Transoral epiglottis resection or partial supraglottic resection was done with the CO2 laser in 20 highly selected patients. Visualization was best accomplished using the Lynch suspension system, but was satisfactory with the Jako-Pilling laryngoscope. The best indications for this procedure were: 1. for visualization of the true vocal cords in previously treated cancer patients whose epiglottis obstructed indirect mirror examination, 2. for removal of obstructing benign epiglottic lesions, 3. as an excisional biopsy in limited epiglottic cancer, especially of the suprahyoid epiglottis. No major complications or operative morbidity occurred. This approach obviated the potential morbidity of external surgical procedures In a select group of patients. Shortened hospitalization, avoidance of tracheotomy, minimal postoperative discomfort and edema, and excellent wound healing were additional advantages seen.

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Patients with head and neck cancer frequently suffer from chronic obstructive pulmonary disease and arteriosclerotic cardiovascular disease, making them poor risks for anesthesia. Arrhythmogenic inhalation anesthetics along with assisted ventilation used in general anesthesia further complicate the intraoperative, as well as the postoperative, course. Cervical epidural anesthesia has been employed in a number of cases of breast and upper thoracic surgery at Walter Reed Army Medical Center with remarkable success. It has also been used in chronic pain control. We described the use of cervical epidural anesthesia for a neck dissection. The technique of placing 0.5% Marcaine® at the level of C7‐T1 is described. Indications, limitations, complications, and the potential uses of cervical epidural anesthesia in head and neck cancer patients are discussed.

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