耳鼻と臨床

M. sternocleidomastoideus, M. trapezius and M. splenius capitis were examined electromyographically about their functioning before and after radical neck disseetion for cancer of the larynx in 33 patients subjected to one-side radical neck dissection. In dition to these cases 10 pacints were treated in the same way under the diagnosis of cancer of the upper jaw and the tongue or of a malignant tumor of the neck. And in controls, 10 normal persons were examined. The findings obstained were studied and compared, with the following conclusions reached.
1) Partial resection of M. sternocleidomastoideus on one side does not directly result in any motor disturbance.
2) The Spike of remaining part of M. sternocleidomastoideus and M. splenius capitis cooperating with it on the same side elicit smaller spike potentials after operation than before it. M. splenius capitis on the other side, which premably works so as to make up for the partial loss of M. sternocleidomastoidens, gives off larg spike potentials after the operation than before it.
These discharges are traced in in normal waves diminished and not in any abnormal waves.
3) M. trapezius and M. sternocleidomastoideus give off abnormal discharges when N, accessorius by which the muscles are innerveted, is impaired. The latter is also under the innerveted the cervical nerve (II-IV), so that the discharges it gives off when the nerve is impaired is traced in wave of complex N.M.U. voltage, and nerve again in those of normal N.M.U. voltage when the nervous impairment is severe.
4) Clincally, M. trapezius was found impaired in no more than some 40 % of cases after radical neck dissection, indicating that the operation, performed with sufficient care, does not result in muscular or other impairment in any considerable number of cnses and that it ought to be extensively used more for its prophylactic than for its therapeutic effect.

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The laryngeal hyaline cartilages, found broken down in 51 of 170 cases of cancer of the larynx, were investigated from various angles, with the following results.
1) The cartilage destroyed was the thyroid cartilage in 40 cases, the cricoid in 20, the arytenoid in 12, and the thyroid as well as the cricoid in 11.
2) The frequency of occurrence of a broken-down laryngeal cartilage was progressively lower in subglottic cancer (42.9 %), in endolaryngeal, in extrinsic, and in intrinsic.
3) The spread of a cancer was found arrested by cartilage, a perichondrium being particularly resistant to a cancerous growth. The ossified part of a cartilage, an ossified part containing bone marrow in particular, appeared to be readily invaded by a cancerous growth.
4) The lower part of the thyroid cartilage and the upper part of the cricoid appeared most highly predisposed to the occurrence of such destruction, followed, in declining order, by the upper end portion of the thyroid, the vocal process of the arytenoid, its basal part, and its upper part, each being the earlist ossified part of the respective cartilage.
5) The occurrence of such cartilage breakdown was likely not to depend on the type of growth of the cancer or an its malignancy except in rare cases.
6) Metastasis in the cervical or the prelarygeal lymph nodes and signs of relapse were observed with high frequency in those cases in which the thyeoid cartilage, particularly, both the thyroid and cricoid were destroyed. The incidence of endolaryngeal was incomparably higher among the cases where cartilages were destoroyed than in those where they were not.
7) Neither the spread of the cancer into the preepiglottic space nor an occurrence of a relapsing cancer in the hypopharynx was likely to be much related to the destruction of the cartilages.
8) Intrin.sic did not metastasize into any lymph node, nor did it relapse or bring about postoperative death, in any cases, whether the cartilages were broken down or not.
9) Cancer of the larynx, endolaryngeal in particular, took more unfavorable course when the cartilages were broken down than when they were not. This was especially the cases when the cartilages destroyed were the thyroid and cricoid.
(This research work was carried out under the direction of Prof. M. Sasaki and Assistant Professor H. Iwmoto.)

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