A fully reliable means of rehabilitating patients with bilateral vocal cord paralysis has not yet been developed. In order to improve upon existing solutions to this problem, the authors have recently described a laryngeal pacemaker, initially tested through stimulation of a cross-over nerve-muscle pedicle from one sternohyoid muscle to the other in the canine. Afferent stimuli, initiated through elongation of the airway during inspiration, were detected by a linear strain gauge sutured to the tracheal rings and appropriately amplified. The current report deals with the application of this concept to pace a nerve-muscle pedicle reinnervating the posterior cricoarytenoid muscle. Videoscopic and cinematographic documentation of electrically paced abduction of the reinnervated vocal fold, synchronous with inspiration, was clearly demonstrated. Only miniaturization of an implantable electronic amplifier remains to permit an attempt at pacing of the paralyzed larynx in humans.

To determine the varied causes of oropharyngeal dysphagia and their respective pathophysiology, a working understanding of the normal anatomy and function of the highly integrated mechanism of swallowing is outlined. This information is presented as the basis for a reasoned and detailed approach to the history, physical examination, and endoscopic evaluation of normal and altered oropharyngeal swallowing. The management of swallowing disorders depends on the nature and magnitude of the responsible clinical condition. Conservative and surgical approaches are discussed. These modalities and their indications are described in detail.

\s=b\A neonate had respiratory distress caused by a parapharyngeal space tumor composed of glial tissue. This entity is rare and may be difficult to diagnose. The origin of glial tissue in the neck is not well understood, since no anatomical extension has been shown. (Arch Otolaryngol 1981;107:638-641) Only ten cases of glial tissue in the parapharyngeal space have been reported in the English literature.This fact makes this condition much rarer than its nasal counterpart (more than 100 published cases). The present report stresses the importance of the early signs of pharyngeal compres¬ sion. Not only can these masses pro¬ duce difficult diagnostic problems, but their origin remains uncertain. REPORT OF A CASEA female infant was the second fraternal twin of a 27-year-old primagravid mother who had an uneventful full-term pregnan¬ cy, except for premature rupture of the membranes 2Vè days before delivery. The infant's birth weight was 1,700 g, and the gestational age was estimated to be 34 weeks. The Apgar score was 7, and although no resuscitation was required, the patient received oxygen because of poor color that subsequently improved. The results of the initial physical examination, including the head, neck, and throat, were considered to be normal.Shortly after birth, severe respiratory distress developed in the patient; this was thought to be caused by bilateral pneumothoraces and required the placement of chest tubes. At the age of 3 weeks, the patient was gradually weaned off contin¬ uous positive airway pressure and oxygen and was starting to gain weight, when spells of bradycardia developed. Chest roentgenograms and ECGs were normal. Two months later, the infant had an upper airway obstruction that was relieved by the placement of an oral airway. Physical examination disclosed a mass measuring 2.5 x 1.5 cm in the left anterior triangle of the neck. The mass was soft, mobile, nontender, and nonpulsating. The overlying skin was mobile and of normal color. There was also a suggestion of a soft mass in the left side of the palate. The jaw was thought to be hypoplastic, and a relative macroglossia was noted. Results of endoscopie exam¬ ination were normal. At the age of 4 months, the infant could breathe adequate¬ ly without an oral tube, gained more weight, and was discharged with a working diagnosis of Pierre Robin syndrome.During the following ten months, there were a series of readmissions for poor feeding, failure to thrive, and occasional cyanotic spells. At the age of 14 months, the infant was irritable and wasted with a weight of 4,000 g, placing her in the third percentile. A general physical examination disclosed noisy respiratory sounds, right ventricular hypertrophy, and hepatosplenomegaly. The ear, nose, and throat exam¬ ination showed a small jaw with a higharched palate, a large tongue, and a devia¬ tion of the uvula toward the right by a mass in the parapharyngeal space. Chest roentgenograms showed pulmonary con¬ gestion, and neck films demonstrated that the pharyngeal air column would not...

Based on the first two patients, paced laryngotracheal separation is clinically effective in controlling aspiration.