Chondrosarcoma is the most common mesenchymal tumor of the larynx and approximately 200 cases have been collected in the world medical literature. It is less aggressive in the larynx than elsewhere: cervical or distant metastases are rare (8.5%), and although local recurrences are not uncommon, they are not catastrophic. A retrospective study was made on eight cases of laryngeal chondrosarcoma. Three cases had originally been diagnosed as idiopathic vocal cord paralysis, possibly because of early involvement of the cricoarytenoid joint or the distal portion of the recurrent nerve. This fact emphasizes the need for accurate laryngeal computed tomography in cases of vocal cord paralysis of unknown origin. Surgical excision is the treatment of choice for laryngeal chondrosarcoma, and conservative techniques may sometimes be appropriate. Supraglottic laryngectomy may be the technique of choice in the rare cases of epiglottic involvement.

The nasogastric tube can produce sudden, life-threatening bilateral vocal cord paralysis and is often an unrecognized cause of this clinical entity. The pathophysiologic mechanism is thought to be paresis of the posterior cricoarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid. Since our initial report of this entity in 1981, several cases have been photo-documented. Study of whole organ sections of an involved larynx have demonstrated the histopathology. Diabetic renal transplant patients appear to be particularly susceptible to the condition, due to prolonged gastroparesis and requirement for nasogastric tube drainage. Esophagoscopy should be performed promptly in these patients when pharyngodynia, hoarseness, or evolving stridor present in the postoperative period.

The clinical observation of aspiration following prolonged tracheostomy prompted a neurophysiologic investigation of the glottic closure reflex in dogs longitudinally evaluated after permanent tracheostomy. The data support significant alterations in the central organization of the protective closure reflex heretofore considered phylogenetically primitive and therefore physiologically stable over wide ranges of functional demand. The data indicate that chronic upper airway bypass results in: 1. increased threshold of the evoked adductor response; 2. random shifts in its latency; 3. rapid attenuation of the primary evoked response to repetitive SLN stimulation; and 4. reduced after-discharge activity, all of which contribute to a weakened, ill-coordinated closure respons.

The study of whole organ sections of laryngectomy specimens has demonstrated the patterns by which cancer spreads from one part of the larynx and hypopharynx to another. These studies have also demonstrated the fibroelastic membranes and ligaments that form the boundaries of intralaryngeal compartments within which cancer is confined in its early stages. They thus have added support to the concept of partial laryngectomy for selected lesions and have illustrated the features of those types of laryngeal cancer that have not responded well to radiotherapy. Whole organ sections of laryngectomy specimens have allowed a more accurate interpretation of preoperative computed tomography and magnetic resonance imaging and have provided a reliable basis for clinical staging.

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