Over the eight-year period to May 1991,256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngooesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4–41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.

Of the 397 patients undergoing total laryngectomy for squamous cell carcinoma by Professor P. M. Stell between 1963 and 1991,73 are known to have suffered a local recurrence. Of these, 17 were treated by radiotherapy and/or further surgery. Secondary surgery was reserved for selected cases of peristomal and pharyngeal recurrence: of the 35 peristomal recurrences, eight were treated surgically. Previous reports of recurrence after total laryngectomy have focused on the problem of peristomal recurrence. Patients with pharyngeal recurrences can also be treated satisfactorily with microvascular surgical reconstruction techniques. Though rarely curative, secondary total pharyngectomy can be highly palliative and results in little additional morbidity.

Clinical, histopathological and ultrastmctural studies in three cases of rhinosporidiosis show complete remission of infection within one year of therapy with dapsone. Light and electron microscope studies confirmed arrest of the maturation of the spores and accentuated granulomatous response with fibrosis following dapsone therapy.

Twenty-five patients with bilateral nasal obstruction due to hypertrophy of the inferior turbinates were entered into a prospective study to compare the efficacy and the associated complications of total inferior turbinectomy and concho-antropexy. We found no significant statistical difference in the efficacy of these procedures in relieving nasal obstruction and discharge (>0.5). Total inferior turbinectomy was associated with more postoperative pain (p<0.05) and with long-term dryness and crusting (p<0.05) which were statistically significant. This is the first trial where concho-antropexy and total inferior turbinectomy are compared.

In the last six years, anterior mandibulotomy was used to approach tumours of the oropharynx and oral cavity in 39 cases. Twenty-six of these had primary lesions in the anterior two-thirds of the tongue. Eight cases had lesions in the base tongue, three in the cheek, and two in the tonsil. Twenty-six cases had T3 tumours, nine had T2 lesions, and four had T4 tumours. Twenty-five patients received post-operative radiotherapy. In 16 cases the mandibulotomy was combined with a marginal mandibulectomy. In 23 cases reconstruction was carried out using a pectoralis major myocutaneous flap. Adequate margins on histopathology obtained in all but eight patients. Bone-related complications occurred in only three patients, all of whom were previously irradiated. Thus the anterior mandibulotomy provides excellent exposure for oral and oropharyngeal tumours, with low complication rate, and avoidance of segmental mandibulectomy.

In an effort to establish factors responsible for our post laryngectomy fistulae we reviewed 357 patients who underwent total laryngectomy between 1965 and 1990, for laryngeal carcinoma. Pharyngocutaneous fistulae occurred in 84 cases (23 percent). There was no difference between the fistula group and the non-fistula group with regard to age, sex, general condition, or tumour differentiation. The only significant, positive association was with previous radical radiotherapy (10 fistulae out of 167 primary laryngectomies (4 percent) versus 74 fistulae out of 190 salvage laryngectomies (39 percent)). The median time to occurrence of a fistula was day seven in both groups. However, in the non-radiotherapy group the median duration of the fistula was 28 days; the majority healing spontaneously, with only one patient requiring surgical closure. There were no ‘hospital’ deaths. In the radiotherapy group the median duration of fistulae was 112 days with 30 patients requiring a total of 66 procedures to achieve closure of the fistula. There were six ‘hospital’ deaths in this group.

We conclude that previous radical radiotherapy strongly predisposes towards the occurrence of a postlaryngectomy fistula. Fistulae in this group tend to be longer lasting and are more likely to require surgical repair.

Tonsillectomies have been performed on a same-day basis in Coventry for the past three years. We report our experience with this technique which has gradually evolved over the last ten years. The procedure is described in detail and the results of the first two years have been analysed. In common with the experience of others, it is possible to perform tonsillectomies safely on a same-day basis.

The distribution of substance P (SP) and calcitonin gene-related peptide (CGRP) immunoreactive (ir) fibres in the cat's larynx was investigated utilizing immunohistochemistry. Many SP- and CGRP-ir fibres with varicosities were found within and below the epithelium and along the basement membrane of the mucosa of all different regions except in the membranous portion of the vocal fold. In the subepithelium, some SP- and CGRP-ir nerve bundles and nerve fibres were recognized around the vessels and glands. In the mucosa, the pattern of distribution and the density of SR-ir fibres were similar to those of CGRP-ir fibres. These reactive fibres were denser in the supraglottic region than in the subglottic region. In the taste bud-like structures, only SP-ir fibres appeared, whereas in the motor endplates, CGRP-reaction was found exclusively. The present findings suggest that the regional distribution of SP- and CGRP-immunoreactivity might be related with sensory and autonomic innervation in the larynx.

Mycobacterial cervical lymphadenopathy is relatively uncommon in the United Kingdom; when cases do occur opportunities for early diagnosis and treatment may be missed. We have reviewed twenty-three cases of mycobacterial cervical lymphadenopathy presenting to an urban general hospital over a four-year period. We discuss the techniques available to aid a diagnosis of mycobacterial disease and suggest a protocol to allow efficient use of these techniques.

Parents of children undergoing (adeno) tonsillectomy were questioned about their preferences for a period of hospitalization. The proportion wanting early discharge increased as their children recovered after surgery.

Defects caused by tumour excision in the floor of the mouth can be closed by different methods. We present thirteen cases treated in our department over the last seven years in whom naso-labial flaps were used. Twelve patients had squamous cell carcinoma of the floor of the mouth and one had fibro-sarcoma of the right lower mandible. Five received post-operative radiotherapy, one was resected following radiotherapy and seven were treated with surgery alone. Patient selection is important to give good functional results without compromising tumour clearance.

Gastric pull-up is a reliable method of one-stage reconstruction following total laryngopharyngoesophagectomy (TLPE). However, the technique of blunt finger dissection for extrapleural extraction of the oesophagus is liable to produce chest complications like pneumothorax. We report a series of 45 patients who underwent gastric pull-up using the technique of oesophageal extraction by stripping which produced virtually no thoracic complications. This simple technique has greatly reduced morbidity associated with gastric pull-up.

After a median follow-up of 12 years, median overall survival of 73 patients with advanced squamous cell carcinoma of the larynx was 65 months. The 61 per cent of patients responding to two courses of initial schedule A combination chemotherapy, not including cisplatin, and the 81 per cent of patients achieving a final complete remission after definitive local therapy, had median overall survival figures of 95 and 97 months respectively. Overall survival and relapse-free survival in 51 patients treated with radiotherapy only with larynx preservation, were not significantly different from the 21 patients who completed their surgery with pre- or postoperative radiotherapy: median overall figures were 71 versus 65 months. These data add weight to our proposal that use of initial combination chemotherapy followed by radiotherapy may eliminate the need for radical surgery, so preserving the larynx in patients with advanced disease, and provides evidence of some long-term benefit with 32 per cent of this entire group surviving 12 years.

Through a combination of retrograde staining by wheat germ agglutinin (WGA) and immunohistochemistry, calcitonin gene-related peptide (CGRP)-reactive sensory neurons projecting from the laryngeal mucosa were detected in the feline nodose ganglion. The size of the CGRP-immunoreactive cell which was regarded as a laryngeal sensory neuron, was about 60 ±m in diameter: the shape of the immunoreactive laryngeal sensory neuron was unipolar. CGRP-reacted laryngeal sensory cells were found in the rostral part of the nodose ganglion extending to the middle part. They aggregated in the most rostral part, were sparse in other parts and were approximately 50 per cent of WGA-reactive laryngeal sensory neurons in number. Our results suggest that this neurotransmitter might play an important role in laryngeal peripheral sensory innervation.

Stomal recurrence after surgery for laryngeal tumours is an extremely serious complication, with a dismal prognosis despite aggressive surgical therapy or high-dose irradiation. Data from 209 patients who underwent total laryngectomy for cancers of the larynx and hypopharynx were retrieved from the registry of the Department of Otorhinolaryngology at the Hospital ‘Virgen de las Nieves’ of Granada. Stomal recurrence developed in 8.1 per cent of them (17 cases). We analysed several parameters from each case: first, those parameters significantly associated with stomal recurrence were detected, and secondly, a logistic regression analysis was done. Three factors were found independently related to stomal recurrence: T-staging, site of the primary tumour and prior tracheostomy. Together with a review of the literature, we discuss our findings and a proposal for management of the high risk patient.

The ENT manifestations of HIV infection are well known and the findings in AIDS patients have been described, nevertheless there are no reports of the frequency of head and neck involvement during the various stages of the disease. From 1987 to 1991, 210 HIV positive patients had ENT evaluation without symptomsrelated selection. The majority of them were men and intravenous drug users. The frequency of enlarged neck nodes, neck mass, nasopharyngeal lymphatic tissue hypertrophy, extranodal localization of non-Hodgkin's lymphomas, Kaposi's sarcoma, oral hairy leukoplakia, candidiasis and other less common findings is reported, in relation to the stage of the disease. Overall 84 percent of the observed patients had head and neck manifestations.An ENT evaluation in every HIV infected patient is suggested.

We report our experience of long-term follow-up of all patients treated during a ten-year period with primary radiotherapy irrespective of the disease stage of their laryngeal carcinoma. This policy was adopted in order to allow all patients the opportunity to save their larynx and to preserve their voice. In the present literature, surgery is favoured for treating advanced disease.

It is common practice following mastoid and middle ear surgery to apply a pressure bandage to the ear for a short postoperative period to reduce local swelling. The bandage is usually secured in such a way as to lift it away from the eye, sometimes with a length of ribbon gauze tied in a knot over the temporal region. Pressure from the knot may cause injury to the underlying tissues leading to post-operative complications which hitherto have not been described.

We reviewed the records of 66 consecutive patients with previously untreated supraglottic laryngeal carcinoma who underwent a supraglottic laryngectomy in our department between 1970 and 1989. There were 23 T1, 30 T2 and 13 T3 cases. Eight patients had neck metastases and underwent neck dissection also. Twentyfour (36 per cent) patients received post–operative radiotherapy. Two–year and five–year survival rates were 88.9 per cent and 82.2 per cent respectively. When the survival rates of the patients with T1, T2 and T3 lesions were calculated separately and compared with each other the differences were not statistically significant. Recurrences, post-operative complications, time to progression and indications for supraglottic laryngectomy are discussed.

Sixteen squamous cell carcinomas of the tonsillar region and 13 carcinomas of the base of the tongue were studied in a search for significant differences between the tumours of these two oropharyngeal subsites, which are known to carry a significantly different prognosis. The characteristics of the tumour cells and the tumourhost relationship were scored on H & E-stained slides, as well as on slides stained with a panel of antibodies. The results obtained were cross-tabulated and analysed with respect to the subsite. Ten variables were tested: cytonuclear pleomorphism, mitotic activity, the presence of atypical mitoses, keratinization, tumour grade, presence of eosinophils, severity of inflammatory response, and the expression of keratin-10, blood group antigens and collagen IV. When split up by site, only cytonuclear pleomorphism revealed a significant difference, tonsillar carcinomas more often exhibiting marked pleomorphism (p=0.04).

Despite having some prognostic relevance for squamous cell carcinomas of the head and neck, the variables tested could not provide an explanation for the difference in biological behaviour of the tumours studied.