The endolaryngeal soft tissues are contained within anatomic spaces bounded, to a large degree, by fibroelastic membranes and ligaments. These structures tend to limit the spread of early cancer to definite compartments, so that small tumors can often be removed by partial laryngectomy with adequate margins. Once these fibroelastic barriers have been breached, cancer spreads readily into adjacent compartments or into adjoining soft tissue or laryngeal framework.

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Repetitive electrical stimulation to the midbrain periaqueductal gray (PAG) and the ventrolateral pons (pontine call site : PCS) reported to evoke natural sounding vocalization in cats. The purpose of the present study was to investigate the descending pathways for vocalization from PAG to the lower brainstem. By means of the electrode which could be used for both microstimulation and microinjection, an anterograde tracer, Phaseolus vulgaris leucoagglutinin (PHA-L), was injected at the site of the ventrolateral PAG where vocalization was induced by electrical stimulation.
At the level of caudal superior colliculus, most labelled fibers were sparsely distributed, and they passed laterally through the dorsal part of the midbrain tegmentum. At the level of the inferior colliculus, they could be traced ipsilaterally to the ventral area along the medial lemniscus. They consisted of a narrow bundle in the dorsolateral part of pontine tegmental reticular nucleus. At the level of medulla, they appeared to be concentrated in a discrete area ventrolateral to the inferior olive and dorsal to the pyramidal tract, and their terminals were found in the vicinity of retrofacial nucleus (RFN) and retroambigual nucleus (NRA).
The bundle of the descending fibers in the ventrolateral pons seemed to correspond to the PCS. RFN and NRA where the terminals of these descending fibers were distributed included the respiratory neurons. The projections from PAG to RFN and NRA would be essential for vocalization by modulating respiratory movements.

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In elderly people, vocal folds are bowed without clinically noticeable organic or functional lesions. In this study, histological examination of such bowing was made, using 64 normal human larynges, with ages ranging from 70 to 104 years old.
The results were summarized as follows : 1) The degree of bowing of the vocal fold was found to increase with age in males. 2) Decrease in the thickness of the lamina propria, especially the superficial layer, of the vocal fold was the cause of bowing. 3) No definite relationship between the thyroarytenoid muscle and degree of bowing was determined. 4) Bowing of aged vocal folds was a geriatric change causing glottic incompetence with consequent voice disorders and was, at least, one of the etiologies of aging of the voice.

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In this study, two contrastive typical tongue shape methods were studied. One was Ship-bottom Tongue (ST) and the other was Rolled Tongue (RT) against upper jaw. An Italian operatic trained singer (dramatic tenor, age 37) sang five Japanese vowels, /a, i, u, e, o/, at the same pitch frequency of 415 Hz and loudness in an unechoic room using the two methods, and the vocalizations were recorded on a digital audio tape recorder. In an acoustic study, two different types of frequency spectra were measured : a long-term average spectrum to investigate differences in the harmonic structures in the low frequency range and a short-term spectrum to observe spectral differences in the high frequency range. The first two formant frequencies were also carefully measured using an analysis-by-synthesis method. In a physiologic study, Magnetic Resonance Imaging (MRI) was adopted to take a sagittal section picture of the articulatory organ during singing in which differences in the two tongue shapes could be observed. All the voice samples were subjected to perceptual evaluation experiments by 48 professional opera singers and student singers, in which ST voices were compared with RT ones in terms of “pithiness impression.” Findings were summarized as follows : (1) ST voices mostly possessed rich harmonics in the frequency range up to 20 kHz, while RT voices revealed less energy in the frequency range above 10 kHz, (2) all the RT voices showed larger distances between the first and second formant frequencies than the ST counterparts, (3) the oral cavity in ST was much larger than that in RT, while the pharyngeal cavity in ST was much narrower than in RT, (4) RT voices were judged more pithy than ST voices. Therefore, it was concluded that pithy impression of RT voices was closely related to the distance between the first and second formant frequencies which was clearly caused by the different control of the tongue shape in singing and that the tongue shape could effect vibration of the vocal folds.

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In 1976, primary tracheoesophageal (TE) fistulisation with the membranous part of the trachea was established by Amatsu for the purpose of voice reconstruction following laryngectomy. In 1983, a short procedure against aspiration was added to the original method. It was arranged to obtain sphincter mechanism by looping both esophagus and TE fistula with inferiorly based esophageal muscle flaps obtained from the posterolateral aspect of the esophagus. The rate of aspiration during deglutition has been remarkably improved after this modification.
In this study, 4 TE speakers without aspiration were subjected to fluoroscopic examination to clarify the mechanism inhibiting aspiration. All of them had no aspiration with slight infiltration of the contrast medium into the TE fistula in 2 subjects. The contrast medium in the fistula was trapped at the level of the muscular loop. Esophageal dilatation with slight elevation at the upper level was the major finding. From these facts, the mechanism that blocks aspiration was concluded to be the muscular loop constricting the fistula when the esophagus dilates at swallowing.

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Larygo-strobography is a newly developed analytic method for quantitative analysis by strobovideography. It's characteristic point is that it can arrange not only in time series all of the vibratory periods of arbitrarily sectioned images of the vocal folds as a single still image, but also superimpose voice-related signals (the voice signal, EGG, subglottal pressure, etc., ) synchronized to the trigger pulse of the laryngo-stroboscope.
The five improvements of the analytic function mentioned below are added to the previous paper.
(1) Three parameters of open quotient, speed quotient, and speed index can be displayed by the automatic calculation from the three numbers of the fields of the opening phase, closing phase, and closed phase during the one vibratory cycle of the vocal fold.
(2) The fundamental frequency of voice synchronized to the each analytic field can be displayed by the automatic count of the time interval between the trigger pulses of the laryngostroboscope.
(3) Three analytic axes can be selected simultaneously.
(4) The analytic axis of the artificially shifted field due to the scope-folding-hand tremor can be corrected automaically by the semi-automatic detection of the boundary between the non-vibratory false vocal fold and the vocal fold.
(5) The differences of the brightness among the each fields due to the difference of the count of the strobo-light radiation can be corrected automatically.

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Cricopharyngeal myotomy was applied to twenty-six in-patients with dysphagia. Twenty (76.9%) patients were regarded as successful. No significant difference was observed between patients who underwent cricopharyngeal myotomy and patients who underwent cricopharyngeal myotomy and laryngeal suspension. The successful rate was highest in laryngeal trauma followed by CVA (cerebrovascular accident). Two of four patients with amyotrophic lateral sclerosis and one of two patients with progressive bulbar palsy were free from dysphagia. Results in patients with thoracic disease were poor. One patient underwent total laryngectomy and another underwent closure of larynx. Results were satisfactory in patients under 65 years old, that is, eleven of twelve (91.7%) were regarded as successful. However, results were unsatisfactory in patients over 65 years old, that is, only nine of four-teen (64.3%) were regarded as successful. A significant difference was observed between the two groups (p<0.005). Cricopharyngeal myotomy was less effective for patients over 65 years old.

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During 11 years from 1983 to 1994,134 cases of laryngeal cancer were treated. In this paper, the clinical analyses of these patients are reported. There were 127 male and 7 female patients (ratio 18 : 1), and their pathological diagnoses were all squamous cell carcinoma. The primary site of 34 cases was supraglottic type and 96 cases were glottic type. Only 4 cases were subglottic type. All cases were grouped by T classification (UICC in 1987); 57 cases (43%) with T1, 37 cases (26%) with T2, 24 cases (19%) with T3, and 16 cases (12%) with T4. The patients were treated using not only single therapy such as radiotherapy or surgery, but also using combination therapy. The 5-year survival rate up to now was 78.4%, which was a little higher than the rates reported by other investigators.
Also examined were the factors that prevent improvement of the laryngeal cancer cure rate. Based on our long-term observations, examination of the deaths by recurrent cancer revealed the importance of preventing cervical recurrence, especially stomal recurrence. Furthermore, from the examination of other causes of death, it was revealed that early detection of secondary digesitive cancer, particularly esophageal and stomach cancer, is necessary.

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Two hundred and ten patients with laryngeal cancer were treated at Oita Medical University Hos-pital over a 13 year period between October 1982 and October 1994. The male/female ratio was about 13 : 1. One hundred and fifty-three (68.1%) patients were diagnosed as having glottic cancer, 60 (28.6%) were as having supraglottic cancer, and the remaining 7 (3.3%) as having subglottic cancer.
According to the UICC TNM classification system 1978, 76 patients (36.2%) were stage I, 45 (21.4%) were stage II, 55 (26.2%) were stage III and 34 (16.2%) were staze IV.
Partial-laryngectomy was performed after 30 Gy irradiation for 67 out of 101 (66.3%) patients with early glottic cancer in order to dissect tumor more radicaly and to preserve their phonatial function. The recurrent ratio in patients that received a partial-laryngectomy (8.4%) was slightly lower (11.4%) than that in patients that received irradiation of only 50 Gy.
The five-year survival rate was 68.7% in patients with larvnaeal cancer (stage I, 80.0%; stage II, 76.7%; stage III, 59.9%; stage IV, 53.4%), 78.4% in patients with glottic cancer, 52.1% in patients with supraglottic cancer, and 80.0% in patients with subglottic cancer.

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We investigated laryngeal nerve paralysis in 141 adult patients : 70 males and 71 females in Tokai university hospital from 1983 to 1993. The age distribution revealed a peak at 60 years. The paralytic lesion was unilateral in 130 patients (right in 49 and left in 81) and bilateral in 11 patients. The causes of paralysis were mostly in idiopathic, postoperative paralysis and paralysis due to intubation for anesthesia. The paralysis due to thyroid tumor was recognized frequently. The recovery rate was high in idiopathic paralysis.

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Carcinoid tumor of the larynx is a rare and malignant neoplasm. It is reported that a case of laryngeal carcinoid tumor in a 74 year old male was located on the surface of the epiglottis with one-sided neck metastasis. He died of multiple metastasis; lung, heart, aorta, pancreas, gallbladder, skin and posterior peritoneal space when 9 months had passed after surgical treatment of suprahemilaryngectomy and one-sided radical neck dissection.
The serum level of serotonin was elevated when lung metastasis was detected. This high level of serotonin was decreased by the chemotherapy of cis-platinum (CDDP) and 5-fluorouracil (5-FU).
It was reported that carcinoid tumors of the larynx were aggressive and malignant with distant metastasis but not with serotonin elevation. Our case suggests that the tumor volume of distant metastasis may increase the serum level of serotonin and that CDDP+5-FU may be effective therapy for this tumor before and/or after surgery.

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In 1949, Takahara first reported acatalasemia, which was a constitutional abnormality characterized by a deficit of catalase in the blood. Acatalasemia patients inherited autosomal recessive genes and its incidence was high in children born of consanguineous marriage.
The patient was a 71-year-old male who underwent total laryngectomy because of recurrence of laryngeal cancer. The operative area was prepared with Oxidol^®, a widely used disinfectant in otolaryngological disease. This antiseptic treatment induced methemoglobinemia, and it took about 16 days to recover from the critical postoperative condition.
In order to clarify the causative factor, a blood hydrogen peroxide mixing test, a skin scratch test, and gene analyses were performed, and catalase activity was measured. He was made the diagnosis of acatalasemia because of the significant decrease in catalase. The patient's family history was also studied and it was found that his parents were first cousins. A catalase activity test of his mother and three children was carried out, and the result showed that all of them had suffered from hypocatalasemia. His gene abnormality was considered as a Japanese-type.
As in the present case, acatalasemia has been often induced accidentally by the use of hydrogen peroxide solution. The detection rate of acatalasemia was high in otolaryngology and oral surgery.
It must be borne in mind that the risk of methemoglobinemia can be minimized by paying special attention to the treatment of patients with Oxidol^®.

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Tracheoesophageal diversion was established by Lindeman in 1975 as a surgical management technique for intractable aspiration. This technique is as follows : The trachea is divided between the third and fourth tracheal ring; after that, end-to-side anastomosis between the proximal trachea and cervical esophagus is performed, and the distal trachea is brought out as a tracheostoma.
This technique is reliable, less invasive and is a reversible procedure for reconstruction.
A case who can speak after this surgery is reported.

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