Upper airway obstruction in the pediatric population has a myriad of etiologies, some of which are easily overseen. We emphasize the importance of thorough airway examination and careful attention to unusual signs, which, in this case, uncovered a fatal tumor. BACKGROUNDAdenotonsillar hypertrophy (AH) and its sequelae in the pediatric population have been considered for well over 100 years. In 1889, it was suggested that obstruction of the upper airway in such affected children caused "backwardness and stupidity." 1 We now have a greater understanding of the neurobehavioral abnormalities seen in obstructive sleep apnea (OSA) that Hill was referring to. Moreover, the many other sequelae of OSA seen in adults (namely, cardiovascular, and metabolic effects) have also been demonstrated in children. 2 The collection of sleep-related airway problems encountered in childhood (snoring, sleep disordered breathing (SDB) and OSA) do not always present with obvious structural airway obstruction 2 and nor is a seemingly obvious airway obstruction in these patients always the root cause of the problem. The pathogenesis of these disorders is more complex and multifactorial. Only 71% of 110 children with OSA and AH who underwent adenotonsillectomy had successful remission of OSA. 3 Obesity, craniofacial abnormalities, neuromuscular disorders, exposure to smoking, and prematurity contribute to the pathogenesis of SDB. 2 IJHNS CaSe RepoRt

Background Noncutaneous cancers of the head and neck occasionally metastasize to skin. We present a case series of patients with skin metastases from non-cutaneous malignancies of the head and neck. A literature review is presented to assess the morphology, pattern of distribution, and morbidity of skin metastases. Methods Relevant cases were identified by a dermatopathologist and cases were reviewed. A literature search yielded 94 cases which were also included. Results The most common primary site, histology, and location of spread was the thyroid gland (42%), squamous cell carcinoma (42%), and scalp (25%) respectively. Skin metastases typically present as a discrete nodules, but the distribution varies. Metastases to skin can occasionally be a patients presenting complaint, but irrespective of timing of presentation portend a poor prognosis. Conclusion Skin metastases are clinically rare, and when present typically herald a poor overall prognosis. Information regarding their distribution and clinical presentation is of importance to the surgeon and oncologist. How to cite this article Emanuel H, Emanuel P. Cutaneous Metastasis of Head and Neck Malignancy. Int J Head Neck Surg 2015;6(2):57-63.

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POSTERS possible when no muscle relaxant is injected. Remifentanil use with an objective of effect site concentration appears to be a solution for anesthesia for this type of surgery. Our work consists in studying the optimal concentration needed to realize the surgery without the necessity to use muscle relaxant and with the lowest side effects.