We herein report a 49-year-old man who presented with primary squamous cell carcinoma of the thyroid gland (SCC). He complained of a painful anterior neck swelling which had spread quickly. We performed an incision and drainage under a diagnosis of acute thyroiditis. We performed a resection of the necrotic tissue and a right lobectomy which was full of a lot of pus. Under a histopathological diagnosis of SCC, successively concomitant chemo-radiotherapy was performed. However, the primary tumor nevertheless continued to increase in size. A preoperative diagnosis is difficult in patients with SCC, since many cases with SCC are diagnosed to be inflammatory lesions. SCC is therefore thought to have a lower radiation sensitivity in comparison to other head and neck squamous cell carcinomas.

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A 39-yeas-old man arrived by ambulance because of acute progressive difficulty in breathing. On arrival, he developed severe dyspnea and agitation. Owing to technical difficulties in achieving endtracheal intubation, an emergency tracheotomy had to be performed at once. After tracheotomy, his respiration status recovered. Unfortunately, at 3 days after admission, bleeding at the tracheotomy wound was observed. As a result, we performed a re-operation on the 3rd day. He was treated by the intravenous administration of hydrocortisone and antibiotics. Swelling of the epiglottis improved 6 days after tracheotomy, and the tube was removed 12 days after admission. The patient was eventually discharged on the 16th day of admission. Thirty adult patients with acute epiglottitis were treated at our department from January 1998 until June 2002. Fifteen cases were males and 15 cases were females between 20 and 80 years of age, with a mean age of 52.3 years. Twenty-two cases were introduced by local otolaryngologist while 3 cases were brought in from emergency hospitals. The mean duration of hospitalization was 8.8 days with a range of 5 to 16 days and no deaths occurred.

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We immunohistochemically investigated the expression of p53 oncoprotein and S-100 protein positive cells in adenoid cystic carcinomas (ACC) of the head and neck. The relationship regarding the clinicopathological parameters and patients' prognosis as well as the local control rates were also analyzed. In the examinations, tissue sections from 48 patients with a pathologic diagnosis of ACC of the head and neck surgically treated at Kurume University from 1971 through 1999 were used. No significant correlation between the expression of p53 oncoprotein and the prognostic factors was observed. On the other hand, the appearance of neck metastasis as well as distant metastasis was significantly higher in the patients with S-100 protein negative staining than in those with S-100 protein positive staining (p<0.05, p<0.01). These results indicate that the expression of S-100 protein positive cells might therefore be a prognostic factor in patients with adenoid cystic carcinomas.

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Medializing a paralyzed vocal fold with external access generally achieves good outcomes, but vocalization remains unchanged in some patients. In efforts to determine the most efficacious management of such patients, we evaluated the outcomes of six reoperative cases of vocal fold medialization. Vocalization had been unchanged in four patients following initial vocal fold medialization due to such factors as posterior gap, and the location or size of the implanted silicone block. Reoperation improved the vocalization of these four patients. Although traction of the lateral cricoarytenoid muscle improved level differences, there was still a problem with the size of a block used. Reoperation did not improve vocalization because the initial surgery caused scarring of the internal perichondrium which made it difficult to achieve effective compression using the silicone block.

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A 55-year-old male suffered from hoarseness after receiving blunt injury of the anterior neck. The CT examination showed multiple fracture of the thyroid cartilage. He underwent surgical repair of the fracture, however, he still complained of a difficulty in speaking in high-pitched voice after surgery. Endoscopic observation of the larynx revealed a shortened left vocal fold and decreased tonus of it. Incomplete correction of the fracture of the thyroid cartilage was identified by reexamination of CT. We performed thyroplasty type IV to compensate disordered laryngeal framework structure. Postoperatively, the voice disorder of the patient was decreased. We conclude that laryngeal framework surgery should be considered as an alternative treatment for voice disorder following a fracture of the thyroid cartilage.

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Generally, the vocal cords vibrate and constitute the sourse of phonation. However, in case with wide glottal gap at phonation due to a scar formation after an injury, surgery or radiotherapy to the larynx, the false folds vibrate instead of vocal cord vibration. In cases whose vocal as well as false folds do not vibrate, The arytenoid mucosa is known to vibrate as a source of phonation (so called arytenoid phonation), In this report, we described a 59-years-old man who was treated with CO₂ laser debulking followed by radiotherapy against glottic Tla cancer. Because of a scar formation after the therapy, there appeared a defect in the right vocal cord and false fold and his suffered from severe hoarseness. Both vocal cord and false fold did not vibrate and, as a result, only the arytenoid mucosa vibrates. Intrafold fat injection was done under the endolaryngeal microsurgery, and the vocal cord and false fold of the healthy side vibrates with the arytenoid mucosa of the injected site. After the surgery, the patient felt comfortable on phonation and the quality of voice improved.

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We performed a new technique of lateralization of the vocal cord for bilateral vocal cord paralysis of a 67-year-old female using an endo-extralaryngeal needle carrier developed by Lichtenberger, and obtained good results. The advantages of this technique in addition to the advantage of the Ejnell's operation are as follows: (1) It is easy to arrange a thread in the proper position because the needle is inserted in the larynx via a direct laryngoscope with a microscope.(2) There is little damage because the thyroid cartilage is not exposed. This technique is thought to be very useful for lateralization of the vocal cord.

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We report a case of interarytenoid adhesion at the vocal processes. A nineteen-year-old male with dyspnea due to traffic accident had an endotracheal intubation for three weeks. Two months later, he complained dyspnea and stridor at the first visit to our outpatient clinic. Laryngoscopy showed bilateral vocal cord immobility, however it did not show the intrarytenoid adhesion at that time. Tracheotomy was performed for acquiring the sufficient air way. Six months later, fiberoptic endoscopy under local anesthesia revealed the adhesion between the vocal processes. Under general anesthesia, the adhesion was excised by a cold instrument and steroid was injected into both vocal processes. Good vocal cord mobility on both sides was obtained just after the operation. Tracheostoma was closed. Two months later, contact granuloma was observed at both vocal processes, but the lesions disappeared after four months of voice therapy and proton pump inhibitor medication. There has not been re-adhesion at the vocal processes for two years and three months. Observing and touching the vocal processes by endoscopy or direct laryngoscopy can provide important information for the precise diagnosis of bilateral vocal cord immobility.

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Functions of phonation and swallowing were assessed after partial laryngectomy. Both functions were almost normal in a patient of T2 glottic cancer with the new glottis reconstructed using a folded skin flap. In a patient of T3 supraglottic cancer with conservation of an upper half of the epiglottis, food intake became possible four months after surgery. Aspiration pneumonia has not occurred. The phonatory function was fairly good. In a patient of T3 glottic cancer with defects of the arytenoid region and the cricoid arch reconstructed using the thyroid cartilage and the hyoid bone, there was almost no problem in swallowing after surgery. The voice was preserved without any respiratory disorder, but the phonatory function was poor.

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We reported a 4-year-old boy of congenital subglottic stenosis. He had inspiratory stridor after birth and recurrent episodes of croup. With a direct laryngoscopic and radiological examination we found subglottic stenosis from over the length of approximately 1cm of a few mm below the true vocal cords. Especially the right and left horizontal diameter of the lumen was shortened. Tracheotomy was performed because of a serious respiratory distress after infection. The stenosis was caused by the abnormally thick cricoid cartilage. After laryngofissure, we shaved the thick car- tilage under the periosteum and transplanted his cheek mucosa on the mucosa-deficient region of the lumen. In the expanded lumen, modified Montgomery silicone T tube that was convex-shaped and closed, was anchored. His voice was good but there was a comparatively severe scar formation in the skin incision and the anterior trachea wall. We have to keep in mind that raw surface may be repaired as well as possible in operation, that postoperative infection may not be caused.

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Twenty-five patients with globus sensation due to gastroesophageal reflux disease were treated with oral administration of ransoprazole or rabeprazole. All patients underwent indirect and fiber optic laryngoscopy, upper gastrointestinal fiberscopy, and blood examination. The reflux esophagitis and hiatal hernia were observed in four and eight patients, respectively. Ten patients were treated with 30mg/day ransoprazole, and fifteen patients were treated with 20mg/day rabeprazole. The efficacy of ransoprazole and rabeprazole was 70% and 67%, respectively. Both ransoprazole and rabeprazole were effective to patients with globus sensation due to gastroesophageal reflux disease.

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