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Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating ≤7 than it is in patients with a GCS rating >7 (p= .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score ≤7 who do not undergo craniotomy and are otherwise stable.

\s=b\Sixty-seven laryngectomies performed for stage Ill and stage IV laryngeal carcinoma were reviewed. Stage III disease was managed by surgery alone. Treatment of stage IV disease was divided equally between surgery only and surgery plus radiotherapy. Five-year survival rates by clinical stage were 73% for stage III and 39% for stage IV. Clinical underestimation of disease occurred in 25% of stage III lesions. Unrecognized cartilage invasion and nodal disease occurred with equal frequency. Survival rates computed on the basis of pathologic staging were 91% for stage III and 41% for stage IV. Patients with stage IV disease who were treated with surgery alone had a 28% survival rate, while those receiving both radiotherapy and surgery had a 56% survival rate. In our opinion, surgical pathologic staging more accurately predicts survival than does clinical staging. Surgery alone appears to be adequate therapy for pathologic stage III laryngeal cancer. Addition of radiotherapy significantly improves survival in stage IV disease.

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