咽喉頭部異常感の成立機序について

THE MECHANISM OF THE PRESENCE OF ABNORMAL SENSATION IN THE LARYNGEAL REGION

　Ⅰ．はしがき

　咽，喉，食道部の異常感が局所の異常（鼻咽の炎症，奇形，喉頭の浮腫，潰瘍，奇形，頸椎異常，食道の炎症，浮腫，悪性腫瘍，気管の炎症など）全身性疾患（心臓疾患，貧血症，内分泌異常など）からあるいは心因性（情緒的ストレスによる）に発来することは諸家により述べられているところであり，その成立に関しても多くは自律神経と関係ありとは述べられているが，この詳細な神経反射経路については発表されていない。私は咽頭，喉頭，食道の自律神経分布の知覚線維を詳述し，ほとんどすべての場合に主役をなすこれら自律神経がいかなる途を経て異常感成立に至るかを解明したいと思う。

　It has been well known that the abnormal sensation, that may occur in the laryngeal region due to organic disease of the larynx, pharynx, esophagus or in general, or psychosomatic disturbances, is related to a state of disharmony in the function of the autonomic nerves. I wish to elucidate this mechanism more in a detail.

　As regards the sensory nerve, the plexus pharyngeus interwoven in the fibrous tissues of the mucous membrane of the pharynx, larynx and esophagus is composed of glossopharyngeal, sympathetic and vagus fibers;fibers from the trigeminal nerve communicate with the plexus pharyngeus.

　Stimulation of the sensory fibers of the autonomic nerve in the epithelium, as illustrated in the figures, causes the stimuli to be transmitted to the center of the medulla oblongata, and then after crossing one part the secondary neuron of the lemniscus medians, and the other part, the tegmen to arrive at the nucleus ventralis in the thalamus ; the third tract reaches the cortical sensory center through the crus posterius capsulae internae.

　The stimuli which traverse the trigeminal sensory fiber reach the trigeminal ganglion, the center of the medulla in the pons in succession, and after crossing by. decussation ascend up the medial lemniscus to the thalamic nucleus and, finally, arrive at the cortical sensory center, as shown in the figure.

　In psychosomatic diseases, on the other hand, the irritation that occurs in the center of emotion in the limbic system stimulates the center of the autonomic nerve in the hypothalamus, which then travels through the vasomotor center and reach the peripheral nervous system in a descending order, as it is also illustrated in the figure.