Various techniques for rehabilitation of voice after total or subtotal laryngectomy, e.g. reconstruc ive laryngectomy (Serafini, Staffieri, et al.), retrograde internal tracheo-esophageal shunt (Staffieri), tracheo-esophageal puncture (Singer) and our procedures were discussed and evaluated from a viewpoint of postoperative function. It is concluded that further studies will be needed in order to obtain a better function and respiration through the natural airway.
Laryngeal cancer has a better prognosis as compared with that of other cancers and the method of treatment has been virtually established. A recent trend in the treatment of laryngeal cancer is to emphasize the conservative treatment of laryngeal function and also improvement of treatment results has occurred. For a more objective selection of patients for the conservative treatment of laryngeal function, it is most essential to estimate properly the pathological extension of the tumor from the clinical findings. The author observed 100 patients with laryngeal cancer treated in the Departmentof Otorhinolaryngology, Tokyo Medical College, to determine various types of extension. Some findings were obtained concerning the downward extension and also to the vocal cord on the other side, which were very significant in selecting the method of treatment. Classification of 100 subjects according to the site of cancer resulted in 24 cases of supraglottic cancer, 69 cases of glottic cancer and 7 cases of subglottic cancer. In 40 cases, surgery was performed. Large sections were prepared for pathological examination. There were 11 cases of supraglottic cancer. It is well-known that supraglottic cancer rarely involves the subglottic region. With supraglottic cancer it is of ten difficult to clinically identif y the lower limit of the tumor. In two of our cases, the extension of cancer below the glottic region was revealed only of ter pathological examination. These were cases of submucosal extension beside the thyroid cartilage and it was difficult to determine the infiltration from observation of the mucosal surf ace. The limitation and fixation of arytenoid movements were observed in these two cases. Good or poor arytenoid movements in supraglottic cancer might suggest extension under the glottic region. A study of 24 cases of glottic cancer showed a parallel relationship between poor arytenoid movements and a deeply penetrating extension of cancer. Whether such extension is unilateral or bilateral is as significant in glottic cancer as arytenoid movements. There were two types of extension to the glottis on the other side: extension along the mucosal surface and also submucosal extension. In the latter mode, cancer develops along the thyroid cartilage and it was difficult to estimate this type from the observation of the mucosal surface. It was, however, considered that a comparison between clinical findings and pathological extension enabled prediction to a certain extent. Infiltration in the cartilage was observed in 11 of 40 cases. A comparison between clinica 1 findings and pathological extension revealed that infiltration in the cartilage was strongly suspected when the following clinical findings were observed: 1) supraglottic cancer extneding to the region below the glottic region, 2) advanced glottic cancer, 3) subglottic cancer with fixed arytenoid movements, and 4) cancer of the anterior commissure with ulceration. A study of the relationship between clinical findings and pathological extension in 100 cases of laryngeal cancer suggested that pathological extension could be relatively accurately understood by the detailed evaluation of clinical findings.
The cartilage was found in the tym nic membrane of 10 temporal bones (7 cases) out of 173 temporal bones (93 cases) from cadavers of children aged under 10 years. In the tympanic membrane the cartilage was noted in the connective tissue layer of the postero-superior quadrant of the tense portion, especially around its uppermost area. The age of 4 out of 7 cases was under 1 month. The cause of death was mostly congenital diseases. However, no abnormality was noted in the middle and inner ears except for the presence of the residual mesenchymal tissue in some parts of the middle ear cavity. Other parts of the tympanic membrane and the auditory ossicles were normally developed and appeared normal. The cartilage in the child tympanic membrane may be a remnant tissue in the developmental process of the malleus. The significance of the cartilage in the tympanic membrane was discussed from the viewpoint of embryology of the auditory ossicles and the tympanic membrane.
Meaurements of the pneumatization areas of the mastoid, as seen in radiographs, in 200 ears with otitis media with effusion and 128 ears of controls showed a tendency f or the pneumatization of the temporal bone in ears with otiitis media with effusion to be depressed when comparedwith those of the controls. Comprison of pneumatization areas of the temporal bone in ears with otitis media with effusion, between the time of tube insertion and 6 months of ter the procedure indicated a tendency where pneumatization of the mastoid improved during the intervals. It was surmized that the tympanostomy tubes improved the pneumatization of the temporalbone.
A 68-year-old woman visited us complaining of foreign body feeling in the pharynx and hoarseness. She received treatment with improvement and she was placed under our observation. Dyspnea developed and palpable mass was noted in the lef t anterior cervical area, f or which the initial operation (tracheotomy, left sided thyroidectomy and partial esophagectomy) was performed under suspicion of thyroidal carcinoma. At the time of operation infiltration had reached the esophagus, which obliged us to perform partial esophagectomy. However, the larynx was preserved because of a request to do so from the patient herself and her family. Her esophagus was successfully reconstructed by two stage method utilizing a Bakamjian DP flap. However, postoperatively stenosis became apt to occur, possibly due to preservation of the lrynx. Plastic operations such as skin graf ting for the stenosis caused cicatrization. About 4 years and 6 months later local recurrence occurred and the tumor was resected. However, another recurrence, a fist-size mass, developed in the left supraclavicular fossa at 4 years and 6 months later. At that time the tumorous mass was again resected. Since then she became cachectic and expired at 9 years and 10 months after the initial operation. This case appeared to us interesting in that laryngeal function of phonation and esophageal function of oral ingestion of food, were maintained up to the terminal stage despite that a total of 12 operations were performed during about 10 years period from the initial operation to death.
When the air in an inverted bell (A) falling into a water tank is discharged through a tube of least resistance, the pressure at the outlet is constant without reference to the changes of following objective resistances ®. In fact, however, the internal resistance of the apparatus is inevitable in greater flow. Then a cock (C) is placed midway on the tube and a pitot tube (B) is set closely to a nozzle attached to the naris, to read the total pressure at this point with a water manometer. While the air passes into the nose and nasopharynx and then out through the mouth, the cock is adjusted so as to fix the water column at 1 cm. in height. As the pressure drop (P1-P2) from inside the bell to the nozzle is constant, the closing angle of the cock is a function of the flow rate. The angle is also a direct index of the nasal resistance or time in seconds necessary for a liter of air to be forced out with the driving pressure of a 1 cm. water column (Fig.1). By means of this method, it was proved that resistance of the nasal cavity was between 3 to 5 seconds for sides, in 94 per cent of 100 normal nasal passages tested.
The author reports a rare case of submandibular salivary gland melanotic pigmentation in a patient with nevus of Ota. The 42-year-old man with nevus of Ota had suffered from sialolithiasis of the submandibular salivary gland. Resection of the submandibular salivary gland was done and melanotic pigmentation was found. Histopathological examination revealed the melanin not in the gland cell but in the interstitial connective tissue. Nevus of Ota usually affects areas innervated by the first and second divisions of the trigeminat nerve, but rarely those innervated by the third division. Involvement of the submandibular salivary gland is rare because the gland is innervated by the third division of the trigeminal nerve.