, the five-year survival rates and larynx preservation rates were poor. Tumors extending to the anterior commissure and the subglottic space were poorly controlled by radiotherapy. We considered that bulky tumor extending to the anterior commissure and subglottic space are not an indication for simple radiotherapy and should undergo partial laryngectomy for the improvement of the larynx preservation.

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We reviewed 13 cases of foreign body in the pharynx or esophagus that were removed by an external incision of the neck. Fish bones were found in 6 cases, dentures in 5 cases, a needle in 1 case and a wrist watch in 1 case. The foreign body was arrested at the entrace of the esophagus in 5 cases, the cervical esophagus in 3 cases, the extra hypopharynx in 3 cases, and was found penetrating the geniohyoid muscle in 1 case and the anterior vertebra fascia in 1 case. In 2 patients with a fish bone foreign body, an abscess formation was found. However, no relation was found the length of stay time the fish bones had been present. As all of patients with denture foreign bodies had mental disease, careful management of dentures against the misswallowing is strongly recommended.

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The differences in oral and pharyngeal kinetic patterns between smokers and non-smokers were studied. A flexible fiberscope, ultrasonograph and pressure transducers were used. Subjects were five smokers and six non-smokers. Multi-modal data were recorded simultaneously. Trial studies were carried out including phonation of /ka/sounds, long/S/sounds, humming, and inspiration and expiration before and after the data acquisition. The results were as follows: The movements of the tongue and soft palates were different for smokers and non-smokers while subjects were smoking a cigarette and/or a fake cigarette. In the case of smokers, the tongue and the soft palate touched at the beginning of smoking. After that, the tongue and the soft palate separated. On the other hand, while non-smokers were smoking a fake cigarette, the tongue and the soft palate did not touch each other. These findings were observed both in ultrasound images and intra-oral and pharyngeal pressure analyses. The contact of the tongue and soft palate in smokers briefly holds smokers within the oral cavity. This may be responsible for the high incidence of oral and pharyngeal cancer in smokers.

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The efficacy of chest X-ray examination performed in search of lung metastasis after the first treatment for head and neck cancer was evaluated. Even lung metastasis or primary lung cancer was discovered by chest X-ray examination, the prognosis was poor and the prolongation of survival time by operation or radiation therapy was not clearly demonstrated. Reconsideration of chest X-ray examination is needed. Regarding treatment, it is important to consider the QOL of the patients, and use of techniques such as an outpatient chemotherapy.

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Cleft larynx, which is a mild type of laryngotracheoesophageal cleft, has been thought to be extremely rare. A case of cleft larynx, with esophageal atresia, inperforate anus and accessory ear, is reported.
The patient showed dysphagia and stridor following normal gestation and birth. After repair of the esophageal atresia, she still suffered from stridor. At 6 months, she was referred to our Department of Otolaryngology, and laryngoscopy and X-ray study revealed a type II laryngotracheoesophageal cleft classified by Benjamin-Inglis.
Since the patient did not suffer from aspiration and the stridor was disappeared gradually in about one year, she was followed for 4 years without any surgical intervention.
It is a matter of course that the life-threatening aspiration due to cleft larynx requires surgical intervention. However, even though a laryngeal cleft exists, surgical repair is not always necessary when laryngeal function is fully compensated, as in this case.

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We developed a new surgical method to prevent aspiration after partial laryngopharyngectomy for piriform sinus carcinoma. After removing the epiglottis and arytenoid on the affected side, half of the hyoid bone connecting to the sternohyoid muscle was fixed to the thyroid and the epiglottic cartilages to reconstruct the epiglottis. A protrusion of the arytenoid was formed with the sternohyoid muscle sutured to the excised end of the arytenoid on the unaffected side. Using a free forearm flap, the supraglottis was covered, and the piriform sinus was reconstructed.
This surgery was performed for a patient with T2N0 piriform sinus carcinoma. Three weeks after surgery, the tracheal stoma was closed and the oral intake of food was begun. The voice was normal. The respiratory and swallowing functions were satisfactory without any dyspnea or aspiration.

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Percutaneous cricothyrotomy is much simpler and less invasive than conventional tracheotomy. Therefore, this procedure has been considered a useful tool for rapidly treating progressive airway obstruction. Moreover, it has recently been reported that percutaneous cricothyrotomy can be employed to manage an excess of airway secretion.
We report two cases of complications due to percutaneous cricothyrotomy in order to manage pneumonia. The first patient was a 78-year-old male with hoarseness and dysphagia after percutaneous cricothyrotomy. The tube was inserted through the thyroid cartilage into the subglottic space. After removing the tube, these symptoms disappeared. The second patient was a 76-year-old male with progressive subcutaneous emphysema around the neck after the insertion of the cricothyrotomy tube. We performed a tracheotomy under general anesthesia, and his subcutaneous emphysema improved 5 days after tracheotomy.
Although percutaneous cricothyrotomy is an effective method for treating airway obstruction, its indications should be decided cautiously, except in cases of airway obstruction. After emergent cricothyrotomy, it is recommended the location of the cricothyrotomy tube be confirmed.

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Distilled water containing of capsaicin 10^-6 mol/ml was sprayed into oral cavity obtain adults, and the concentration of substance P (SP) in the saliva was measured before and after the spray. Similary, the concentration of SP in the saliva before and after chewing gum which contained about 6×10^-8 mol per piece of capsaicin was also measured for ten adults. A significant rise in SP in the saliva after the capsaicin administration in both procedures was seen.
SP significantly increased in the saliva of dysphagic patients with amyotrophic lateral sclerosis, Parkinson disease, oculopharyngeal muscular dystrophy, Guillain-Barre syndrome, and spinocerebellar degeneration after capsaicin administration. Therefore, it can be said that chewing gum is an adequate treatment for mastication and swallowing, and that the increase in SP in the saliva leads to greater sensitive trigger for the swallowing reflex.

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