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The author previously reported three cases of tracheal stenosis caused by prolonged intubation using cuffed tracheal tubes and cannulas. These patients were cured completely by repeated removals and electro-coagulation of granulation tissues under endoscopy.This paper presents additional three cases, which were successfully treated by different conservative manipulations. In one case, a long-term intubation of a microporous EPTFE tube was applied to the Stenotic portion of the mediastinal trachea. In the other two cases, a T-shaped silicone tube was used. These manipulations are safe and applicable even with the patient in a serious condition, The author claims that tracheal stenosis can be treated more successfully and easily by conservative manipulations.

Four patients who developed dyspnea after prolonged endotracheal intubation were referred from the thoracic surgery department.They had been controlled their respiration under prolonged intubation after surgery.In three cases, endotracheal granuloma at the site of the pressured cuffs were successfully removed and cauterized endoscopically.In the fourth patient, who resisted the above treatment, a teflon tube was inserted into the trachea in order to keep the air-way patent. This patient has been tolerating the intubation for about sixteen months without any dyspneic spells.

Nine cases of nonspecific granuloma of the larynx were examined and treated by the Department of Otolaryngology, University of Tokyo, between the years 1973 and 1976.All of the granuloma were confined to the unilateral posterior vocal cord; seven were sited at the right side and two were at the left. This site predominance was not in accord with most reported series saying the predominance of the left side.There was a significant preponderance of males over females (7 to 2). Age range was from 35 to 68 with a mean age of 46.7 and majority of cases appearing in the fourth decade.Hoarseness was the most common symptom occurring in six patients (67%), the next was sore throat. The patient waited an average of 13.6 months after symptoms began before visiting us.There seemed to be some etiologic factors other than the minor trauma based on “the hammer and the anvil” theory by Jackson. Any minor trauma causing the damage of mucosal surface might induce granuloma formation.Resection by cup forceps under direct laryngoscopy was mandatory. If recurred, electrocautery under microscope following it was the treatment of choice, and the effective results were obtained.

1. Flow-Volume loops of lesions in the trachea and larynx showed decrease of peak expira tory flow (plateau formation). In tracheal stenosis, F-V loops showed much more decrease than in laryngeal stenosis.2. The values of forced expiratory volume in one second were relatively well preserved both in laryngeal and tracheal obstruction.3. In bilateral immobilization of the vocal cords, cases with the value of peak expiratory flow less than 50% of normal complained marked dyspnea subjectively. The value of 50% was thought to be one of the indicators for surgical treatments.4. Flow-Volume loop method was simple and effective for evaluating the site and nature of major air way stenosis and for evaluating surgical results.

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.

A case of successful reconstruction of the cervical trachea was reported. A 33-year-old male was involved in traffic accident and suffered damage to his cervical trachea. Annular excision of the stenotic trachea and end-to-end anastomosis was performed. Mobilization of the lower trachea at the upper mediastinum was done by splitting the sternal manubrium. Laryngeal release technique was not used. Procedures and advantages of this surgery were discussed.

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.

Bronchial anomaly of trachea-bronchial trees is rather rare. Cases, however, have been reported these days after newly developed intruments are devised, with master of bronchography technique.33 years old female, complaining of productive cough was bronchoscoped and right upper lobe bronchus was found to be originating from trachea. This was confirmed by bronchogram.55 years old female, with cough & hemosputa was found to have bronchial anomaly and bifurcation rather irregular in its divisin.Cases were reviewed with recent available literaturs pathology was discussed.

Remarkable morphological changes of the fiber arrangement was observed in the middle lamina propria of the pathological human tympanic membranes. These changes were present mainly in the middle zone of the pars tensa. There were several fibers running in entirely different directions among the regularly arranged radial and circular fibers. These abnormal fibers had a tendency of forming fiber bundles of varying sizes and lengths. It is stressed that the normal fiber arrangement was undoubtedly disordered in the healing process of the inflamed middle lamina propria of the human tympanic membrane.

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.

Two cases of Tracheal tumor are presented.47 year old male, complaining of intermittent dyspnea getting worse past 6 months, was admitted for removal of the tumor from tracheal wall.Under local anesthesia, patient was placed in supine position, and the Tracheotomy was carried out on 3rd through 6th tracheal Ring.The tumor which was well pedunculated was removed from posterior wall of trachea, and electrocautery was applied at steeled area.Tumor was proved to be adenoid cystic carcinoma histologically. The incision was well closed in usual maneuver.54 year old male was admitted to the Department of Chest Surgery on emergency base of acute dyspnea.Patient had had intermittent dyspnea past 1 year.Patient was prepared in same manner as former patient was done. The tumor, arising from right lateral wall, was removed without any disturbance of Respiration in quick procedure.Recurrence was noted 3 months after operation, and the patient is ready for resection of trachea.Literatures were reviewed together and the management of rescue of airway problems was discussed.

160 seamen, including 73 deckmen, 62 engineers and 25 others were investigated clinically.Advanced chronic inflammation of pharyngeal mucous membrane was visualized in 88.8% of all engineers, 67.2% of all deckmen and 72.0% of other members.Laryngeal mucosa was found to be rather pathological, erythematous, edematous and polypoid in 63% of engineers, 40% of deckmen and 32% of other crews.More or less same data were obtained concerning the tracheal mucous membrane.On the other hand, there was no distinct difference among thee groups, concerning the nasal mucous membrane.There seem to be short acting reversible irritation to the upper respiratory mucous membrane of deckmen and rather long acting irreversible irritation to that of engineers.The ventilation of the engine room should be mostly improved to get rid of the engineers' complains.Another interesting thing was found, that the deckmen are apt to catch cold during their vacation and off the ship, and engineers are so during their on duty in engine room.

So far, iatrogenic foreign bodies were somewhat hesitated to report in medical journals. Recently, following cases of iatrogenic foreign bodies in air passage were seen in our clinic; adenoid mass, a piece of a fractured metal stylet, an injection needle, tooth, a damaged electric bulb for bronchoscopic illumination and a cotton ball. These foreign bodies seem to be unpredictable to occur. Intense precaution during surgery by physicians involved in upper air way (otolaryngologists, anesthesiologists, dentists, chest surgeons etc) and constant inspection of medical instruments by operation room staffs could avoid these unhappy accidents.

The efferent nervous system of the guinea pig inner ear is histochemically investigated. Remarkable activity of alkaline phosphatase and acetylcholinesterase is demonstrated by Burstone's (1958) azo dye method and Koelle's (1949) method as modified by Gomori (1952) respectively. The distribution pattern of both enzymes in the efferent nervous system is entirely similar. The intraganglionic spiral bundles, fascicles of the osseous spiral lamina and efferent plexus of the organ of Corti reacted intensely for both enzymes. Afferent nerve fibers give no histochemical reaction for both alkaline phosphatase and acetylcholinesterase. However, spiral and vestibular ganglion cells are rich in both enzymes, though they belong to the afferent nervous system. The significance of both enzymes in the nervous system of the guinea pig inner ear is briefly discussed.

A new system for observation and recording of the laryngeal view has been attained by use of a mcdified oblique-angled type telescope conbined with a powerful light source. The scope can be connected to an ordinary 35mm camera with a motor-drive device, a 16mm cine-camera, or a video-TV camera.The laryngeal view through the new scope is quite similar with that obtained by an indirect laryngoscopy. The oblique view angle is 70° for better visualization of the area near the anterior commissure of the vocal folds. We could obtain a clear picture of the laryngeal patholgy even in a 5 y-o child without any difficulty. For still photos a slide-type film (ASA 100) was used with no pushing and successful pictures were obtained in full-size.It was considerd that our tystem is usefull not only for clinical but also for educational purposes.