Clinical investigation was conducted on 204 cases of unilateral vocal fold paralysis who had been referred to our clinic during the past 8 years (1993-2000).
Among these patients, 147 were males and 57 were females. The most frequent cause of their paralysis was an inavoidable side effect of their surgery, and their most common complaint was hoarseness. The left vocal fold was affected in 147 cases (72.1%), and the right in 57 cases (27.9%). In the patients that eventually recovered vocal fold movement, the mobility of the vocal fold was restored within 6 months. In most of the cases that lost complaint without the recovery of vocal fold movenent, decrudescence was achieved within 7 months. Therefore, phonosurgery should be taken into consideration for cases of unilateral vocal fold paralysis that still suffer from symptoms of vocal fold paralysis around 6 months after the onset of vocal fold paralysis.

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A tetra-probe 24-hour pH monitoring was performed on 10 cases suspected of laryngopharyngeal reflux disease, and the advantages of this procedure were examined. The proximal probe was placed in the hypopharynx (just above the upper esophageal sphincter), a second in the middle esophagus, a third a few centimeters above the lower esophageal sphincter, and a distal sensor in the stomach.
The pH at the four sensors could be monitored simultaneously, and consequently the gastroesophageal and laryngopharyngeal reflux could be easily examined. The pH-metry revealed a pattern of reflux, so the relationship between the four sensor locations could be well documented on the pH tracing, A tetra-probe 24-hour pH monitoring has become one of the most reliable functional examinations for laryngopharyngeal reflux disease. Generally pH-metry is considered the gold standard for laryngopharyngeal reflux disease, whereas there is no consensus with respect to the number of pH sensors, their location, or the interpretation of results from them.

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We retrospectively analyzed complications following Groningen voice prosthesis insertion in tracheoesophageal voice restoration. In total, 22 patients within a follow-up period between 7 and 37 months, were enrolled in the study. Leakage through or around the prosthesis, which occurred in 15 (68%) patients, was the most frequent complication. However, permanent closure of the tracheoesophageal shunt was required in only one patient. Granulation and infection around the tracheoesophageal shunt occurred in 6 (27%) patients. Spontaneous extrusion of the prosthesis occurred in 5 (23%) patients, due to the insertion of a shorter prosthesis (5 mm-type). Stoma stenosis occurred in 4 (18%) patients, for whom stomaplasty was performed. Other complications were stenosis at the jejunum-esophageal anastomosis in two patients, and, in one patient each, esophageal foreign body, acute abdominal disorder due to excess air intake, and tracheoesophageal fistula. Patients should be examined at the shunt and the prosthesis on the esophageal side whenever they have an increase in leakage and a change in shunt voice. We do not recommend insertion of the shorter prosthesis (5 mm-type). Patients should be informed about the complications that can occur after insertion of the voice prosthesis beforehand, and it is important to deal with any problems at an early stage.

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Spindle cell carcinoma (so-called carcinosarcoma) consisting of squamous cell carcinoma and sarcoma-like components is rare.
An 82-year-old man came to our clinic complaining of hoarseness and slight dyspnea. Since his tumor appeared to be a large polypoid lesion of the right vocal cord and the supraglottic space was stenotic, we tried to remove the mass to alleviate his dyspnea using laryngeal forceps. However, a part of the mass was stuck in the glottic area, and emergency endotracheal intubation and tracheostomy were performed because of severe dyspnea. A large part of the tumor was removed under laryngo-micro-surgery, followed by radiation therapy totaling 72 Gy for 2 months. The patient is still in good condition with no evidence of recurrence or metastasis today 14 months after the termination of therapy.
It is generally agreed that most cases of spindle cell carcinoma of the larynx are not invasive, unlike squamous cell carcinoma. Based on a review of the literature, surgery or radiation therapy seems mostly effective for this type of lesion. In the future, it will be necessary to clarify the clinical specificity of this lesion.

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Chondrosarcoma of the larynx is known to be very rare. Depending on the size of the tumor, total laryngectomy, larygofissure and endoscopic resection have been the choices for surgical intervention. We report the clinical process of a rare case of chondrosarcoma, originating in the cricoid cartilage. A 55-year-old man complaining of hoarseness for two months, showed on laryngoscopic examination a submucous tumor. CT scan revealed a mass in the cricoid cartilage, in which high and low densities were intermingled. Suspecting a benign laryngeal tumor, we performed laryngomicro surgery, as well as an excisional biopsy of the cricoid cartilage and the first to fifth tracheal ring, which suggested chondroma. Then we performed a tumor resection and tracheotomy under general anesthesia. Consequently, the final pathological diagnosis based on the surgically resected specimen was chondrosarcoma. Although we recommended a total laryngectomy, the patient refused this radical surgery. One and a half years have passed postoperatively without recurrence. Strict observation of the tumor's progress is required in this case.

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We have experienced 3 cases of delayed intractable dysphagia without any anastomotic stricture occurring more than several months after free jejunal graft reconstruction with pharyngolaryngoesophagectomy for carcinoma of the hypopharynx. All three cases had undergone end-to-side anastomosis. In one patient, the dysphagia was caused by a bend in the jejunal graft just below the proximal anastomosis. In the other two patients, it due to a compression of the jejunoesophageal anastomosis caused by a distal blind loop in the jejunal graft. We per-orally inserted an endoscopic linear stapler and cut the bent portion of the jejunum or the distal anastomosis for a length of from 1 to 3 cm in all three cases. The dysphagia improved after surgery in all cases.
Our surgical procedure per-orally using an endoscopic linear stapler is less invasive and effective in relieving intractable functional stenosis in patients with a free jejunal graft.

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We have treated 9 patients for laryngeal contact granulomas using Rebamipide and Serrapeptase since 1999.
In 5 out of the 9 cases the granuloma lesions resolved after taking Rebamipide and Serrapeptase. Four patients who had recurred after their surgery, the lesions resolved in 3 out of the 6 patients.
Rebamipide gave substantial protection, and effect against inflammations as a free radical scavenger.
This study supports the efficacy of Rebamipide in the treatment of laryngeal contact granuloma. We consider Rebamipide effect for the gastroesophageal reflux and that caused granuloma reduction. We also consider Rebamipide effect against local inflammation of the larynx and that caused granuloma reduction.

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