STUDIES ON THE NERVE INNERVATION OF THE LARYNX Part II The Influence of Nerve Interception to the Vocal Cord Muscle By D.H. LEE, M.D. From the Departm

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1 STUDIES ON THE NERVE INNERVATION OF THE LARYNX Part II The Influence of Nerve Interception to the Vocal Cord Muscle By D.H. LEE, M.D. From the Department of Oto-Rhino-Laryngology, Tokyo Medical College (Director: Prof. T. Shiroiwa) Experiments was conducted with 35 grown-up dogs to resect the superior and inferior laryngeal nerves on one side, and observations was made for a long period on the figure of the vocal cords. At the same time, histological changes in the intrinsic laryngeal muscles of the animals was thoroughly investigated, and the following conclusions were made. 1. From the experiments in resection in various parts of the main recurrent nerve, it was learned that, in the various parts resected, no difference was observed in the figure of the vocal cords after the resection. No change was noticed for six months in the position of the vocal cord on the side where the nerve was resected, and remained at all times in the paramedian position. Nor any movement was perceived in the vocal cord or in the arytenoid cartilage. As a histological 2. change in the intrinsic laryngeal muscles of a dog more than three weeks after the resection of the recurrent nerve on one side, very conspicuous atrophy was observed in the thyro-arytenoid muscle on the resected side. The fact has been recognized that the degree of atrophy declined in the order of the posterior crico-arytenoid muscle, and then the lateral cricoarytenoid muscle. No atrophy was noted in the anterior cricothyroid muscle, while slight atrophy appeared in the traverse part of the arytenoid muscle, not only on the resected side, but also on the side which was not resected. 3. In cases where more than three months had elapsed since the resection of the main recurrent nerve on one side, a compensatory movement on the normal side of the vocal cord was observed. 4. In a dog whose anterior branch of the recurrent nerve on one side had been resected, the vocal cord on the resected side had taken the paramedian position at the time of respiration. Anterior two-thirds of the glottis were opened spindleshaped at the time of phonation, showing the form of the vocal cord similar to the clinically so-called "internusparesis" Histologic ally, atrophy has been observed only in the thyro-arytenoid muscle. 5. In a dog whose inter-mediate branch of the recurrent nerve on one side was resected, the vocal cord on the resected side had taken the paramedian position at the time of respiration. Posterior onethird of the glottis on the resected side did not closed at the time of phonation, showing the form of the vocal cord similar to the clinically so-called " transversusparesis"histologically, conspicuous atrophy was seen in the posterior crico-arytenoid muscle alone. Hence, in the case of dogs, this form of vocal cords is considered to be the real post icusparesis" 6. In a dog whose posterior branch of the recurrent nerve was resected on one side, no intrinsic laryngeal muscle had showed atrophy. At the time of respiration, the vocal cord on the resected side was situated in the paramedian position, and higher than the opposite side, and therfore appeared to be shorter. So the vocal cord on the normal side looked slackened and paralyzed. At the time of phonation, both vocal cords closed together almost at the median line. 7. In the experiments of resection of both the internal and external branches of the superior laryngeal nerve, both vocal cords closed together, at the time of phonation, almost at the median line, " 10-32

2 and the movement of the arytenoid cartilage was normal. At the time of respiration, however, in the case of resection of the internal branch, slackening of the vocal cord on the normal side and of the slowness of movement was observed. In the case of resection of the external branch, slackening of the vocal cord on the resected side and of the movement was seen. Histologically, conspicuous atrophy was observed by the resection of the external branch in the anterior crico-thyroid muscle.

1) Arnold, G.E.: Vocal Rehabilitation of Para- Dysphonia. III. Present Concepts of Laryngeal lytic Paralysis, Arch. Otolaryng. 65: 317, 1957. 2) Arnold, G.E.: Vocal Rehabilitation of Paralytic Dysphonia.

11 1) Arnold, G.E.: Vocal Rehabilitation of Para- Dysphonia. III. Present Concepts of Laryngeal lytic Paralysis, Arch. Otolaryng. 65: 317, ) Arnold, G.E.: Vocal Rehabilitation of Paralytic Dysphonia. IV. Paralytic Dysphonia due to Unilateral Recurrent Nerve Paralysis, Arch. Otolaryng. 66: 284, ) Aronld, G.E.: Vocal Rehabi- of Paralytic Dysphonia. V. Vocal Sympto- litation matology of the Bilateral Loss of Abduction, Arch. Otolaryng. 70: 444, ) Arnold, G.E.: 10-42

Vocal Rehabilitation of Paralytic Dysphonia. X. Functional Results of Intrachordal Injection, Arch, Otolaryng. 78: 179, 1963. 5) Andersen, K.F. & Jensen, A.M.

12 Vocal Rehabilitation of Paralytic Dysphonia. X. Functional Results of Intrachordal Injection, Arch, Otolaryng. 78: 179, ) Andersen, K.F. & Jensen, A.M.: Unilateral Paralysis of the Superior Laryngeal Nerve, Acta Otolaryng. 57: 156, ) Brodnitz, F.S.: Goals, Results and Limitations of Vocal Rehabilitation, Arch. Otolaryng. 77: 148, ) Evoy, M.H.: Observations with Certain Experiments on the Paralyzed Vocal Cord in Dogs, Laryngoscope 70: 1268, ) Fernand, V.S. & Young, J.Z.: The Sizes of the Nerve Fibers of Muscle Nerves, Proc. Roy. Soc. B. 139: 38, ) Fateen, M.: Experiments on the Recurrent Laryngeal Nerve in the Dog, Acta Otolaryng. 50: 141, ) Ferreri, G. & Cerquiglini, S.: Photoelectrolaryngography and the Function of Vocal Cords, Acta Otolaryng. 50: 344, ) Jabonero, V.: Uber die Normale and pathologische Histologie der Innervation des Kehlkopfes, Z. Mikr. Anat. 64: 364, ) King, B.T. & Gregg, P.L.. An Anatomical Reason for the Various Behavior of Paralyzed Vocal Cores, Ann. Otol. Rhinol. & Laryng , ) Koizumi Hideo: On sensory Innervation of Larynx in Dog, 58: 199, ) Konig, W.F. & Leden, H.: The Peripheral Nervous System of the Human Larynx, Arch. Otolaryng. 74: 153, ) Lemere, F.: Innervation of the Larynx. I. Innervation of the Laryngeal Muscles, Am. J. Anat. 51 : 417, ) Lemere, F.: Innervation of the Larynx. III. Experimental Paralysis of the Laryngeal Nerve, Arch. Otolaryng. 18: 413, ) Lemere, F.: Innervation of the Larynx. IV. An Analysis of Semon's Law, Ann. Otol. & Laryngol. 43: 525, ) Leden, H. & Moose, P.: The Mechanics of the Cricoarytenoid Joint, Arch. Otolaryng. 73: 541, ) Multagh, J.A. & Campbell, C.J.: Respiratory Function of the Larynx. II. Elementary Physiology of the Recurrent Nerve, Ann. Otol. Rhinol. & Laryngol. 57: 465, ) Negus, V.: The Mechanism of Phonation, Ann. Otol. Rhinol. & Laryngol. 66: 817, ) Negus, V.: The Mechanism of the Larynx, Laryngoscope, 67: 961, ) Pressman, J. & Kelemen, G.: Physiology of the Larynx, Physiol. Rev. 35: 506, ) Ruedi, L.: Some observations on the Histology and Function of the Larynx, J. Laryng. & Otol. 73: 1, ) Williams, A. F.: The Recurrent Laryngeal Nerve and the Thyroid Gland, J. Laryng. & Otol. 68: 719, 1954, 25) Walsh, F.B.: Clinical Neuro- Ophthalmology, The Williams & Wilkins Co., Baltimore, 1957, 26) Williams, R.G.: Idiopathic Recurrent Laryngeal Nerve Paralysis, J. Larng. & Otol. 73: 161, 1959.

Title 泌尿器科領域に於ける17-Ketosteroidの研究 17-Ketosteroidの臨床的研究第 III 篇 : 尿 Author(s) 卜部, 敏入 Citation 泌尿器科紀要 (1958), 4(1): 3-31 Issue Date URL

Title 泌尿器科領域に於ける17-Ketosteroidの研究 17-Ketosteroidの臨床的研究第 III 篇 : 尿 Author(s) 卜部, 敏入 Citation 泌尿器科紀要 (1958), 4(1): 3-31 Issue Date 1958-01 URL http://hdl.handle.net/2433/111559 Right Type Departmental Bulletin