Upper (cerebrum cortex) and lower (mainly the medulla oblongata) brain region neural mechanisms related to swallowing have been identified. Although a number of studies have clarified the functional anatomy of swallowing in the lower region, the details regarding the control of swallowing in the upper region are still poorly understood. In recent years, several objective and minimally invasive techniques for measuring the brain activity have been developed, such as functional magnetic resonance imaging (fMRI). In the present study, we investigated the areas of brain activation associated with neural activity during saliva swallowing in six healthy subjects using fMRI. We used an event-related design for the study. The sensorimotor cortex, premotor cortex, supplementary motor, basal ganglia, thalamus, anterior cingulate gyrus, insula, and cerebellum all showed activation. Given that these extensive neural networks are involved with each other, we concluded that the upper central region of the brain controlled complex swallowing movements. Studies using noninvasive brain imaging techniques such as fMRI may clarify the connections between these swallowing neural mechanism networks. As such, more fMRI studies should be conducted in the future.

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We herein report 38 cases of supraglottic carcinoma treated at Kyushu University from 2009-2012. The three-year overall survival and cause specific survival were 46.9%, 51.0% respectively. The three-year rate of larynx preservation was 36.0%, which significantly worsened due to an advanced T stage. In stage Ⅲ and Ⅳ cases, the rate of larynx preservation in the group undergoing induction chemotherapy followed by chemoradiotherapy was better than that in those undergoing concurrent chemoradiotherapy, but not significantly so.

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We herein report the case of a patient with dysphagia due to lower cranial neuropathy, which was caused by herpes zoster virus infection. Dysphagia from vagus nerve paralysis (which occurred due to left palatal paralysis), the curtain sign, muscular paralysis of the left pharynx, and the laterality of pharynx clearance were confirmed at the time of the patient's first medical examination. Ingestion was enabled early due to an improvement in the function of the pharyngeal compressor muscles； however, the patient's palatal paralysis was still present and unilateral vocal cord paralysis was observed at a medical examination that was performed 30 days after the patient's initial presentation.

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Acute epiglottitis is an infectious disease that may progress rapidly and cause suffocation within a few hours after onset. It may be misdiagnosed as a viral infection because of relatively mild inflammation of the pharynx. We herein report the case of a 50-year-old man with a sore throat who visited the emergency room of our hospital 8h after symptom onset and soon experienced suffocation. Emergency airway management was immediately performed using Portex^® Mini-Trach II^®, and surgical tracheostomy was performed the following day. Thereafter, he recovered quickly. His wife was a nurse and had good knowledge of the criticality of this disease. She had initially suspected he had acute epiglottitis and brought him to the hospital. Had she not acted so quickly, he might have died suddenly. The risk of acute epiglottitis is well recognized by otorhinolaryngologists, but the concept of this disease is not widely known among medical staff, including other-specialty doctors. Therefore, doctors with other specializations may sometimes find it difficult to diagnose this disease. This case suggests that knowledge of acute epiglottitis should be shared among medical staff.

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