Arytenoid adduction combined with thyroplasty type I would be a surgery of choice for vocal cord paralysis with a large glottal chink during phonation. This paper describes the tips for how easily, safely and effectively this surgery can be perfermed. The knack of how to approach the muscle process is palpation of the cricoid cartilage on which the process sits. Blunt separation should be made from below until reaching the crico-arytenoid joint, only on and along the upper ridge of the cricoid cartilage. Opening the joint to reveal the joint surface confirms the joint. In combining the arytenoid adduction with thyroplasty type I, care should be taken on the steps and order to which the window of thyroplasty type I and suture holes for arytenoid adduction are made.

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The larynx has three functions to perform; they are, in order of importance to the maintenance of life, 1. respiration, 2, deglutition, and 3. phonation. The presence of the larynx is not usually well perceived regarding its function of respiration, but once its injury results in bilateral medial immobilization of the vocal cords (i.e., bilateral vocal cord paralysis), it can be a very awkward problem to handle.
Common causes of vocal cord paralysis are said to be neck or chest operation, intubation anesthesia, and tumors. However, vocal cord paralysis arising from such causes is unilateral in most cases and may be treated paying attention to phonation alone. In some other cases, however, vocal cord paralysis is bilateral. Vocal cord paralysis of this type is a hard nut to crack for the otorhinolaryngologist.
Various therapies for a respiratory disturbance in bilateral vocal cord paralysis have been described by many investigators. Viewed from another angle, however, this fact may mean that each therapy has both advantages and disadvantages.
This paper describes the technique for anterior dilation which can be performed relatively easily in the treatment of bilateral medial immobilization of the vocal cords.

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For early carcinoma of the vocal fold, three different therapeutic methods are mainly employed in daily clinic, radiotherapy, endoscopic laser surgery and cordectomy through laryngofissure. Each therapy has advantage and disadvantage by itself. However, if the indication is precisely and exactly drawn up, each therapy is thought to be an efficient treatment to some exent even today. The cordectomy is the most recommendable because an entire resection of the vocal fold can be performed with saf ty margin. On the other hand, insufficient glottal closure will happen after the cordectomy, resulting in breathy husky voice. Hence, we have newly designed a reconstructive surgery in order to avoid insufficient glottal closure even after cordectomy. A graft is made using the ipsilateral ventricular fold and this graft is displaced to the site of glottis. By a new glottis with the healthy vocal fold and the displaced ventricular fold, complete glottal closure is obtained. A patient can phonates one week later after the surgery. The ventricular fold has the same physical property as the vocal fold. Therefore, it is reasonable to use the ventricular fold to replace the vocal fold from the viewpoint of phonatory mechanism, especially vibratory wave motion.

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Two cases of juvenile laryngeal papilloma were treated by laser surgery and α-interferon (αIFN). In the case of multiple papilloma, the diffuse papillomatosis of bilateral vocal cords demanded four-time operations although the pedinculated papilloma of the right arytenoid was curable with a single laser surgery. The web of the anterior commissure was formed after operation. The case of the solitary pedinculated of the right vocal cord was curable with a single laser surgery. After the third and fourth operations of the multiple case and the single operation of the solitary type, αIFN was medicated with an ultrasonic nebulizer. This medication was useful without side effects.

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“End-to-side” vascular anastomosis was introduced for free-flap transfer in head and neck reconstructive surgery, and the advantages and disadvantages were discussed. In this procedure, the donor artery was anastomosed to the recipient's external carotid artery, and the donor vein was anastomosed to the internal or external jugular vein. Since the caliber of the donor vessels could be enlarged by making a cut-back, and the vessels were anastomosed to the side of large recipient vessels, the indication of “end-to-side” anastomosis was not restricted by the size of vessels. Moreover, the technique was easier than “end-to-end” microvascular anas-tomosis. The presence of arteriosclerosis was considered one of the major problems in conducting the arteriotomy of external carotid artery. The use of arteriotomy clamp and scalpel was helpful to aboid vessel wall damages. It seemed very risky to use this technique for anastomosis of the donor vein to the ligated jugular vein.

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We experienced nine female cases of infantile subglottic hemangioma during the period from 1984 to 1992. Characteristic clinical symptoms, surgical repair and postoperative courses are presented. Supraclavicular, xyphoid, as well as stridor, were the presenting symptoms in all cases. In addition, six cases had a barking cough. These symptoms developed one to two months postnatally, none having been present at birth. Five cases were treated with steroids, resulting in a marked improvement in dyspnea. Four patients also had hemangiomas in another anatomical location. Eight of the nine cases underwent surgical repair. Tracheotomy was done and the hemangioma was removed through a laryngofissure under a surgical microscope. We separated the overlying laryngeal mucosa, removed the tumor and then closed the epithelium with fibrin paste. Seven of these eight cases were successfully decannulated 20 days to 6 months later. Outcomes were good. The surgical technique employed produces no scarring, thereby avoiding laryngeal stenosis. One of the nine cases underwent tracheotomy and the hemangioma was vaporized with an Nd-YAG laser under a laryngeal microscope.

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During the period from 1975 to 1991, 71 cases with thyroid papillary or follicure carcinoma were treated in our clinic. In these cases, 16 cases (22.5 %) of the 71 had postoperative recurrence. In 15 cases of the 16, the sites of recurrence were neck lymph node, distant metastasis in 7 cases and primary in one case. All the recurred cases were papillary carcinomas in histopathological findings. The risk factores on recurrence were aged person, male, existene of neck lymph node and expanded primary tumor.

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The submandibular region is masked by the mandible and submandibular gland, thus making it difficult to grasp its lesions. The region often gives rise to inflammatory lymphadenopathy and, the ultrasonic diagnosis can be difficult sometimes. In the present study, we performed ultrasonography on the submandibular region of cases with known pathological diagnoses. Studies regarding ultrasonic diagnosis of (1) disease of the submandibular gland, (2) submandibular lymphnodes and (3) sialolith were carried out. This report reviews the problems and possible changes. A satisfactory accuracy rate of 82% was achieved for the diagnosis of disease of the submandibular gland. Percentage of accurate diagnosis of submandibular lymph node metastasis was considerably lower compared to other regions of the neck. Detection of sialolith in the warthin's duct was also low owing to the structure of the submandibular region. When ultrasonography was performed by pressuring the floor of the oral cavity, it was possible to observe the changes in the size, form, and position of the lesions. Thus, ultrasonography can be considered as a very effective diagnostic technique in that region.

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Oculopharyngeal muscular dystrophy exhibits the symptoms of dysphagia and ptosis usually. We report a 34-year-old female case, with a chief complaint of hypernasality. And we decided to operate a surgical treatment because of very slow progression of this disease. To use the remained soft palate elevation effectively and to minimize the operative procedure, we employed a plastic operation of the pharyngeal posterior wall using the silicon block. After operation, the hypernasality was markedly improved and the veropharyngeal distance was reduced appropriately. So this method was considered as an effective treatment for the hypernasality. In this paper, the method is demonstrated and discussed bibliographically.

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The authors performed thyroplasty type I surgery on six patients as the treatment of hoarseness due to unilateral recurrent laryngeal nerve palsy and followed them for more than six months. Four patients were satisfied with their results. Three of these four virtually proved excellent phonatory functions and remained stable. The other, although his paralyzed vocal fold was in the upper position, showed a prominent improvement of his voice. His phonatory function got slightly worse six to eight months postoperatively, but his voice remained good enough in his daily life. Two patients were not satisfied with the results. In one patient, a cartilage window was opened at the higher level and thus taking more time for medialization caused tissue edema. Since the paralyzed vocal fold of the other was in a relatively high position, he underwent arytenoid adduction eight months after the first operation and his voice became normal.

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We examined 34 patients with nasal and paranasal papilloma between April, 1984 and May, 1992. The results obtained are as follows ; 1) The average age of the patients was 58. 1 years. Men were affected more frequently than women, in a ratio of 4:1. 2) One-sided nasal obstruction was the most common symptom, although expansive growth of the papilloma caused exophthalmos or blurred vision. 3) Histopathologically, 5 cases were exophytic type and 29 cases were inverted type. Six cases showed malignant change. 4) Six out of thirty cases showed recurrence. And three cases out of them showed malignant change to carcinoma.

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Fifty cases of blowout fracture (BOF) were reconstructed by surgery. Several types of BOF were demonstrated by the findings of imaging and surgery ; among the medial types of BOF, there were localized type, wide type, and the entrapment of medial rectus mucsle type. III ground lamella which was deviled into anterior and posterior ethomod sinus was one of important landmarks. Among the inferior type of BOF, there were linear type, narrow type and wide type.

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A retrospective analysis identified 16 children (under 20 years), 11 male and 5 female, with malignant tumors of the head and neck evaluated at our Department from 1980 to 1992. Primary malignant neoplasms of the head and neck in children were not common, accounting for about 0.5 per cent of all our head and neck malignancies. In terms of anatomic location, the nasopharynx was the most common site of presentation. Ten children had nonepithelial malignancies, six had epithelial carcinoma. The two most common malignancies were lymphomas (n= 5) and nasopharyngeal carcinoma (n=4), and a variety of tumors composed the remainder. The epithelial carcinoma tended to increase incidence at puberty, although the non-Hodgkin's lymphomas could occur at any childhood age. The five children who were alive without disease for more than 5 years, demonstrated no serious late effects on day-to-day activities. Now, with the introduction of multimodality treatment regimens, the children can expect long-term survival. It is only through the combined efforts of all specialties involved that the most appropriate treatment modality can prevent suffering late effects and organ disorder will realize. Due to the increase of long-term survivors, the survey of quality of life of cured children is considered to be essential.

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Subsequent cervical metastasis after treatment for primary tumor has much influence on the prognosis of T₁, T₂N₀ tongue cancer. We investigated clinically the subsequent cervical metastasis in the cases of T₁, T₂ tongue cancer treated during the period from 1979 to 1990. The results were as follows. 1) In the incidence of subsequent metastasis, there was little difference between T and T. We have to be careful about potential risk of even T₁. 2) The cumulative five-year survival rate of the group of subsequent metastasis and that of the group of cervical metastasis on first examination were almost the same. Subclinical metastasis was implicated as the possible cause of subsequent metastasis. 3) We had no way to evaluate 'subclinical metastasis' clinically. 4) Onset of subsequent metastasis was within one year after treatment and that result of treatment was pessimistic one. But the patients with subsequent metastasis after more than two years had good survival rate. Careful follow-up should be mandated to detect cervical metastasis as early as possible especially during the first two years.

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