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In order to avoid direct damage to the teeth by a laryngoscope a prosthesis was devised. The prosthesis was made from polyester resin with thermo-plasticity following a model of the dental arch in each patient. Thus, the prosthesis perfectly fitted the dental arch of each patient and did not disturb the scopic view during laryngomicrosurgery.

A case of a large epiglottic cyst is reported. The patient was a 79-year-old man who complained of an abnormal sensation in the larynx during phonation. On examination, he was found to have a massive epiglottic cyst arising from the lingual surface of the epiglottis, displacing it in a posteroinferior direction and almost totally occluding the pharynx. No view of the larynx could be obtained indirectly. The huge cystic mass was an obstacle to conventional intubation for general anesthesia. An endoscopically guided nasal intubation was therefore undertaken using a fiber-optic laryngoscope. The fiber optic laryngoscope was easily maneuvered past the cyst and an anesthetic tube railroaded through the larynx. The cyst was removed using a tonsillectomy snare under direct laryngoscopic observation.Histopathological examination revealed a lymphoepithelial cyst, whose walls were lined by stratified squamous epithelium accompanied by abundant lymphoid tissue.

The present study indicates that conservative therapy should be chosen initially and repeated operation is not recommended. were adults with the age ranged from 20 to 81 years. The ratio of male to female was 2.6: 1.The majority of the patients had a sore throat, odynophagia and dysphagia with mild to severe fever. Some patients complained of dyspnea increased in the supine position and decreased in the sitting position, suggesting that a swollen epiglottis dropped down backwards to obstruct the laryngeal orifice in the supine position. This kind of dyspnea is a characteristic symptom in acute epiglottitis.Tracheotomy was performed in two and tracheal intubation in one, and no death occurred.Lateral neck roentgenograms were obtained in 16 cases in the course of acute epiglottitis.The diagnosis of the disease was roentgenographically confirmed in 81 per cent of the cases, but in each case the diagnosis had been made initially by indirect laryngoscopy. The intervals between the onset of symptoms and doctor contact and hospitalization were within 7 days.Antibiotic therapy was done in most cases. Most signs and symptoms resolved in three to five days, with a dramatic decrease in pain and dysphagia within 24 hours.Epiglottic swelling resolved in seven to eleven days and 70 per cent of the cases were discharged within that time.

The authors have questionnaired 67 ENT practitioners in Tochigi prefecture on acute epiglottitis. Several interesting answers have been obtained.Almost a half of doctors have had an impression that incidence of this disease gradually decreased in recent years.Eleven per cent of doctors have pointed out that acute epiglottitis occurred more frequently in children than adults. This tendency is noted in U.S.A. and often European countries. However, previous several reports in Japan have indicated that the disease more frequently affects adults than children.All the doctors (100%) have made a diagnosis of acute epiglottitis by indirect and/or direct laryngoscope, with reference to several characteristic symptoms of the disease.The majority of doctors have not regarded an incision of the edematously swollen epiglottis as the first choice of the surgical treatment. Penicillins and/or cephems have been most commonly used in cases.Some doctors have encountered the patients who died because of airway obstruction in the course of the desease.

Cervical periesophageal abscess is one of the complications of foreign bodies in the cervical esophagus. A case of dysphagia due to traumatic cervical periesophageal abscess is reported. The patient was a 58-year-old female who had complained of dysphagia and a foreign body sensation in the larynx for approximately 2 days after a piece of large fish bone was ingested inadvertently. Roentogenological examination revealed a marked thickening of the periesophageal region caused by submucosal emphysema and abscess. Clinical symptoms and roentogenological reviews confirmed the diagnosis. Therefore, the abscess was widely opened by the lateral cervical incision, but no foreign body was found. The submucosal emphysema was supposedly caused by active mobility of the foreign body and the abscess occurred by secondary infection. The main cause of dysphagia was the mechanical obstruction by emphysema and abscess, disturbing the passage of bolus and the elevation of the larynx.

Cryosurgery is gaining more and more importance as a therapeutic modality within the field of head and neck surgery.Cryosurgery was performed in two patients with hemangioma arising from the entrance of the esophagus.Case 1: A 41-year-old woman was referred for the diagnosis of hemangioma in the entrance of the esophagus which had been present for approximately five years. The patient felt slight pain on deglutition and sometimes noticed hemoptysis. The lesion was treated with cryoapplication of -60°C on its surface through the direct laryngoscope under general anesthesia. Cryoapplications were repeated by overlapping frozen areas during treatment. The duration of the individual freezing cycles ranged from one and half to three minutes. Over a period of 3 weeks the patient received 2 cryosurgical treatments. Postoperative healing was uneventful. After 3 weeks following 2nd cryosurgery the lesion disappeared without leaving a remarkable scar. No recurrence was noted after one-year follow-up.Case 2: A 54-year-old man was admitted to the hospital with a history of foreign body sensation in the throat. Endoscopic examination revealed a dark, blue swelling in the entrance of the esophagus, suggesting a hemangioma. The lesion was frozen in three applications of -60°C each time. The frozen region was overlapped to compass the entire tumor. After thawing the frozen areas began to swell. In 24 hours it was almost twice of its original size. Then the necrotic tissue was well demarcated from vital tissue and on the seventh postoperative day the brownish lump exfoliated and showed a persistent smaller tumor. Total regression of the hemangioma and overgrowth of normal mucosa followed with a satisfactory functional result. No further growth was observed after six-month follow-up.The general treatment of the hemangioma in the larynx, hypopharynx and esophagus was briefly discussed.

A case of dysphagia due to traumatic cervical emphysema is reported. The patient was a 51-year-old female who had complained of a foreign body sensation in the throat. She thought that she might have pharyngeal cancer. She occasionally found a firm mass in the lateral region of the pharynx (this was actually a lateral pharyngeal band). She tried to remove it by an iron needle stick. The patient noticed cervical swelling after repeated swallowing action.Roentgenographic examination revealed a marked thickness of the posterior wall of the hypopharynx due to submucosal emphysema. Submucosal emphysema disturbed mechanically the elevation of the larynx and the movement of the epiglottis. Thus, the bolus of food was easily aspirated into the tracheal lumen.Cervical emphysema disappeared in approximately 2 weeks after the injury of the pharynx without any intensive antibiotic therapy.

A case of dysphagia with acute onset due to polyneuritis cranialis is reported.The patient was a 29-year-old female who had complained of dysphagia and hoarseness for approximately two weeks following common cold.Clinical symptoms of dysphagia, right soft palate paralysis, right vocal cord paralysis and right accessorius cranial nerve paralysis commenced in two weeks after upper respiratory infection possibly by virus. Clinical diagnosis was made of dysphagia with sudden onset due to polyneuritis cranialis on the basis of the following findings:1) The onset of symptoms (C2-3) was rather abrupt following upper respiratory infection.2) The paralysis of right IX N. glossopharyngeus, X N. vagus and XI N. accessorius was present.3) Initial clinical symptoms disappeared in 40 days under therapeutic regimen of Vitamin B1, B12, corticosteroid and antibiotic administration.4) The paralysis of right VII N. facialis and XII N. hypoglossus occurred in 4 months after disappearance of initial symptoms.5) The paralysis of VII N. facialis disappeared in 2 months under the same therapeutic regimen as applied for initial clinical symptoms. However, XII N. hypoglossus remains paralyzed.

A recurrent case of Forestier's disease in a 65-year-old female is reported. The patient complained of dyspnea and dysphagia at the age of 58 years. She was diagnosed as Forestier's disease after the X-ray examination of the spine. The cervical roentgenogram revealed bony proliferation of anterior margin from C3 to C6 and ossification of posterior longitudinal ligament from the level of C6 to C7 It was considered that the symptoms was caused by stenosis of the pharynx and cervical esophagus due to the pressure by bony proliferation.The symptoms were diminished by resection of the bony proliferation. Three years after, however, the symptoms recurred and the cervical roentgenogram showed bony proliferation from C3 to C6. Re-resection was performed 7 years after the first resection and the symptoms were lessened, again.Literatures on the pathogenesis, diagnosis and treatments for Forestier's disease were reviewd. In this review we found many reports about dysphagia due to Forestier's disease but a few about dyspnea. More over in the surveyed literatures, there was no case report in which re-resection of bony proliferation was performed for a treatment of Forestier's disease.