Scarring of the vocal folds can occur as the result of blunt laryngeal trauma or, more commonly, as the result of surgical, iatrogenic injury after excision or removal of vocal fold lesions. The scarring results in replacement of healthy tissue by fibrous tissue and can irrevocably alter vocal fold function and lead to a decreased or absent vocal fold mucosal wave. The assessment and treatment of persistent dysphonia in patients with vocal fold scarring presents both diagnostic and therapeutic challenges to the voice treatment team. The common causes of vocal fold scarring are described, and prevention of vocal fold injury during removal of vocal fold lesions is stressed. The anatomic and histologic basis for the subsequent alterations in voice production and contemporary modalities for clinical and objective assessment will be discussed. Treatment options will be reviewed, including nonsurgical treatment and voice therapy, collagen injection, fat augmentation, endoscopic laryngoplasty, and Silastic medialization.

Granular cell tumors have a predilection to occur in the head and neck. Thirty granular cell tumors have been diagnosed during the past 26 years at UCLA; 13 of which presented in the head and neck. Of these 13 cases, 10 were correctly diagnosed on the primary pathological specimen, which included one fine-needle aspirate and three frozen sections. Four cases required diagnostic confirmation with electron microscopy or histochemistry. The tongue accounted for more than one third of the cases. Three lesions exhibited locally aggressive behavior, but none of the tumors metastasized. Initial treatment was wide local excision in all but one case; recurrence was noted in two cases. Fine-needle aspiration can be used to provide preoperative diagnosis of granular cell tumors. Wide local excision with histologically confirmed clear margins provides definitive treatment.

\s=b\In chylous fistulas following radical neck dissections, we have found reexploration to be unrewarding, with infrequent identification of a specific leakage site intraoperatively and persistent fluid accumulation postoperatively. As an alternative, we injected tetracycline hydrochloride into the supraclavicular wound bed. This procedure resulted in a rapid, sustained decline in fistula output in two of three cases, avoiding surgical intervention. Tetracycline sclerotherapy has been described for treatment of intrathoracic and other intracavitary fluid collections. We believe that tetracycline sclerotherapy is an effective adjunct in the management of chylous fistulas following radical neck dissections and that this therapy should be attemptedbefore surgical reexploration.

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\s=b\ Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery. Ten consecutive cases of the clavicular osteomyelitis were reviewed at the over the past seven years. Six cases were associated with prior surgical procedures, and five cases presented as chronic wound drainage. One case was related to a pharyngocutaneous fistula following a supraglottic laryngectomy. Four patients presented with acute symptoms resulting from hematogenous spread, and two of the four patients had Staphylococcus aureus on blood cultures. Long-term intravenous antibiotic therapy (six to eight weeks) was used to successfully treat cases of hematogenously spread osteomyelitis. Wide surgical d\l=e'\bridementwas the mainstay of treatment in the chronic conditions, with antibiotic therapy having a secondary role. Myocutaneous flaps were required in two patients who had had surgery and antecedent radiotherapy. To conclude, the surgeon should be aware that osteomyelitis of the clavicle can occur as a complication of head and neck procedures. In addition, the treatment of the chronic form of clavicular osteomyelitis is surgical d\l=e'\bridementand possible flap reconstruction. 90024 (Dr Calcaterra). Clavicular osteomyelitis is a rare entity that poses a significant diagnostic and therapeutic challenge to the head and neck surgeon. Osteo¬ myelitis of the clavicle may result from either the hematogenous or con¬ tiguous spread of a bacterial infection. The latter is becoming more frequent¬ ly recognized, being associated with the increased use of subclavian punc¬ tures for central venous access and large extirpative head and neck proce¬ dures.1·2 Diagnosis of osteomyelitis associated with a draining sinus tract has led to the development of more sophisticated radionucleotide studies.3 Also, experiments indicate that many cases of osteomyelitis are best treated by surgical débridement and vascular¬ ized flap coverage of the resultant defect.4Advances in the diagnosis of clavic¬ ular osteomyelitis and both the anti¬ biotic and surgical treatment of the disease have had an influence on its current management. To assess the status of this disease at our institu¬ tion, the recent experience at the Uni¬ versity of California, Los Angeles Center for the Health Sciences, was reviewed. MATERIALS AND METHODSA retrospective chart analysis of all patients treated at our institution with the clinical diagnosis of clavicular osteomyeli¬ tis was performed. The study period cov¬ ered seven years, from 1980 to 1987. Ten patients were identified as having osteo¬ myelitis of the clavicle. Their charts were reviewed, and clinical data on microbacteriology, histopathology, radiographie studies, treatment, and follow-up were obtained. A case report is presented that demonstrates the use of vascularized mus¬ cle flaps in the treatment of clavicular osteomyelitis. REPORT OF A CASEA 69-year-old man presented to us with otalgia, dysphagia, and odynophagia and was found to have squamous cell carcino¬ ma of the left vallecula, w...