The existence of superfast myosin heavy chain (MHC), found in jaw-closing muscle and extraocular muscle (EOM), was also found in rat laryngeal muscles. Immunostaining and western blot using anti-EOM superfast MHC antibody were performed to identify and localize superfast MHC in rat laryngeal muscles. Specific reactivity of laryngeal II L MHC was confirmed by western blot. By immunostaining, all fibers in the thyroarytenoid muscle reacted with EOM superfast MHC antibody. A scattered pattern of positive fibers was observed in the vocalis, the posterior cricoarytenoid and the lateral cricoarytenoid muscles. EOM superfast MHC was not detected in thecricothyroid muscle. Co-expression of EOM superfast MHC and type II B MHC was observed, and expression of EOM superfast MHC was seen in laryngeal muscle innervated only by recurrent laryngeal nerve, with the highest density of EOM superfast MHC in the thyroarytenoid muscle. The expression of EOM superfast MHC in rat laryngeal muscle is consistent with the functional demands for airway protection and glottic closure reflex. The MHC phenotype, or relative composition of myosin heavy chains, reflected the physiologic demands on each laryngeal muscle.

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The positive rates of 16 specific IgE antibodies were examined using the CAP-RAST system in the sera from 10 patients with pharyngolaryngeal allergy (PLA), 22 patients with nasal allergy (NA), and 12 patients with non-allergic cough and/or pharyngeal discomfort (NCP). The combined positive rates of all allergens measured were 60.0% in PLA, 81.8% in NA, and 25.0% in NCP. The positive rates of house dust and mite were higher in NA than in PLA. The positive rates of cockroach, moth, candida, orchard grass, and ragweed were higher in PLA than in NA. A good correlation was found between the CAP-RAST classes of house dust allergen and those of cockroach allergen in PLA, but was not found in NA. There were no patients with a positive IgE result specific to formaldehyde in either PLA or NA. In conclusion, the results indicate the difference of sensitization between in PLA and in NA, and the importance of cockroach allergen in PLA. Gaseous formaldehide is not very important as an allergen in both PLA and NA.

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Early cancer of the larynx is sometimes regarded to be successfully treatable with whatever technique applied by skilled experts. However, local control, larynx conservation, and cause-specific survival rates of these lesions are still not 100%. In this paper, 323 patients with glottic cancer of the larynx (142 T1a, 98 T1b and 83 T2) and 68 patients with supraglottic cancer of the larynx (12 T1 and 56 T2) were reviewed retrospectively in detail in order to obtain better treatment outcomes.All patients underwent conservation treatments initially.
With respect to the local control rate, any treatment modality could result in a good treatment outcome for glottic T1a and supraglottic T1 cancer. In contrast, laser surgery alone yielded the worst treatment outcome for glottic T1b and T2 cancer. In addition, for supraglottic T2 cancer, both partial laryngectomy and radiotherapy followed by laser debulking surgery obtained a better local control rate. All local recurrence of laryngeal carcinoma could be successfully remedied by partial laryngectomy, whereas in the case of laser surgery, more than half of the patients showed local repeat recurrence.
No patients with T1a glottic cancer showed neck recurrence. In contrast, 2% with glottic T1b, 2% with glottic T2, 17% with supraglottic T1, and 13% of the patients with supraglottic T2 cancer showed neck recurrence without any further local recurrence.
In total six patients died of distant metastasis without locoregional recurrence. The local recurrence rate showed no significant relationship with the distant recurrence rate, whereas the regional recurrence rate had a significant relationship with the distant recurrence rate (p<0.01).
These results suggest the following :
1) Laser surgery alone is not the indication for the treatment of glottic T1b nor T2 cancer in many cases. Partial laryngectomy is not the indication for the initial conservation treatment of early cancer of the larynx. In contrast, for local recurrence, partial laryngectomy is the most reliable salvage surgery.
2) Although regional recurrence is rare, patients must be followed-up carefully.
3) Although distant metastasis is also rare, care must be taken especially for patients with neck recurrence.

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Ninety-five cases of early laryngeal carcinoma treated with laser surgery were reviewed and the pitfalls of laser surgery were discussed. The disease specific survival rates and the larynx conservation rates were as followed (in respective order) : 100% and 93% for glottis T1, 95% and 71% for glottis T2,100% and 100% for supraglottis T1, and 60% and 60% for supraglottis T2. One glottis T2 case died of local recurrence and two supraglottis T2 cases died of neck and distant metastases. Total laryngectomy was required in thirteen cases with residual or recurrent tumors after surgery. These included five with glottis Ti, six with glottis T2 and two with supraglottis T2. Failure of local control was caused by the insufficiency of the laser surgery technique in Ti cases and the over indication of laser surgery in T2 cases. Some complications (fixation of the vocal cord, infection in the prelaryngeal space, laryngeal edema) occurred in four of ninety-five cases and the tracheotomy was required in one these case. Almost all of these problems were remedied by conservative treatment.

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The pitfalls in the treatment of early laryngeal cancer were investigated on the basis of 119 patients who were treated by radiotherapy for T1 (Stage 1) glottic cancer at Hiroshima University Hospital between 1978 and 1995. The results are as follows.
1) Characteristics of tumors that cause recurrence include : an increase in elevation, having a large volume and invasion to anterior area. A strict course of observation should be performed for the patients who were treated for T1 glottic cancer with these characteristics. This course of observation is imperative for the preservation of the larynx during therapy for recurrence.
2) Accurate diagnosis for T1 glottic cancer with CT, MRI, Stroboscopy and proper therapy are important for the prevention of recurrence.
3) Otolaryngologists should pay as much attention as radiotherapists to the technical matters involved in the progress of treatment outcomes.

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A survey regarding post-laryngectomy olfaction was conducted on 17 patients. 12 patients expressed the ability to smell after laryngectomy. All of five patients who had esophageal voice and five of 10 patients who had electrolaryngeal voice stated that they could smell. The post-operative period before patients indicated that they could smell ranged from 0 to 5 years. These patients who claimed the ability to smell could not do so with complete function. 11 patients (65%) hoped to regain normal olfaction.
In order to achieve this goal, we manufactured a tool to restore the capability of smelling. Utilization of this tool is projected to restore normal nasal airflow and to improve the olfactory threshold. This tool offers an invaluable improvement of the quality of life of patients that have undergone laryngectomy.

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Primary small cell carcinoma is an aggressive neoplasm commonly arising in the lung and its incidence in the larynx is extremely rare. This report describes a case of primary small cell carcinoma originated at the epiglottis accompanied by bilateral cervical lymph node metastasis in a 56-year-old female. Chemotherapy and 50Gy of radiotherapy were initially introduced according to a conventional protocol of treatment for this tumor, which resulted in an insufficient response. Thus, she underwent horizontal laryngectomy together with bilateral modified radical neck dissection, followed by postoperative radiotherapy and chemotherapy. Her clinical course has been uneventful for 11 months postoperatively. The majority of previous reports stated that patients with small cell carcinoma of the larynx should be treated with combination chemotherapy and radiotherapy. However, surgery could be the preferred treatment if the tumor is locally restricted.

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Residual larynx tissue after SCHLP was obtained from a patient with hypopharyngeal cancer, who had suffered multiple recurrences. Two and three-dimensional histopathological studies were conducted using serially sectioned whole laryngeal specimens. The inner surface of musculoperichondrial flap was newly epithelialized by ciliated columinal epithelium. Multiple cartilaginous fragments were observed beneath the epithelium surface. The inner space of the residual larynx was wider at the false vocal fold and the arytenoid level rather than at the vocal fold level. This suggests that the false vocal fold and the arytenoid have important roles in phonation after SCHLP.

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Leiomyosarcoma of larynx is extremely rare. It accounts for approximately 5% of all soft-tissue sarcoma and occur the rate of 3% in the head and neck region. Leiomyosarcoma of larynx accounts for approximately 10% of all sarcoma in head and neck region.
A 56-year-old man was admitted to our hospital for a 2-month history of hoarseness. An excisional biopsy was performed using microlaryngoscopy. Histological examination revealed highgrade dysplasia. Subsequent clinical symptoms, however, indicated extreme deterioration. It was judged that the lesion had transformed into cancer. We used radiation and chemotherapy to treat the tumor. One year later, a recurrence in the subglottic area was found. This lesion was identified as leiomyosarcoma using pathological examination. We treated the tumor by total laryngectomy.
Immunohistochemical studies are helpful in making an unambiguous diagnosis. In this case, smooth muscle specific antigen and desmin was stained positively. The clinical course of this case suggested a pathogenesis of multiple primary malignancies rather one than radiation induced.

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A 82-year old woman visited our hospital after having suffered from hoarseness for one year and dyspnea for several days. Clinical examination revealed a swelling of the left vocal cord and subglottic region. An emergency tracheostomy was performed under local anesthesia. Five days later, direct microscopic laryngoscopy was performed under general anesthesia and several biopsies of laryngeal lesion were taken following an extirpation that was as complete as possible. The lesion was diagnosed as plasma cell granuloma by histological and immuno-histochemical examination. The hoarseness and dyspnea disappeared after surgical excision followed by successful treatment with steroid administration. Only four cases, including this case, of laryngeal plasma cell granuloma were reported.

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