[The benefit of head rotation on pharyngoesophageal dysphagia from three cases of paraganglioma in the parapharyngeal space].

The benefit of head rotation to the affected side is indicated during swallowing in patients complaining of dysphagia with unilateral pharyngeal palsy and/or laryngeal palsy. We experienced three cases of severe dysphagia after operations for giant paragangliomas (two vagal paraganglioma and one carotid body tumor) in the parapharyngeal space. During operation, the transmandibular transpterygoid approaches were applied to ensure better surgical views, and tracheostomy was performed to keep the airway open after operation. In each case, dysphagia during the pharyngeal stage of swallowing was significantly improved with rehabilitation using of this head rotation. We believe that rather than forbid oral intake, using an active bolus with head rotation is important for cases where dysphagia in the pharyngeal stage of swallowing is present with unilateral pharyngeal and/or laryngeal palsy. Repetitive swallowing exercises are important to reacquire the complicated movement of swallowing. Additionally, an active bolus flowing into the pyriform sinus on the healthy side will prevent a relaxation disorder of the cricopharyngeal muscle on that side. Furthermore, compensatory movement of the arytenoid on the healthy side improves dysphagia. We emphasize the usefulness of head rotation during swallowing rehabilitation for dysphagia with unilateral pharyngeal and/or laryngeal palsy in spite of its simplicity.

[A consideration of determining the removal or retention of teeth in the patient with a few remained teeth].

The alveolar bone of edentulous ridge is resorbed after the teeth extraction and the subsequent denture insertion. For the periodontal structure, the stress transmitted along the longitudinal axis is favorable, but the horizontal stress is destructive. Under the overdenture application which the retained teeth have the reduced clinical crown, it is possible to prevent the alveolar bone resorption and to improve the involved teeth. However it is difficult for the inclined teeth to get the successful results. In a case, having a few remained teeth contained the embedded root stump and the overdenture being applicated, we obtained the suggestion as follows. 1. Also the embedded root stump is useful to prevent the alveolar bone resorption. 2. The top and direction of longitudinal axes of the inclined abutment teeth can be determined by means of surveying the least teeth movement when the stress was applied to the teeth by the fingers with dental pincette. 3. Also to the inclined abutment teeth, it is possible to transmit the stress along the longitudinal axes, when the overdenture has the contact with the short dome coping at the top and in the inferior area to the longitudinal axes inclined, and is relieved in the superior area to its axes.