Laryngeal granulomas after endotracheal intubation were observed near the vocal process. The pathogenesis of the laryngeal granuloma has not yet been established. The purpose of this investigation was to clarify the cause of these granulomas. Two different experimental procedures were adapted for this study. In the first series, 54 intact hemilarynges obtained from 35 human cadavers with known histories of intubation, were studied. Extent of injury to the vocal process was observed macroscopically and histologically. In the second series, the vocal processes of 16 mongrels were injured using a rasp, and each stage of the healing process was histologically observed. The results are summarized as follows; I. Injury to the vocal process after intubation and caused factors. 1) A triangular-shaped injury exists posteriorly to the area which is clinically termed vocal process. 2) The lesion begins as a defect in the covering mucosal epithelium and pro-gresses in stepwise fashion as a congestion of the layer of mucosal propria, a necrosis or a defect of the layer of mucosal propria, and exposure of the arytenoid cartilage as the terminal stage of pathogenesis. 3) With regard to the location and extent of injury, lateral preference wasnot observed. 4) A sexual predominance of injury was not recognized, however, severe damage to the vocal process extending to the cartilageneous membrane and arytenoid cartilage occurring in cases with intubation for periods longer than 24 hours, was observed in the female. Furthermore, a comparison between the length of vocal cord and diameter of the ventilating tube revealed that the tube used in females was larger than that used in males. 5) A lesion is not worsened by hypoproteinemia, hypoalbuminemia or anemia, which was generally believed to be the cause. 6) Usage of a respirator was not a precipitating factor of injuries. On the contrary, non-use of a respirator led to more severe injuries in cases of intubation of longer than 12 hours. II. Healing of injury to the vocal process. 1) Two weeks are required for complete healing in cases where injury extends to the epithelium and submucous proper layer, while four weeks are required when injury extends to the arytenoid cartilage. 2) Healing of injury beyond the arytenoid cartilage isaccompanied by growth of a secondary granuloma adjacent to the site of the original lesion. 3) This second granuloma begins to develop as a wide crater-like lesion which later changes to a long stalk. Accordingly, the arytenoid cartilage becomes necrotic with development of the granuloma.

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The laryngeal protective reflex during deglutition is one of the most important functions of the larynx, in addition to phonation and respiration. Clinicaly, aspiration occurs in the lesion of the neuromuscular system including recurrent laryngeal nerve (RLN) paralysis. In this investigation, particular attention was paid to elucidate the mechanism of aspiration in RLN paralysis. For this purpose, three different experimental procedures were adopted: 1) In the first series of the experiments, electrical activities of the intrinsic and extrinsic laryngeal muscles and subglottal pressure with up and down movements of the larynx were recorded simultaneously during deglutition, using felines with a polygraph unit. 2) In the second series of the experiments, afferent discharge from superior laryngeal nerve (SLN) and RLN were also recorded as same manner as mentioned in the first series. 3) In the third series of the experiments, measurement of subglottal pressure in normal adults and RLN paralysis patients during deglutition was performed. On the basis of the results of the experiments, the following conclusions appear justified; 1) The activities of the intrinsic and extrinsic laryngeal muscles in the feline are highly constant in each deglutition. The result of other investigators have demonstrated that this is also the case for man as well as canine. 2) Subglottal pressure in the feline during deglutition shows the following pattern; the pressure rises with the start of deglutition, temporarily drops during laryngeal elevation and rises again during the downward movement of the larynx, and drops at the end of deglutition. This pattern is not affected by resection of the unilateral RLN. 3) The SLN is involved with the sensory function of the pharynx, larynx and trachea. At least two types of afferent discharge, perhaps from superficial and profound sensory nerves, are suspected. 4) The afferent discharge from the RLN in the larynx and trachea is not as distinct as that from the SLN, and this seems to cor-respond with some various change in thorax. 5) The pattern of subglottal pressure in man during deglutition is the same as that of the patient with RLN paralysis, and also the same as that of the feline.

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The structure of sensory nerve endings of the human larynx has appeared in a few studies, however their role in the physiological function of the larynx, i. e. degulutition and protection of the upper respiratory organ, still has not been described in detail. This study was carried out to examine the structure of sensory nerve endings of the human laryngeal mucosa by means of light and electron microscopy and to discuss their relationship to the physiological function of the larynx. The results are summarized as follows; 1. In adults, sensory nerves and their endings are observed most frequently on the laryngeal surface of the epiglottis. 2. A comparatively large number of sensory endings are seen in the arytenoid region and false cord, although they are not as strongly developed as in the epiglottis. 3. Sensory nerve endings are very rarely seen in the vocal cords. 4. The types of sensory nerve endings observed in this study are free endings of simple or complex tree-like shape and corpuscle endings with glomerular patterns. 5. In the terminal portion, some varicosities of the axon or concentration of the terminal fibers are observed under the epithelium. Furthermore, very small varicosities of the fine terminal fibers are seen in the epithelium. 6. Using electron microscopy, nerve varicosities with an accumulation of mitochondria were observed. They partly lack the cytoplasm of Schwann cells and are in close contact with basal cells of the epithelium. No membrane specializations were observed between the basal epithelial cells and nerve varicosities. 7. In the newborn and infantile larynx a development of nerve fibers growing upward towards the epithelium are seen in the epiglottis, arytenoid region and false cord, how-ever it is not prominent in the vocal cords. 8. These nerve endings of the larynx seem very sensitive to any kind of stimulus and may be concerned with the degulutitive or protective function of the larynx.

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Statistical observation of 58 cases with postoperative maxillary cysts, which were treated surgically and conservatively at the department of otolaryngology of Saga Medical School from November 1981 to October 1984, was performed. The results are summarized as follows; 1) The age of the patients ranged from 23 to 69 years. The average age was 44.0 years. 2) The male to female ratio was 37: 21. No significant lateral preference of affected maxillary sinus was found. 3) The incubation period from the last surgical treatment to onset of the symptoms was an average of 17.7 years; the shortest was four months and the longest was 43 years. 4) Most of the patients complained of symptoms such as cheek swelling and/or pain, regardless of the number and site of the maxillary cysts. 5) It appears that ENT doctors should perform follow-up examinations on patients for three months after surgery in fear of the development of maxillary cysts.

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Although mucoceles of the frontal, ethmoid and sphenoid sinuses are less common than those of the maxillary sinuses, patients in the former group suffer from a wider variety of symptoms than those in the latter. Eye ball disturbances are generally accepted as one of the most important symptoms. Nineteen cases of frontal, ethmoid and sphenoid sinus mucoceles were treated surgically in our clinic over the past three years from November, 1981 to December, 1984. Data obtained from these cases are discussed. Results are summarized as follows; 1) Origin of the mucoceles was found in thirteen cases of frontal sinuses, four cases of ethmoid sinuses and two cases of sphenoid sinuses. 2) Four cases were recognized as primary cysts and fifteen cases were secondary cysts. 3) These mucoceles were found relatively frequently in patients in their thirties and fourties, and the male to female ratio was 13:6. 4) Many of the secondary cyst cases were initially operated on their teens. 5) There were a few cases who complained of nasal symptoms. 6) Rhinogenic visual disturbances were found in one case of posterior ethmoid sinus and in two cases of sphenoid sinus.

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From October 1981 to September 1984, 97 cases of nasal allergy were observed. There were 75 cases of house dust allergy, 50 cases of Japanese cedar pollinosis, 19 cases of orchard grass pollinosis and 28 cases of ragweed grass pollinosis. Nineteen per cent of the patients had other allergic diseases and eighteen per cent had family histories of allergy. The results of a radio-allergosorbent test (RAST) using seventeen different grasses suggested the existence of crossallergenicity to many grass pollens in five of the cases. The seasonal variation of serum reaginic activity in Japanese cedar pollinosis was observed.

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We observed 224 patients suffering from Japanese cedar pollinosis in and around Saga-city from March to June of 1984. The ratio of males to females was almost equal. Seventy two percent of the patients were between 20 and 39 years of age, while 74 percent of the patients were first taken ill during this same age bracket. The results of a radio-allergosorbent test (RAST) using a Japanese cedar pollen disc were positive in 207 out of 211 cases. A positive RAST was observed in 94% of those cases exhibiting positive intradermal reactions to the extract of Japanese cedar pollen. Eye symptoms were observed in 86% of 210 cases who responded of the questionnaire.

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The patient was a 16 year-old boy who complained of swelling of the left cheek. Surgical treatment (Caldwell-Luc technique) was performed under general anesthesia. A large tumor was found in the left infratemporal fossa which was compressing the maxillary sinus and extended to the superior orbital fissure. The tumor was removed completely with minimum blood loss. Histological examination showed hemoangiofibroma with collagen fibers in the center and numerous vessels in which the thromboses were partially scattered.

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Whether or not the tongue should be reconstructed with a pectoralis major myocutaneous island flap, during hemiglossectomy with ipsilateral radical neck dissection, in patients with a localized tongue cancer (T₂N₀M₀), has been the cause of much controversy with regard to the effects on vowel formants. To compare the effects on vowel formants, we reviewed the phonetic records of 3 patients having the tongue reconstructed with a pectoralis major myocutaneous island flap, and of 2 patients with hemiglossectomy alone. At periodic intervals after surgery, patients' voices were recorded on a SONY tape re-corder and analyzed by a KAY sound spectrogram. Intelligibility tests using a confusion matrix of 100 words were also performed. F₁-F₂ plots (Fant G, 1960 and Peterson E, 1951) and isovowel lines of the vowels, /i/, /e/, /a/, /o/ and /u/ for a group of normal subjects, and for the glossectomy subjects in both resection alone and reconstruction cases are presented. We found that recovery from abnormal to normal vowel pronunciation progressed during the stable stage and termination of the postoperative cicatricial healing of wounds, both in patients with resection alone and reconstruction, although acoustic and perceptual characteristics of consonants did not show a marked difference when comparing the immediate postoperative stage to the present.

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It is generally accepted that actinomycosis is a chronic infectious disease which often occurs in the oral cavity or jaw with occasional brain involvement as well. Foci of suppuration may liberate pussy discharge containing the causative organism Actinomyces israelli. This paper reports a case of 37 year-old female suffering from abnormal sensation of her pharynx, probably derived from Actinomyces infection in the right palatine tonsil. Histological examination for the resected tonsil revealed the presence of “Druse” of Actinomyces adjacent to the superior tonsillar fossa. Numerous, radially arranged hyphae were also found. Acute inflammatory infiltrate around “Druse” was seen, as one of the host reactions against Actinomyces. After the histological confirmation, antibiotics (Penicillin) was administered.

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A case of malignant pleomorphic adenoma of the palatine tonsil is reported. A 58-year-old woman had complained of abnormal sensation of the throat. Physical examination revealed that the left palatine tonsil was enlarged and coated with a white film. Histological examination of the biopsy specimen revealed the tonsillar tumor to be malignant pleomorphic adenoma. A tonsillectomy involving the surrounding tissue with elective neck dissection of the left side was performed using CO2 laser. It was considered that the tumor originated from the minor salivary glands in the pharyngeal mucosa and extended into the palatine tonsil. The patient remains in favorable condition at this time, 12 months after surgical treatment.

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The patient was a 2 year-old female infant who suffered from right palatine tonsillar tumor. Histologcal examination revealed a leiomyoma, after tonsillectomy. Leiomyoma is a benign tumor which commonly occurs in smooth muscle of the skin, uterus or digestive organs. However, leiomyoma of the palatine tonsil is quite rare, because, in general, there is little smooth muscle in the palatine tonsil. Accordingly, leiomyoma of the palatine tonsil may originate from two possible sources, the first being vascular smooth muscle and the second hamartoma. Vascular smooth muscle is of prime suspect in this case because of its histological characteristics and its high frequency in oral cavity. Most literature on leiomyoma of the oral cavity states that its prognosis is favorable, but some investigators have reported its recurrence or even metastasis. Therefore, care must be taken after completion of therapy.

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Fourteen patients with laryngeal tumors were treated using CO₂ laser equipment at our clinic from March 1983 to November 1984. In this study, we paid special attention to the healing of the mucosal wound after laser surgery, and evaluated the significance of the application of laser surgery in the treatment of those tumors. The results are summarized as follows; 1) In 5 cases of laryngeal carcinoma, laser surgery was effective in reducing mass lesions before radiation therapy. In most cases, the region of the vocal fold injured by laser beam was covered with a white coating for a few months after the end of radiatin therapy. It appears that laser therapy in laryngeal carcinoma should be applied to the depth of the vocal ligament. 2) In 7 cases of laryngeal epithelial hyperplasia, a white coating remained for about one month. It seems that laser vaporization may be applied to the depth of the vocal ligament at the initial operation. 3) Two cases of laryngeal papilloma were treated using laser therapy. The first was a case of solid mass lesion which was cured by laser surgery only. The second was a case of multiple mass lesion which remains after three unsuccessful laser surgery.

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Multidimensional measurements of pitch, intensity and mean flow rate, including the measurement of maximum phonation time, are common procedures used in evaluation of voice disorders. Using a RADAR-CHART of pitch, intensity and mean flow rate on easy phonation, we studied 103 voice disorder patients in whom routine phonetic function tests were completed preoperatively and postoperatively. These same patients were also examined using conditions of variable pitches and intensities. From this study, we concluded that construction of a RADAR-CHART composed of the above-mentioned three parameters during easy phonation, in addition to measurement of the parameter of mean flow rate under the special condition of maximum phonation time are indispensable methods for providing valuable information in the study of phonetic function in voice disorder patients.

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We investigated two cases of Essential (Voice) Tremor with hand tremor, with particular focus on the voice disorders. The patient in case one was a 59 year-old male. Quavering voice tremor was observed during contextual speech. Rhythmical voice tremor on vowel prolongation ranging from approximately 5-6 Hz was observed. Synchronous tremors were also observed in the soft palate, neck, chest wall and abdominal wall. The larynx was normal and vocal fold tremor was not observed, but vertically oscillating movement of the larynx could be seen under the skin of the neck. The rhythmic activity of the cricothyroid muscle became synchronous with voice tremor. Synchronous changes in pitch, intensity and air flow rate were observed in a phonatry function test. Abdominal wall tremor (5-6 Hz) was observed on intentional expiration. He has a family history of essential tremors. The patient in case two was a 48 year-old male. Voice tremor was not observed during contextual speech but on vowel prolongation rhythmical voice tremor (5-6Hz) was observed with synchronized tremor in the abdominal wall. The larynx was normal and vocal fold tremor was not observed. Synchronized changes in pitch, intensity and air flow rate were observed. Abdominal wall tremor (5-6 Hz) was observed on intentional expiration. He also has a family history of essential tremors. It is suggested that the voice tremors were caused by a rythmical chage of intrathoracic pressure.

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A woman, aged 18, had suffered from a psychogenic voice disorder since the age of eleven. She presented with a childlike voice and speech. Her voice was higher in pitch (330 Hz) and shorter in maximum phonation time (9 sec) than the normal adult female, and was reduced in loudness. On sound spectrographic analysis, the frequency of each formant (F1, F2, F3) of her voice was higher than normal, being similar to that of a child's voice. Results of personality tests suggested she was rather immature. Following voice therapy and psychotherapy, she was able to read aloud in a normal voice and a sound spectrogram revealed that her formant frequencies had become nearly normal.

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The purpose of this investigation was to clarify the caused factors of aspiration resulting from recurrent laryngeal nerve paralysis. Fourteen patients who complained of aspiration were studied. The data were obtained and analyzed by fluoroscopic X-ray cinematography. The results are summarized as follows: 1. Only 5 out of 14 patients (36%) complaining of aspiration were actually confirmed radiologically to be suffering from aspiration. 2. There was no relation between the state of aspiration and the position of the paralyzed vocal fold. 3. Aspiration occurs in both the rising and falling phases of laryngeal movement. 4. It appears that aspiration results from an incompetent sphincteric action and/or a weak protective reaction.

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We observed the deglutition movement in MEIGE'S syndrome with dysphagia using a simultaneous four channel electromyogram recording system, an X-ray T. V. and a video-taperecorder to investigate the relationships between muscle action and movement of each part of the food channel in deglutition. Results of the electromyogram suggest that the deglutition reflex was disturbed by a functional disorder in the central nervous system. A remarkable finding in the electromyogram was that the cricopharyngeal muscle had a very short relaxation time, and which disturbed food passage in the pharyngo-esophageal junction. The sternocleidomastoid muscle contracted with each deglutition. Cricopharyngeal and infrahyoid myotomy, probably the adequate treatment for this case, could not be performed due to his refusal.

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Polyneuritis cranialis is a syndrome which is caused by various diseases such as brain tumor, motor neuron disease, anemia, avitaminosis, viral infection and many other diseases. Hence, we must exhaustively attempt to identify the original diseases with as many examinations as possible. The patient is a 32 year-old female who complained of dysphagia, hoarseness, and a disturbance in the ability to elevate her shoulders. Upon admission polyneuritis cranialis (IX, X, XI cranial nerves) was diagnosed and many examinations were done. Chest X-ray showed bilateral hilar lymphadenopathy and sarcoidosis was determined histologically by Daniel's biopsy. The original symptons greatly improved within seven days after admission, however, right peripheral facial palsy developed a few weeks later, so steroid therapy was indicated. The origin of neurologic manifestations in sarcoidosis is briefly discussed.

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Thirteen patients with malignant tumor of the head and neck were treated with a combined chemotherapy consisting of Cisplatin, Peplomycin and Mitomycin C. Among 11 evaluable patients, there was no complete response, however, a partial response (≥50% regression) was found in 10 patients. From these results, the effective rate was determined to be 91% (10/11). A partial response was found in six cases of squamous cell carcinooma, two cases of lymphoepithelioma, one case of undifferentiated carcinoma and one case of malignant lymphoma. Toxic reactions such as nausea and vomiting were found in 77% (10/13) of the cases, but they were mild. Leukopenia, anemia and thrombocytopenia occured about two or three weeks after onset of this regimen but these changes were temporary and recovered to within normal limits after four to five weeks. Nephrotoxicity and hepatotoxicity were minimal. However, one patient succumbed to Penlomycin-induced pulmonary fibrosis.

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A case of tracheopathia chondro-osteoplastica is reported. The patient was a fifty year-old female who had developed hoarseness and a cough. Physical examination revealed a massive lesion from the anterior commissure to the subglottic area of the larynx. This lesion was removed through a laryngofissure under general anesthesia. Histological examination confirmed the presence of bony and cartilaginous islets within mucosa. Moreover, the osseous nodule contained fatty or cellular bone marrow. The diagnosis of tracheopathia chondro-osteoplastica was established by pathological examination and a CT-scan. This clinical entity is less common in Japan than in foreign countries. Only fifteen cases have been reported to date in Japan. Clinical features are briefly reviewed.

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The real-time-B-scan is utilized to detect a sclerosis or thrombotic stenosis of the carotid artery. This method was applied to determine whether a radical neck dissection was indicated or not for arresting to the cervical lymph nodes in cases of head and neck carcinoma. The procedure of the scan was undertaken as follows; i) transverse scan for detecting the internal jugular vein, external-, internal-carotid artery and common carotid artery, in addition to detecting the cervical mass, ii) longitudinal scan for clarifying the nature of the vessel walls, such as tapering, compression, invasion or shifting, iii) scan during swallowing, for detecting the paradoxical or coordinating movement adjacent to the mass and the vessels, iv) scan in setting a position of Valsalva's maneuver.

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A case of primary hyperparathyroidism is reported. Making a preoperative diagnosis of tumor localization is important for successful surgery. In this case, abnormal views were obtained in the region of the left lower pole of the thyroid by ²⁰¹T1-chloride scintigraphy, ultrasonography, and arteriography. Tumor extirpation was performed under general anesthesia. Histopathological findings showed parathyroid adenoma. The patient remains in favorable condition and serum Ca levels are within the normal range.

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