The inner fascia of platysma muscle was used as a pedicle flap for reconstruction after hemilaryngectomy for T3 glottic carcinoma. This new technique was applied to four patients. No granulation, no stenosis, no disturbance in deglutition and fairly good voice were obtained in all cases. The procedure is as follows.
A preliminary tracheostomy is performed through the third and the fourth tracheal rings and a general anesthesia is given. Two transverse skin incisions are made on the hyoid bone and on the third tracheal cartilage and they are connected with a vertical incision along the anterior border of sternocleidmastoid muscle on the involved side. A quadrangle skin flap is carefully peeled off under platysma muscle with its inner fascia.
Hautant's hemilaryngectomy is carried out. The arytenoid cartilage is removed occasionaly with the upper portion of the cricoid cartilage on the involved side. The superior and posterior area of the wound is covered with pyriform sinus mucosa. The cut edge of the opposite vocal cord is sutured to the outer perichondrium of the thyroid ala in order to prevent a webformation.
The quadrangle skin flap including platysma muscle is advanced into the laryngeal cavity and sutured to the surrounding cut edge of the laryngeal mucosa, that is, the anterior edge is sutured to the fascia at the point of the false cord, vocal cord and subglottic region; the mucous membrane at the posterior commissure is double sutured to the fascia with 3-0 chromic catgut, then the fascia is strained and sutured to the upper and lower edges and the laryngeal cavity is primarily closed. No stent is employed. Tracheostoma is closed two weeks after the surgery.

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Incidence of visual disorders induced by head injuries is well known. Such accident may result from optic canal fracture through apex of the orbit, which is caused by slight blow on lateral-upside of the eyebrow. The author believes that it is better to operate on the above-mentioned case at an early stage after shock or unconscious state of the patient has passed. Many surgical operative procedures to treat these cases have been reported; 1) anterolateral craniotomy, 2) extranasal transethmoidal approach, 3) permaxillary transethmoidal method. An intranasal approach was applied in this series. The intranasal transethmo-sphenoidal technique is the most excellent for optic nerve decompression without cosmetic sacrifices. In this paper, the author's Method is shown in detail. A local anesthesia was be used. At the first step of the operation whole ethmoid cells can be cleared away with Griinwald's type of punch-forceps, then the middle turbinate is simply dislocated laterally towards the middle meatus, thus exposing the sphenoid ostium to view. The sphenoid cavity being completely opened, the optic canal becomes visible. In this situation, the method can be devided into two series. When linear or depressed fracture is clearly recognized or prominence of the optic canal is noted, the fractured bony particles should be lifted and then removed. When undefinite and flat prominence of the canal wall is observed, lateral wall of the ethmoid (lamina papyracea) should be removed and compact bony part at the junction between the ethmoid and the sphenoid (so-called apex orbitae) is visualized. With sharp curettes and chisels, the compact bone is resected to find out the optic canal. Immediate improvement of vision will be shown in the patients who were successfully treated in the operation.

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Two cases with epiphora following the surgery of the maxillary sinus were reported. In these cases we found that the inferior end of the lacrimal passage was closed by a cicatrical tissue.
Dacryocystorhinostomy by paranasal approach was perfomed under an operating microscope. An incision of about 50 mm long was made along the operative scar on the oral vestibule. Frontal process of the maxillary bone was exposed and anterior wall of the lacrimal canal was removed with a small straight chisel. The vault of anterior end of the inferior nasal meatus was the most easily recognizable marking in order to start the removal of anterior wall of the lacrimal canal. After exposure of the membranous nasolacrimal duct, its nasal wall was ovally excised about 7 to 10 mm in diameter. The mucoperiostal layer which covers the agger nasi was incised parallel to the posterior border of the new opening of the nasolacrimal duct. This newly made flap of the mucous membrane was placed anteriorly so that its external margin adapts to the anterior lacrimal flap with adequate tension. Then the both flaps were brought together with one or two sutures and tied.
Two patients treated by this method were relieved of epiphora. The dye test after the operation was positive in these cases.

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It was reported that a man of 73 years old had his head injured by a traffic accident and 2 months later had his left VIth, Xth, and XIIth cranial nerve paralized. Whether the cranial traumatic sequelae developed into multiple cranial nerve paralysis or the paralysis was caused from multiple cranial neuritis which afterwards accidentallyaccompanied the head injury was discussd from the standpoint of clinical neurology and neuropathology. The discussions led to the conclusion that exact diagnosis must depend on the accumulation of future comparative studies of clinical and postmortem pathological findings on head-injured patients.

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Two cases of facial palsy following acute otitis media in an infant and a child were reported. The first case was a 7-month-old infant and the second, a 4-year-old boy. Although they had been treated with antibiotics for about ten days since the onset of the otitis, sudden facial palsy appeared without preceding aural discharge in both cases. Fortunately, complete recovery in two cases have been achieved by conservative treatments, such as repeated paracentesis and powerful chemotherapy. The origin of the facial palsy was suggested of direct inflammatory damage on the facial nerve in the first case and toxic neuritis and vasomotor paralysis indirectly in the second. The authors emphasize that if the facial palsy is steadily increasing or at least not decreasing after adequate conservative treatment for several days, immediate surgery should be performed.

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A series of ten experiments on guinea pigs was performed to study the effects of NaCl crystals on the cochlear microphonics which were recorded from the basal turn with the differential electrode technique. The magnitude of the responses was determined on a cathode-ray oscilloscope for a stimulating tones of 300Hz of a certain intensity which evoked an output of 300μV of the cochlear microphonics after the application of NaCl to the round window. The NaCl crystals were equalized with the precise bolters of which meshes were 0.20mm and 0.25mm respectively, and then two pieces of right cubic crystals selected under a binocular microscope were placed directly on the round window membrane.
The results obtained were plotted in Figure 2, and the averaged curve of the cochlear microphonics after the application of NaCl crystals on the round window were shown in Figure 3 with the standard deviation at every five minutes during the recording. The variations of the cochlear microphonics of each animal were relatively small at the beginninig of the experiment and then showed remarkable increase afterwards. The course of changes of the cochlear microphonics in averaged curve are as follows; The cochlear microphonics showed an initial overshoot which was followed by a primary rapid decrease and then by a temporary recovery. A second decrease of more moderate rate was finally observed. The output of the cochlear microphonics at the peak of overshoot which occurred 1.5 minutes after the salt-application showed 7% increase of the original level and the output at the bottom of the primary decrease which was observed 15 minutes after the salt-application showed 55% of the original level. The recovery was incomplete but a marked increase (70% of original level) was observed. The cochlear microphonics decreased to a level of 205μV±72μV at 60 minites after the application of NaCl crystals on the round window.
A reversible damage of CM-generating system which is caused by the osmotic and ionic changes of the labyrinthine fluids seems to be responsible for the initial overshoot and the primary decrease of the cochlear microphonics following the salt-application. The temporary recovery of the cochlear microphonics seems to be caused by the renormalization of the ionic concentration of the perilymph and the endolymph due to production and absorption of the fluids. The second decrease of the cochlear microphonics was considered as the result of an irreversible progressive damage of the hair cells and of the fluids-production system. The permeability of the round window membrane and the metabolism of the labyrinthine fluids were considered as the factors influencing the previously mentioned changes of the cochlear microphonics after the application of NaCl crystals on the round window.

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Fifteen cases of dysphagia with acute onset were clinically investigated. Radiocinephotography and electromyography were applied to all cases. The author tried to classify the cases into two categories, central lesions and periferal lesions. The onset of dysphagia with central lesion ranged from five days to two weeks, and the duration of dysphagia was rather long. On the other hand, the onset of dysphagia with peripheral lesion ranged less than three days, mostly within twenty-four hours and the duration of dysphagia was short. Healing process of dysphagia with peripheral lesion was also quick, within seven days.
Cinephotographic observation revealed that dysphagia with central lesion was markedly demonstrated in the first stage (oropharyngeal stage) and coordination of muscles of deglutition was much disturbed.
Electromyographic observation showed interesting results as follows; The pattern of deglutition of the patient with central lesion was much irregular and showed disturbance in coordination of swallowing muscles. Continuous swallowing was difficult and resulted in misdeglutition. However, the denervation potentials were not observed at all. Amplitudes of electromyogram showed generally low voltage.
The swallowing pattern of the patient with local lesions was regular and each muscle of deglutition contracted in order timewise. Coordination of muscles was good and the bolus passed easily the entrance of esophagus. Continuous swallowing was possible. The liquid, however, was rather difficult to be swallowed in rapidly repeated pattern. The denervation potentials were well observed if seen within two weeks of onset. High voltages and fasciculation were often observed as signs of renervation.
Generally speaking, the central lesion accompanies the other signs and symptomes than dysphagia, and takes longer time of healing. On the other hand, peripheral lesion does not associates with the other signs nor symptomes than dysphagia and has healed within two weeks mostly.

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Eleven of 13 subjects after supraglottic laryngectomy clinically presented no aspi- ration. Four of them were studied by cineradiography from a surgical point of view. The hyoid bone was preserved in Case I ; in Case II, base of the tongue was extensively resected and the aryepiglottic fold was excised more than a half on one side; in Case III, the aryepiglottic fold was reconstructed with a superior cornu of the thyroid cartilage in Case 1v, the hyoid bone was preserved but the remnant of the larynx was not closely apposed to base of the tongue.
Case I does not get barium over the laryngeal inlet due to the apposition of the arytenoid eminence to base of the tongue. In Case II, 111, N, a bit of barium enters over the laryngeal inlet at the begin of the deglutition and is cleared by the subsequent backward movement of the tongue. It is noticed that 1) the reconstruction of the aryepiglottic fold with the superior cornu of the thyroid cartilage is a very useful technique to prevent aspiration, 2) the extensive resection of base of the tongue, the removal of the hyoid bone or the insufficient apposition of the laryngeal remnant to base of the tongue tends to aspiration.

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Es wird über einen Fall des Ganglioneuromes des linken Seitenhalses bei einer 18-jährigen Krankenschwester berichtet. Der kindesfaustgroBe, elastisch weiche Tumor hat sich vom linken Seitenhalse bis zur hinteren Rachenwand erstreckt. Da der Tumor sich hauptsächlich am Hals befand, wurde die Exstirpation desselben von außen vorgenommen. Während der Operation ergab sich, daß die Aa. carotis interna und externa gänzlich von dem Tumorgewebe umgehtillt waren. Obwohl der Operateur die Carotis externa vom Tumorgewebe ablösen konnte, war die AblOsung der Carotis interna sehr schwierig. AuBerdem war die Wand der Carotis interna so morsch geworden, daß die Arterie während der AblOsung verletzt und versehentlich abgeschnitten wurde. Die beiden Stiimpfe der Arterie mußten unterbunden werden, urn die heftige Blutung daraus zu stillen. Wegen dieses Versehens muBte der Operateur ein Drittel des Tumors zürilckbleiben lassen. Der resezierte Tumor wog 154 g. Die Patientin konnte aber ohne bedrohliche Hirnerscheinung die Klinik entlassen. Diese Tatsache ist vermutlich darauf zürtickzuführen, daß die Carotis interna wegen des langjahrigen Vorhandenseins des Tumors allmahlich gedriickt war und die kollateralen Bahnen dieser Arterie schon gebildet worden waren.

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Five cases of hypoparathyroidism and three cases of phrenicoparalysis after extensive neck surgery were reported. All cases of hypoparathyroidism showed typical tetanic signs, such as numbness of hands and feet, obstetric hands and twitching of facial muscles at the second or third postoperative day. The serum Ca levels of them were under normal range and the phosphate levels above normal. They were treated with intravenous injection of Calcicol (calcium gluconate) and parathormone in acute stage and then with oral dosage of calcium lactate and Calciferol (Vit. D2). The time courses of serum Ca level of each patient were plotted in Fig. 3.
Three cases of phrenicoparalysis showed directly after the operation a labored breathing with difficulty to cough up the accumulated secretion in the respiratory tract. Radiological examinations revealed remarkable elevation of the diaphragma at injured side. They were treated with Bird's Respirator for 2-3 weekr.
Lastly a case in which hypoparathyroidism and phrenicoparalysis have occured simultaneously was breafly reported. The relationship between them was also discussed especially concerning to the respiratory alkalosis due to hyperventilation with the respirator.

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Recurrent otitis media is frequently found in the child who has low serum gammaglobulin value. The author tried to treat these patients with recurrent otitis media by administration of gamma-globulin. Thirty-four children were given gamma-globulin, and 81% of them showed good results. Recurrent otitis media in child seems to have a close relation with immunological deficiency.

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