We have reported that the activity of the mechanoreceptors against vibration in the subglottic mucosa enhances reflexive contraction of the contralateral thyroarytenoid muscle (TA) primarily via the recurrent laryngeal nerve (RLN) and partially via the internal branch of the superior laryngeal nerve (ISLN), both of which are indispensable for reflexive laryngeal control. Morphologically, some parts of the laryngeal mucosa receive sensory innervation from both RLN and ISLN.
In the present study, we recorded respiratory neurograms of the Galen anastomosis (GA) of spontaneously breathing cats under general anesthesia. Rhythmic inspiratory activities were recorded from GA and they were synchoronous with the activities of the posterior cricoarytenoid muscle (PCA). Weak expiratory activities were also recorded from GA. Sections of the nerve branches for the adductor muscles did not affect the rhythmic activities of GA. When the nerve branch to PCA was sectioned, the inspiratory activities of GA disappeared. An additional section of the main trunk of RLN resulted in disappearance of the remaining expiratory activities.

View full abstract

The silver impregnation method developed by Barker was used to investigate proprioceptors in human intrinsic laryngeal muscles. The posterior cricoarytenoid and interarytenoid muscles were obtained from the laryngectomy specimen of a 65-year-old male patient suffering from laryngeal cancer. Under a light microscope, receptors which are accompanied by special terminal apparatuses, including muscle spindles, Golgi tendon organs and spiral nerve endings, were observed as well as free nerve endings which have no special terminal apparatus. In other words, the intrinsic laryngeal muscles investigated had all types of proprioceptors like other skeletal muscles. These findings may renew our understanding of physiological meanings of proprioceptors in the intrinsic laryngeal muscles.

View full abstract

Movements of laryngeal components for different vocal attacks were investigated with the use of a digital fluorography (DF) system. In this paper, three kinds of vocal attacks (soft, hard and breathy attack) were compared through subtracted images obtained with TID mode subtraction technique.
In the hard attack, the vocal folds during adduction were thicker and the false vocal folds adduction was more marked than in the soft attack. The distention of the subglottal space due to the increase in subglottal presser was larger in the hard attack than in the soft one. In the breathy attack, the vocal folds during adduction were thinner than in the soft attack, and the false vocal folds did not adduct. These findings suggested an existence of a incomplete glottal closure before phonation.

View full abstract

The intraluminal pressure in the esophageal orifice was measured during swallowing and at rest in ten patients before and after cricopharyngeal myotomy. Three patients received unilateral myotomy and seven underwent bilateral myotomy prior to the postsurgical measurement. Following unilateral cricopharyngeal myotomy, the resting pressure in the esophageal orifice decreased markedly but did not disappear completely. Therefore, the upper esophageal sphincter function remained. Following bilateral cricopharyngeal myotomy, the resting pressure in the esophageal orifice was completely eliminated. The deglutition pressure in the hypopharynx and cervical esophagus remained at the same level as that before surgery in both unilateral and bilateral myotomy cases. We conclude that the effective cricopharyngeal myotomy should be a bilateral myotomy that consists of a removal of the entire muscle layer extending 3cm or greater in the crania-caudal direction by 1cm in the muscle fiber direction.

View full abstract

A total of 45 patients with hypersensitive throat were examined. They complained of persistent paroxysmal cough, itching and irritation of the throat. However, they have never had episodes of nasal allergy nor bronchial asthma. Intradermal test revealed that 73% of the patients were sensitive to inhalant allergens. Major inhalant allergens were house dust mite, house dust, mold and Japanese cedar pollen. Clinical findings in the pharynx and larynx were unremarkable. The etiology of this disease might be allergic reaction and hypersensitivity of the sensory nerve system in the mucosa of the pharynx, larynx and trachea.

View full abstract

Acute epiglottitis is often accompanied by dyspnea which occasionally call for an emergency tracheotomy or intubation. This study reviewed 40 patients with acute epiglottitis who were treated in our clinic for the recent 10 years.
The average age of the patients was 40 years and most of them were smokers. A traumatic lesion of the epiglottis was thought to be the cause in 8 patients. All 40 patients had sore throat, and 15 of the 40 patients complained of dyspnea. Four of the 15 dyspnea patients required emergency airway maintenance and one of the four died of the airway compromise. Swelling of the epiglottis frequently extended to the aryepiglottic fold but the vocal cord and oropharynx were not involved. Antibiotics and steroid were employed for the treatment.
The results indicate that micro-injuries can cause acute epiglottitis, and that chronic irritation by smoking might be a predisposing factor. Acute epiglottitis can be successfully treated with medication in most cases. It should be, however, kept in mind that acute epiglottitis sometimes causes a fatal dyspnea.

View full abstract

Cure-rates and phonatory functions following Nd : YAG laser surgery were compared with those following CO2 laser surgery. The results were as follows. 1) There were no differences in the curerate between the two types of lasers. 2) The maximum phonation time and the range of fundamental frequency in patients treated with Nd : YAG laser were smaller than those treated with CO2 laser. The mean air flow rate, intensity of voice and acoustical analysis showed no differences between the two lasers. This means that as far as comfortable phonation is concerned, there is little difference between two lasers. We conclude that the treatment of laryngeal cancer with Nd : YAG laser would be a pertinent choice when CO2 laser is not near at hand.

View full abstract

An 82-year-old man who underwent vertical partial laryngectomy at the age of 65 years developed aspiration lasting for 2 years. In the previous surgery, the right half of the larynx was removed and a repair was conducted with the use of the piriform sinus mucosa. A laryngeal closure by means of the modified Habal & Murray technique was carried out with failure. The failure was caused by the existence of scar tissue in the right hemilarynx. The right piriform sinus was absent, causing a narrow hypopharynx.
The purpose of treatment under this condition was to establish a good food passage without voice conservation. To do this, the scarred right hemilarynx was removed together with the whole laryngeal skeleton and the myomucosal component of the left hemilarynx was preserved. A wide hypopharyngeal lumen was constructed with the use of the laryngeal myo-mucosal flap and the mucosa of the narrow hypopharynx. Postsurgical pharyngoesophagogram demonstrated smooth passage with no stenosis nor fistula formation.

View full abstract

Various surgical techniques have been reported for the treatment of aspiration. Laryngeal closure is one of those methods. Usually it is performed under general anesthesia. However, it is difficult for poor risk patients to undergo this procedure. This paper reports a new method of laryngeal closure which is conducted with the endolaryngeal laryngomicrosurgery technique. Silastic gel (Fycone 6600, Fx82®) is injected in the vocal folds. The vocal fold edges are deepithelized and the bilateral vocal folds are fused by means of fibrinogen (Beriplast P®). This method was successfully conducted in two patients. It is easy to perform and can be completed within a rather short time.

View full abstract

A case of cricoarytenoid joint arthritis associated with rheumotoid arthritis was reported. A 59-year-old female with a long history (40 years) of rheumatoid arthritis involving all joints including the intervertebral joints was brought to the hospital because of a sudden onset of severe dyspnea during physical training in December, 1989. Emergency tracheostomy was performed. A fiberscopic examination revealed swelling of the bilateral false cords and aryepiglottic folds and fixation of the bilateral vocal cords in the median position. An electromyographic study of the posterior cricoarytenoid muscle revealed marked activities during inspiration. A CT scan demonstrated deformed arytenoid cartilages. The CT and EMG findings led us to the diagnosis of a laryngeal involvement of long-standing rheumatoid arthritis. Arytenoidectomy was conducted on the left side and the swelling of the false cords and aryepiglottic folds subsided following surgery. The vocal cords, however, remained fixed. Histologic findings noted in the extirpated arytenoid cartilage were similar to those in other joints having rheumatoid arthritis. It should be emphasized that otolaryngologists should have more awareness of the laryngeal involvement of rheumatoid arthritis in their clinical practice.

View full abstract

A 42-year-old man developed posterior glottic stenosis following an attempt of self-burning. He was intubated for 2 weeks and tracheotomy was performed for a failure of extubation. Laryngoscopy revealed adhesion at the posterior glottis which severely limited abduction of both vocal folds and arytenoids. The scar tissue of the posterior glottis was resected by means of carbon dioxide laser under endolaryngeal microsurgery on two occasions. These two procedure, however, were not successful to stop recurrent stenosis.
An open surgery was conducted. Following laryngofissure, scar tissues were submucously removed. The wound at the posterior glottis was covered by rotation mucosal flaps obtained from the postcricoid area and a free buccal mucosa graft. Human fibrin glue was employed for the grafting. The posterior glottic space was sufficiently enlarged. The tracheostoma was closed 10 months after the surgery. Two years and 6 months after the surgery, the patient has a good respiratory and phonatory function.
On the basis of the successful result in the present case, the authors emphasize the usefulness of free mucosal graft with fibrin glue in the treatment of posterior glottic stenosis. This procedure does not call for the use of a laryngeal stent.

View full abstract

A case of primary laryngeal adenocarcinoma was reported. The patient was a 63-year old male who had undergone surgical treatment for gastric and esophageal cancer 27 months before. His complaints were horseness and fullness of the larynx. A tumor was noted on the laryngeal surface of the epiglottis. On the basis of a biopsy a histological diagnosis of adenocarcinoma was made. A total laryngectomy was performed for the treatment. A detailed histopathological study of the surgical specimen revealed that the disease was a primary laryngeal adenocarcinoma originating from the small salivary gland.

View full abstract

Otorhinolaryngologists in Japan appear to be unfamiliar with hyalinosis cutis et mucosae, because this disease has not been reported in the otorhinolaryngological literature of Japan. This paper presents a case of hyalinosis cutis et mucosae with laryngeal involvements.
A 59-year-old man was referred to our clinic, complaining of hoarseness and multiple papular lesions of the mucosa of the pharynx and larynx and the skin of the face and extremities. The pharyngeal mucosa was whitish-yellowish and atrophic. The laryngeal mucosa was irregularly thickened. The epiglottis, aryepiglottic folds and vocal cords were involved. Histological examinations of the skin of the left elbow revealed hyaline material diffusely deposited in the dermis. Hyaline substance was found also in the lamina propria of the vocal cord mucosa. An electron microscopic examination revealed that the hyaline material was composed of fine filaments and fine granules.Multiplication of basal laminae was seen around the capillaries. These findings led us to diagnose hyalinosis cutis et mucosae.

View full abstract

Sarcoidosis is a systemic disease characterized by granulomatous inflammation which may arise in many organ systems. Sarcoidosis of the larynx, however, is extremely rare. In this report a case of sarcoidosis affecting the right vocal fold is presented. A 47-year-old female had complained of hoarseness and sore throat during swallowing. Indirect and direct laryngoscopies demonstrated a diffuse swelling extending from the right vocal fold to the false vocal fold. The epiglottis and arytenoid were intact. Biopsy specimens obtained from the right vocal fold showed non-caseous granuloma with Langhans type giant cells. In some Langhans type giant cells asteroid bodies were observed. She was treated with oral medication of predonisolone and relieved from the hoarseness.

View full abstract