A series of 28 cases of bilateral laryngeal nerve paralysis treated in our department during the period from July 1971 to November 2002 was reported. There were 17 males (mean age: 61 years) and 11 famales (mean age: 51 years). Among their chief complaints, hoarseness was the most common (12 cases), followed by dyspnea (9 cases). Dysphagia was noted in 11 out of the 28 cases. The vocal cords were fixed at the median position in 12 cases, paramedian position in 7, and the intermediate position in one case. In 5 cases, the paralysis was incomplete. In the remaining 2 cases, a fixed position was not recorded. As for the cause of their paralysis, 14 cases developed paralysis immediately after surgery, namely thyroid surgery in 9, esophageal surgery in 2, and cardiovascular surgery in 3. Non-surgical causes were malignancy in 5 cases, intubation in one case, and idiopathic in 7 cases. In the single remaining case, paralysis developed after trauma on one side and then idiopathic paralysis was noted on the other. Tracheotomy was performed in all cases except 3. As for the method of glottoplasty, the anterior opening method was the most commonly (9 cases) used in our department. In 3 out of the 28 cases, a spontaneous recovery was noted. It was concluded that glottoplasty is only indicated after an observation period of at least 6 months after the onset of paralysis.

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We reviewed 11 cases (males: 5, females: 6) of laryngeal foreign body that had been admitted to our hospital between August 1971 and December 2002. Their ages ranged from 11 months to 84 years. Ten cases were under 4 years of age. The foreign body was located in the subglottic region in 9 cases, and, in one case each, the glottic region and between the glottic region and the trachea. All of the foreign bodies were removed in the operating room (fish bones in 4 cases, peanuts in 3 cases, and, in one case each, an artificial tooth, a light-emitting diode, a thumbtack, and an intubation tube). Tracheotomy was performed in 4 cases because of laryngeal edema, dyspnea, or the maneuver to remove the foreign body. Severe complications appeared in 2 cases, one of these was postoperative pulmonary edema, and the other resulted in death.

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Dislocation of the arytenoid cartilage is an usual laryngeal injury that can occur following blunt trauma or medical instrumentation to the laryngeal cavity, for example, after endotracheal intubation. In past reports, the diagnosis of arytenoid dislocation was usually made clinically and using a laryngoscope. The utility of CT imaging in the diagnosis of arytenoid dislocation was reported. Electromyography of the intrinsic laryngeal muscle was also described as a useful diagnostic examination to rule out neurogenic arytenoid cartilage dysfunction, such as recurrent laryngeal nerve palsy. However, it was very difficult to perform an electromyographic examination of the intrinsic laryngeal muscle and to understand the reciprocal positions of the laryngeal cartilage from CT imaging for general otolaryngologists. Additionally, a means of distinguishing whether the arytenoid dislocation was the anterior type or the posterior type, and to reduce the arytenoid dislocation according to the dislocated type, has not been established. Thus, it is necessary to establish an effective diagnostic protocol that does not require the patient's effort or cause physical damage.
First, we made the morphological observations of the laryngeal cavity for a model of arytenoid dislocation extracted and prepared from human cadaver. The model of the anterior dislocation of the arytenoid cartilage demonstrated that the vocal fold of the affected side was flaccid and the arytenoid cartilage was displaced high-laterally, with an abnormal medial projection of the vocal process on the adductive position of the arytenoid cartilage when the muscular process of the arytenoid cartilage was pulled along the lateral cricoarytenoid muscle. The model of the posterior dislocation of the arytenoid cartilage demonstrated that the vocal fold was prolonged tensely and that the arytenoid cartilage was displaced high-laterally in the adductive position of the arytenoid cartilage with a more tensed vocal fold when the muscular process of the arytenoid cartilage was pulled along the lateral cricoarytenoid muscle.
Using the above-mentioned basic morphological observations, we next studied retrospectively the clinical examinations of the patients diagnosed as having arytenoid dislocation (anterior type: 10 cases, posterior type: 6 cases). The video-fiberscopic findings showed the following. For the anteriorly dislocated patients, the vocal fold was flaccid and made more flaccid on phonatory movement with the abnormal medial projection of the vocal process. For the posteriorly dislocated patients, the vocal fold was prolonged tensely and made more so on phonatory movement. The x-ray video-fluorography of the larynx on repetitive phonation /he/ showed an abnormally high and diagonal displacement of the vocal fold on the dislocated side with the upper structure of the arytenoid cartilage in both types of arytenoid dislocation. Palpating the cricoarytenoid joint showed abnormal swelling with tenderness at the lesion for the posteriorly dislocated patients, but not for anteriorly dislocated patients. Sagittal CT imaging at the level of the posterior cricoarytenoid ligament indicated the condition of the dislocated arytenoid cartilage. At others level, the condition of the arytenoid cartilage could not be seen clearly. Horizontal and coronal CT imaging did not show the dislocated arytenoid cartilage clearly either.
From these findings, we concluded that the best way to diagnose arytenoid dislocation is as follows. First, x-ray video-fluorography of the larynx on repetitive phonation should be taken to detect both types of arytenoid dislocation. Then, laryngeal fiberscopic findings and palpation of the cricoarytenoid joint should be examined to distinguish whether the arytenoid cartilage is dislocated anteriorly or posteriorly.

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Surgery is sometimes necessary in refractory cases of swallowing training for dysphagia. We performed tracheoesophageal diversion to prevent intractable aspiration in the following eighteen patients with degenerative neuron disease: eleven with amyotrophic lateral sclerosis and three with Parkinson's and other diseases. Tracheoesophageal anastomosis was chosen as the operation procedure in seven patients, laryngectomy in nine, and laryngectomy with a folded pharyngeal flap in two.
Most patients with ALS decided to undergo the operation due to the extreme distress resulting from the aspiration of saliva and liquid. On the other hand, in most other patients the operation was recommended due to repeated aspiration pneumonia. Seventeen patients are now postoperatively able to have any kind of solid and liquid diet.
The surgery for aspiration prevents aspiration pneumonia and reduces sputum, and moreover provides oral intake for a longer time. Therefore, tracheoesophageal diversion should be a highly beneficial procedure for patients with degenerative neuron diseases, resulting in an improvement in the patient's QOL.

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Nasal polyposis is often observed in patients with Aspirin-induced asthma (AIA). Therefore, nasal polypectomy must be considered in postoperative asthma attacks. The aim of this study was to measure sensitivity to methacholine provocation in patients with nasal polyposis and to discuss the relationship between hyper-responsiveness of the lower airway and nasal polyposis.
Fifty-five patients with nasal polyposis were studied. These patients were divided into 3 groups; 7 patients who had a history of AIA, 23 patients with allergic rhinosinusitis, and 27 patients with non-allergic rhinosinusitis. These patients were examined for respiratory resistance through the mouth, spirometry, and analysis of flow-volume curves and using methacholine provocation test.
As a result, the sensitivity of the lower airway in patients with AIA was statistically higher than that of another patients. This result suggests that the methacholine provocation test should be useful to diagnose hyper-responsiveness of the lower airway.
Inconclusion, it is important to consider the sensitivity of the lower airway before nasal polypectomy.

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Various voice prosthesis have been used in order voice for patients who were laryngectomy. We have used a new type of voice prosthesis, the Provox 2 from 1998 to 2002, in 14 cases of which 10 patients had a tracheoesophageal shunt (TE shunt) and 4 patients had a tracheojejunum shunt (TJ shunt). Nine of the 10 patients who had TE shunt could achieve sufficient communication ability with the Provox 2, and 3 of the 4 patients with TJ shunt also phonated clear voice. There was no major discomfort were observed, since the Provox 2 is a long term indwelling prosthesis which is anterograde insertion. We also evaluated the site of the vibratory source of these patients with videofluoloscopy.
In the cases of TE shunt, the neoglottis seems to be located in the place between C4 and C5 and it was thyreopharyngeum muscle, while in the cases of TJ shunt, the place of vibratory source depends on the each case.

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In this study, we report 3 patients with deep cervical abscess who had a 2-year history of collagen disease as an underlying disorder, along with a review of the literature. The primary focus of the abscess was in the submandibular gland.
These patients had been receiving adrenal cortical hormones for a long period to treat their collagen disease. The average time of hospitalization is about 3 weeks in patients with deep cervical abscess without complications. However, although in our patients, the only 2, so give exact times hospitalization was 6 weeks. This extended time may have been due to long term adrenal cortical hormones treatment related effects such as reduction in immunity, and protraction of their symptoms related to an increase in pain thresholds. However, although collagen disease may be a factor in protracted deep cervical abscess, it does not necessarily contribute to a poor prognosis.

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We report the first known case of adenosquamous carcinoma of thyroid with both adenocarcinoma and squamous carcinoma found in the same metastatic lymph node. A cervical induration had been found in 1995 and resected with the metastatic left axillary lymph node, because of its growth after 5 years. The primary lesion was diagnosed as adenosquamous carcinoma, but the metastatic lymph node was different. After 1 year, however, the metastatic right axillary lymph node was resected because of the tumor's growth and diagnosed as adenosquamous carcinoma. The patient was died of the cancer 1 year and 7 months after the first operation.
Patients with adenosquamous carcinoma of the thyroid have a poor prognosis, and their survival periods are believed to be less than 2 years after rapid growth. It was supposed that only adenocarcinoma existed as a thyroid tumor, which changes into adenosquamous carcinoma during the rapid growth phase. Therefore, thyroid tumors, should be resected immediately after rapid growth can begin.

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