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Management of the neck in squamous cell carcinoma of the upper aerodigestive tract continues to be a topic of great debate. One major problem is that incorrect clinical staging is expected in approximately 20% of necks. This is true of both clinical stage N0 and N+ necks, even when imaging studies are used. This prospective study of 108 necks in 79 patients examined the role of intraoperative palpation and inspection in improving the surgeon's ability to predict nodal stage. Of 62 patients with N0 necks clinically on both sides, 26 were staged N+ by intraoperative node examination. Nineteen of the 26 were histologically negative (73% false‐positive). Of the 36 patients staged intraoperatively as N0, 10 were histologically positive (28% false‐negative). Of 108 necks judged clinically to be N0, 25 (23%) had occult metastases and 11 (10%) had extracapsular spread. Forty‐one of 108 clinical N0 necks were believed to have positive nodes at the time of neck dissection. Of these 41 necks, 30 (73%) were found to be histologically N0 (false‐positive). Of the 67 clinical N0 necks that were also believed to be N0 intraoperatively, occult metastases were found in 14 (21% false‐negative). Therefore, intraoperative staging did not significantly improve the false‐negative rate. Frozen‐section biopsy obtained in the operating room was reliable in 24 (92.3%) of 26 patients. Although frozen‐section biopsy was not performed in all patients, these data suggest that upstaging the neck without frozen‐section biopsy is much less reliable. This study supports the use of frozen‐section biopsy before converting the selective dissection to a radical or modified neck dissection in most instances.

The case of a 76-year-old white woman with squamous cell carcinoma of the thyroid gland arising in a background of Hashimoto's thyroiditis is presented. Squamous cell carcinoma of the thyroid gland is a very rare and aggressive tumor, and only a few cases are reported as arising in Hashimoto's thyroiditis. Although Hashimoto's thyroiditis alone does not necessarily predispose patients to malignancy, the finding of a prominent nodule in such a patient should suggest the possibility of malignancy, and an aggressive search and treatment regimen, including surgical intervention, should be pursued.

A prospective study was carried out which tested three hypotheses: 1) certain tumors of the head and neck that originate in sites other than the nasopharynx may cause middle ear effusion; 2) middle ear effusion is a predictable sequela of radical maxillectomy as well as total or partial resection of the soft palate; and 3) middle ear effusions that follow surgery to remove head and neck lesions are due to disturbances in palatal function, specifically to tensor veli palatini muscle dysfunction. Our results indicate that one fourth of all subjects had some evidence of middle ear abnormality prior to entering into treatment although they were asymptomatic. The treatment process influenced the function of the middle ear, as 79% of the subjects experienced middle ear-eustachian tube dysfunction following treatment, and 23% were found to have developed a perforation of the tympanic membrane or required myringotomy and tube insertion to relieve middle ear effusion. The results of these studies indicate that surgery that is adequate to remove cancer of the maxilla, tonsil, or palate in most cases interferes with the function of the tensor veli palatini muscle, resulting in functional eustachian tube obstruction. The need for attention to and the treatment of middle ear effusion in such patients is emphasized in light of other sensory deficits in this patient population.