Laryngeal sarcoidosis presents with hoarseness, cough, and dysphagia. Shortness of breath due to upper airway obstruction may occur. Indirect laryngoscopy reveals mucosal edema and erythema, granulomas, and nodules. The supraglottic larynx is the most frequently affected area. Systemic corticosteroids can be used initially; however, with persistent symptoms and/or severe airway problems, intralesional steroid injections may be more effective, as in the six patients presented.

Two hundred patients with squamous carcinoma of the head and neck were evaluated prospectively for synchronous second primary tumors. Complete head and neck examination, chest x-ray, and barium study (when indicated) revealed synchronous tumors of the upper aerodigestive tract in 24 patients (12%). Eleven patients had a second primary in the head and neck area. Nine patients had carcinoma of the lung, while four had carcinoma of the esophagus. Seven patients had a second primary outside the upper aerodigestive tract either in large bowel or prostate. During the period of this study, an additional 13 patients were seen with metachronous tumors 1-12 years after initial treatment of their index tumor. Most of these metachronous tumors were in the lung and esophagus and were noted within 1-3 years of treatment of the primary head and neck cancer. Detection of synchronous second primary is very important for prognosis and management of the index tumor, while early diagnosis of metachronous lesion is crucial in the follow-up of these patients.

The search for a convenient, rapid manual dexterity examination, which could be used at the time of the otolaryngology resident applicant's interview, led us to assess the following areas: purposeful hand direction, depth perception, tactile discrimination, finger pressure coordination, finger visual tracking of moving objects, spatial visualization, finger strength, speed of movements, fine control precision, finger dexterity, steadiness during movement, steadiness without movement, and neatness. With the astronomical increase in applicants to a limited number of positions in the field of otolaryngology-head and neck surgery, the application of an accurate, efficient manual dexterity assessment at the time of applicant interview is desirable. Presently, dental school applicants are screened by a series of manual dexterity tests. To develop our screening test, we integrated manual performance tests currently in use by private industry, occupational therapists, and dental school admission committees. Thus, applicants who are able to master fine microsurgical and macrosurgical techniques common in our specialty will be preferentially selected.

Extensive resection of carcinoma that involves the tongue base and supraglottic larynx is accompanied by significant potential morbidity and mortality. This is often indicated by poor rates of cure and the limited palliation afforded by radiotherapy alone. Removal of a significant portion of the posterior tongue frequently results in intractable aspiration. Techniques in reconstruction of the oropharyngeal defect and tongue base have included primary closure, random flaps, and myocutaneous flaps. Each of these techniques has been successful, to some degree, in resurfacing pharyngeal defects. However, the functional results in regard to deglutition are less than satisfactory as a result of aspiration. Frequently, simultaneous or delayed total laryngectomy is performed to deal with the pulmonary complications. Various types of laryngoplasty do not uniformly correct the problems of aspiration and deglutition associated with subtotal glossectomy. Our experience includes eight patients who had advanced squamous cell carcinoma of the tongue base, vallecula, and the supraglottic larynx. All patients underwent partial or subtotal glossectomy and laryngectomy. The mucosal defect was reconstructed with pectoralis myocutaneous flap. In order to reestablish voice, a primary tracheopharyngeal shunt was created with the use of a portion of cricoid and upper trachea. The majority of these patients have had successful rehabilitation of deglutition, mastication, and speech.

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