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Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally. Four such penetrating and migrating foreign bodies of the upper aerodigestive tract are presented. Review of the literature revealed 321 cases of penetrating ingested foreign bodies, of which 252 remained intraluminal and 43 were found extraluminally, with the status of the remainder indeterminate. Analysis revealed that an intraluminal penetrating foreign body carried a higher overall mortality than one that migrated extraluminally. Although intraluminal and extraluminal penetrating foreign bodies may remain quiescent for years before presenting a complication, no correlation existed between mortality and the duration of the foreign bodies' retention. The greatest mortality was seen with vascular complications followed by diffuse and local suppurative processes. The overall mortality was significantly reduced in the postantibiotic era.

Review of the literature reveals 76 cases of fibrous histiocytoma of the deep structures of the head and neck. To this we have added 11 of our own cases, and analyzed the total group to determine clinical and histological features of a high risk population. Age, sex, presence of pain, location of tumor, size of tumor, and local invasion appear to be important clinical criteria. Bizarre giant cells, numerous and atypical mitoses, necrosis, and inflammation appear to be important histologic features. The treatment of choice is wide local excision. Chemotherapy appears to produce tumor regression.

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The clinical course of papillary adenocarcinoma of the thyroid is delayed but aggressive and lethal in an estimated 11-16% of the patients. Death results in the majority of patients from respiratory obstruction produced by a collar of tumor that has proliferated from residual or multicentric thyroid disease. Review of a large series of cases reveals an incidence of invasion of the aerodigestive tract of 1-6.5%. Six such cases are presented in which resection of the larynx, trachea and pharynx were performed along with total thyroidectomy with local control of the disease and prolonged survival. In five cases conservation surgery was done. Three patients had prior thyroid lobectomy with recurrence and invasion of the air passages 2-5 years later. Intraluminal thyroid carcinoma may be confused with a primary lesion of the larynx, trachea or hypopharynx.