岩田 義弘

正常嚥下において輪状甲状関節の存在意義を検討するため正常成人10名(平均年齢32歳:23〜45歳)を対象に超音波画像装置で甲状軟骨、輪状軟骨の運動を観察検討した。超音波画像診断装置のプローブと頸部の間に柔らかいキテコを間に挟んで観測した。甲状軟骨、輪状軟骨は鮮明に観察可能であった。安静呼吸時、喉頭挙上直前、喉頭が挙上、さらに下降開始の状態が観察できた。輪状甲状間は安静呼吸時には変化しなかった。空嚥下直前に輪状甲状軟骨間は安静時の平均19.0%の開大が見られた。喉頭鏡上から下降に移行する時、輪状甲状間は67.0%に短縮した。下降が開始すると輪状甲状間は65.0%に短縮し10例中5例に前後の滑走を認めた。甲状輪状間の開大は輪状甲状筋の弛緩と披裂喉頭蓋筋の収縮が関与していることが疑われた。嚥下初期に輪状甲状間が広がることは喉頭挙助直前に下咽頭食道入口部が広がることになり誤嚥を起こしにくぐする機構の1つと考えられた。(著者抄録)

頸動脈再建を要した頸動脈小体腫瘍の1例を経験したので報告した。症例は、57歳の男性で左頸部腫脹が主訴であった。術前診断には造影CT検査が有用であり、Balloon Matas testは、頸動脈血行遮断の判定に有用であった。手術前日に栄養血管の塞栓術を行ったが、術中出血量の軽減に有用であった。人工血管で頸動脈の再建を行ったが、術後合併症なく経過良好である。(著者抄録)

Anterior nasal atresia is a relatively rare condition that may cause airway obstruction. An 8-week-old newborn male with bilateral anterior nasal bony atresia was treated surgically via a sublabial approach. The stenotic bony apertures were widened using a surgical drill and tracheal tubes (I. D. 3.0mm) were placed in each nasal cavity for 4 weeks.<br>Three years after the operation, no recurrence was found. Fifty cases of anterior nasal atresia, including our case, have been reported in Japan. Only one case of bony stenosis was reported in 1938, and we believe that our patient is the second reported case of anterior nasal bony atresia in Japan.

The electroglottogram (EGG) has been used to obtain details of vocal fold vibration. Applications of the EGG, however, are limited in use for voice disorders since characteristics of EGG waveforms associated with vocal fold vibrations are still poorly understood. We analysed the EGG waveform characteristics to compare them with simultaneous measurements of supra and subglottic pressure in the normal male subject sustaining the vowel /a/ at constant pitch with different intensity levels. The results are : The periodicities of the consequent frequency are completely coincident among the EGG wave, supra and subglottic pressure waveforms at different intensity levels. With regard to the amplitude variations of the EGG waveform in the vocal cycle, the increasing amplitude corresponded with a rapid increase of subglottic pressure and a decrease of supraglottic pressure which is indicative of the closing phase of the vocal folds. The gradual fall of amplitude associated with the parting of the vocal folds corresponded with an increase of supraglottic pressure from negative values and maintenance of negative subglottic pressure. The negative flatter portion of EGG wave corresponding to the opened phase exhibited higher positive supra glottal pressure and lower pressure of the subglottic even at different sound pressure levels. When increasing the intensity during constant pitch phonation, the values of the contact quotient and contact speed index decreased, and the contact closing slope became steeper.These findings reveal the tendency of increasing vocal tension following louder vocalization. Simultaneous measurement of EGG waveforms, and supraglottic and subglottic pressures might provide useful and detailed information for understanding EGG waveforms, laryngeal dysfunction and/or research for voice disorders.

A patient who developed toxic shock syndrome (TSS) following sinus surgery is described. A 22-year-old male complaining of pyrexia (39°C), general fatigue, watery diarrhea, nausea, muscle soreness and sore throat was admitted as an emargency patient to one of our infirmaries 19 days after sinus surgery had been performed at another hospital. Hypotension with a systolic blood pressure of 80 mmHg and erythroderma on his palm and sole were noted. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in pus secreted from the right nasal cavity. Appropriate hydration, antibiotics and local clearance of the infection was applied in the management of the TSS. Good prognosis ensued without γ-globulin therapy. TSS should currently be con-sidered as an important complication of nasal surgery.

In our clinic, laryngo-micro surgery under general anesthesia with endotracheal intuba- tion or neurolept analgesia without intubation (NLA) have been commonly practiced for the surgical treatment of voice disorders due to polyps or polypoid degeneration of the vocal cords. Here we report the differences in postoperative phonatory functions caused by anesthesia with/without intubation. Laryngo-micro surgery (under anesthesia with intubation: 17, NLA : 14) was performed on 31 cases (16 polypoid, 15 polyps). After operation, the maximum phonation time (sec), air flow rate (ml/sec), pitch (Hz), pitch perturbation quotient (%), amplitude perturbation quotient (%), and normalized noise energy (dB) were obtained using a phonatory device PS-77 and an acoustic analyser SH-10. No significant differences were observed between the phonatory parameters in the NLA group and those in the intubation group. However, in the phonatory parameters of the NLA group, there were more normalized mean values and smaller standard variations than in the intubation group. From these results, we conclude that laryngo-micro surgery under NLA has the advantage of producing a stable postoperative phonatory effect, since it provides a good chance to observe the vocal cords' vibrations and to make an acoustic evaluation of the voice in the course of an operation.