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Nasopharyngeal stenosis and oropharyngeal stenosis are rare and challenging problems in the pediatric population. The most common etiology is currently the surgical trauma associated with adenotonsillectomy. Stenosis can vary from a thin band to a complete obstructing cicatrix. Presenting symptoms range from mild hyponasal speech to severe airway obstruction. We present a series of eight children with varying degrees of stenosis and associated symptoms. Choice of treatment varied with the severity of disease. In our series, successful interventions included triamcinolone acetonide injection, lysis of adhesions, rotational and advancement mucosal flaps, and jejunal free flap. Preoperative evaluation and individualized surgical repair are essential for successful treatment.

Laryngotracheal trauma is rare and complications are frequent. Twelve major series totalling 392 cases have been published over the past decade, with complication rates as high as 40%. We have treated over 30,000 trauma victims at our Level I Trauma Center over the past 5 years, of which 109 had neck injuries, but only 12 suffered cervical laryngotracheal trauma. The mechanism of injury was penetrating in eight and blunt trauma in four. The time to tracheostomy decannulation varied from 7 to 60 days. Airway patency was assured without stenosis or significant granulation tissue in 10 of the 12 patients. Three patients suffered permanent voice changes. Based on review of the 392 previously reported cases and a critical analysis of our 12 cases, a detailed management algorithm is proposed.

\s=b\A retrospective search of the Duke University Melanoma Clinic patients identified 399 cases with primary malignant melanoma located in the head and neck region. Ninety-five percent of the deaths in this series were from metastatic melanoma. Various clinical and pathological data were examined and their effects on survivability and disease-free intervals were evaluated. The characteristics noted included sex, age, depth of the invasion, thickness, site of the lesion, histologic type, and nodal status. A multivariate regression analysis identified the following factors as having a negative effect on survival: nodular histologic type, scalp primary, increasing Clark level, and male sex. In comparing head and neck, extremity, and truncal primary sites, the median survival for patients with head and neck malignant melanomas was notably less. These differences correlated with a higher incidence for male patients, for patients with thicker lesions, and for patients with an increased frequency of nodular histologic type. (Arch Otolaryngol 1983;109:803-808) Management of malignant mela¬ noma has plagued physicians for centuries. Robert Carswell, MD,1 in 1834, is credited with the first clinical description of a malignant mel¬ anoma, while Pemberton,2 in 1855, reported one of the first cases of mela¬ noma of the head and neck. He de¬ scribed a 53-year-old manwhowasseen with a "black patch of disease on the right cheek."2 This patient soon died of diffuse metastatic disease. Primary melanoma of the head and neck ac¬ counts for 25% to 30% of all melano¬ mas. The head and neck region is highly visible to both the patient and the phy¬ sician, suggesting that early diagnosis of melanoma in this location should be possible. The skin of the head and neck, however, is unique for several reasons. It has a much higher density of melano¬ cytes than comparable areas on the trunk or extremities.3 The extent to which it is exposed to sunlight and its rich investment of both lymphatic drainage and vascular supply, causes ham, NC 27710 (Dr Fisher). the head and neck region to be more susceptible to the development of pri¬ mary melanoma and to show a higher propensity for both local and distant metastatic spread. Reported five-year survival rates for persons with head and neck mela¬ noma range from 8% to 60%.47 Most of these series involve a small number of patients collected over a long period during which the treatment regimens were not always comparable. This makes statistical evaluation and com¬ parison with other studies difficult. In this article, we describe our experi¬ ence with 399 patients with cutaneous head and neck melanoma treated dur¬ ing a ten-year period during which standardized treatment and adjuvant therapy protocals were performed. MATERIALS AND METHODS Patient Population General Characteristics.-The Duke University Melanoma Clinic in Durham, NC, has registered more than 2,500 patients with melanoma during the last ten years. During a retrospective, comput¬ er-aided data search, 399 cases of head and neck mela...

Penetrating head and neck trauma in children causes uncommon and potentially life‐threatening injuries. We reviewed the charts of 21 patients who sustained penetrating injuries to the face or upper neck. Seventeen males and 4 females, aged 32 weeks' gestation to 19 years (mean = 10.2 years) comprised the study population. There were 15 gunshot wounds, 1 shotgun injury, and 5 stab wounds. Significant problems included 7 vascular injuries, 6 central nervous system injuries, 5 ocular injuries, 3 airway compromises, 2 facial nerve injuries, 1 cervical esophageal penetration, and 2 cases of pneumothorax. Three deaths occurred, but the majority of the patients survived and sustained minimal permanent disability. Included in this review is a unique case of an intrauterine gunshot wound to the face at approximately 32 weeks' gestation. The treatment protocol, differences from adult patients, and management highlights are reviewed.