If the posterior part of the upper esophageal sphincter (UES) were to lag behind due to the presence of dense tissue strands between the sphincter and the prevertebral ligament, as suggested in the literature, it would be impossible to use the larynx as a radiographic indicator of the location of the UES at intraluminal pressure measurements. The goal of this investigation was to study UES behavior during induced movements in autopsy specimens and to search for dense fibrous strands between the UES and the prevertebral fascia. Histologic studies of frozen sections and paraffin sections showed a loose fatty tissue in the prevertebral space. There were no dense connective tissue strands. Autopsy specimens were used in experiments mimicking the laryngeal/UES elevation during swallowing. The results of this study indicate that the larynx and the UES move as one entity. When one is attempting to register the UES movement during swallowing, the laryngeal skeleton can therefore serve as a radiographic indicator of the UES movements.

Ketamine with adrenaline was used as a local anesthetic for the removal of naevi, dermatofibromas, and verrucae in a double-blind study. 1 Laser surgery was used in 10 and excision using a knife in 22 cases. The ketamine concentration employed varied between 12.5 and 20.0 mg/ml. The adrenaline concentration used was 10 microg/ml. The total doses of ketamine used per patient ranged from 12.5 to 30 mg. Anesthesia as tested using the pin prick, was obtained within 1 to 3 minutes after injection and lasted for up to 11 minutes. In all patients, the injection of ketamine caused some smarting that lasted for a few to 15 seconds. Erythema always was observed in the injection area and this observation broke the double-blind code. Extrapyramidal side-effects (light-headedness and dizziness) were reported by 18 (56.2%) of our patients. Conclusion: The use of ketamine as a local anesthetic is similar to the use of lidocaine even when the doses used are small. The only drawbacks of ketamine are its short duration and the high incidence of extrapyramidal sideeffects.