True vocal fold paralysis and goitre are both common problems encountered in ENT practice. Their co-existence, however, should arouse suspicion of the presence of malignant thyroid disease. A rare case of true vocal fold paralysis caused by a clinically occult subglottic adenoid cystic carcinoma, in a 72-year-old, is described. The existence of multinodular goitre in this patient was co-incidental and confounded the diagnostic process.

Adenoid cystic carcinoma of the cervical trachea is rare and its diagnosis and surgical management challenging. We report a case with an unusual presentation and discuss the diagnosis and management. The preferred surgical management is tracheal resection, however this is often not feasible and many alternative techniques have been used. Here an anterior castellated approach is described, a modification of that more commonly used for benign tracheal strictures. We found it gave excellent access to the posterior tracheal wall which we feel is superior to a straight vertical tracheal incision. It also facilitates a tracheal widening procedure if indicated, and safeguards the recurrent laryngeal nerves which are particularly vulnerable in the cervical part of the trachea.

In order to test the clinical and prognostic significance of flow cytometrically assessed DNA content in minor salivary gland tumours we evaluated 75 neoplasms of the palate, 55 of which were carcinomas. Benign neoplasms were exclusively DNA diploid with low S-phase fractions while 22 per cent of malignant tumours manifested a DNA aneuploidy and 23.5 per cent high S-phase fractions (>5 per cent). Significant statistical correlations between DNA content and tumour size, histological grade, lymph node metastasis and lethality were observed. Our findings suggest a potentially important role for flow-cytometry in the evaluation of these neoplasms.