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Background:  Adenocarcinoma, not otherwise specified (ANOS), is a malignant salivary gland tumor that exhibits ductal differentiation but lacks any of the histomorphological features that characterize the other defined types of salivary carcinoma. Case presentation:  This article describes a case of ANOS of the buccal mucosa rapidly metastasizing to the right lung and frontal lobe of brain. Conclusion:  Even though metastatic adenocarcinomas in the oral cavity from other primary sites are a common inclusion among the metastatic tumor of oral cavity, the distant metastasis from an ANOS is a rare finding.

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INTRODUCTION:Tracheostomy is a common procedure performed in critically ill ventilator-dependent patients to provide long-term airway access. About 10% of the ICU patients require prolonged mechanical ventilation and hence a tracheostomy is needed. Early bedside tracheostomy in such patients reduces the length of stay in ICU and number of days on ventilator by facilitating weaning. AIMS AND OBJECTIVES: This prospective clinical study aims to study the results of early versus late Tracheotomy in critically ill patients of ICU and other Emergency wards. This study also aims to observe and analyze the outcomes of bedside open tracheostomy, in relation to its safety, complications, and duration of hospital stay; mortality and problems of decannulations. MATERIALS AND METHODS:This is a prospective study done in Govt. Medical College, Calicut from Jan 2013 to June 2014 and includes all the patients in ICU's and wards who underwent bedside tracheostomy by open surgical method during the study period. Results: The study sample consisted of 60 patients in the age group of 15-75 years. 41(68%) males and 19(32%) females. The main indication for tracheostomy is prolonged ventilation (90%). Patients with head Injury fared better than with neurological diseases in our study, with a statistical significance. (P value-0.02).Mortality is 53.33%. One patient died directly as a result of the procedure. Remaining patients recovered from primary disease and decannulated. There was significant relationship between early tracheostomy with early weaning, early decannulations and shorter ICU and overall hospital stay (P value <0.05). All complications were managed conservatively without any sequelae. CONCLUSION: Operative complications of bedside tracheostomy are less. Most of these develop in the first week and can be managed without morbidity. Majority of deaths in our study are related to the primary disease rather than the procedure. There was no significant relationship between timing of tracheostomy with laryngotracheal stenosis and overall mortality.