Total glossectomy is the most crippling of all oral cavity resections. Speech problems are unavoidable and post-operative aspiration is often severe. Two patients are presented who have had tongue reconstructions following near-total glossectomies. In each case a quilted, split-skin grafted pectoralis major muscle flap was used. The speech and swallowing results of these two patients are compared with two patients who underwent a hemiglossectomy and total glossectomy respectively without tongue reconstruction. Only if the suprahyoid and extrinsic tongue muscles are preserved can an active oral phase of swallowing and usable speech be regained by tongue reconstruction.

In the newer surgical procedures for fistula speech, finger occlusion of the tracheostoma is mandatory for speech production. This can be embarrassing as it draws attention to the patient's stoma. Finger occlusion is unhygienic and at times inconvenient. A new tracheostoma valve has been designed to eliminate the need for finger occlusion for speech. It has been evaluated clinically in nine laryngectomees, all of whom retained a good objective quality of speech similar to that obtained by finger occlusion. Vocal efficiency measurements with the valve are very encouraging. The valve is simple to use, of universal size, self-retaining, does not need any skin cleansing and obviates the need for skin adhesives to hold the valve in place.

Pseudodysphagia is the description of the sensation of a feeling of a lump in the throat—commonly known as the globus symptom. A prospective analysis of 145 consecutive patients with this symptom seen by an Otolaryngologist has provided confirmation that a high proportion of these patients have a treatable basis for their complaints and that most can be successfully managed without time-consuming and expensive investigations—provided clinical evaluation includes thorough visualisation of the oropharynx and supraglottis. The explanation for the symptomatology in patients who suffer from reflux oesophagitis is probably referred pain from the region of the lower oesophageal sphincter rather than spasm of the upper sphincter. The expression globus hystericus is outdated and should be discarded, and we recommended describing the symptoms as primary globus pharyngeus when there is no evident cause and secondary globus pharyngeus when the aetiology is detectable.

Abstract Flexible fibreoptic bronchoscope has been employed in the examination of the nasopharynx, pharynx, larynx, trachea, bronchus and intrathoracic oesophagus under local anaesthesia. It is used either for diagnostic or therapeutic purposes. A total of 1690 procedures have been performed with no complication. The indications and findings in these procedures are listed. The advantages and limitations of the use of flexible fibreoptic bronchoscope as a ‘panendoscope examination’ instrument are discussed.

An earlier paper (Cheesman et al., 1985) described assessment procedures for ‘failed’ oesophageal speakers who were referred to Charing Cross Hospital for possible Surgical Voice Restoration in 1983–4.

This paper presents the results of surgical voice restoration in the first fifty laryngectomized patients referred and analyses the reasons for failure in those where surgical voice restoration was unsuccessful.

94 per cent of patients who underwent secondary voice restoration were successful at two weeks post-surgery, but this success rate dropped to 73 per cent at three months. Reasons for this are explained and the pre-requisites for a successful surgical voice restoration are indicated.

The use of a specially designed silastic keel endoscopically inserted into the larynx to prevent restenosis after division of anterior commisure webs of the larynx is described. The treatment of such webs is discussed.

During 1968–1979, 55 cases of epithelial neoplasms originating from the maxillary antrum were diagnosed and treated within the referral area of 1.5 million inhabitants.

A majority of the patients were operated upon after pre-operative irradiation therapy (40–50 Gy). No significant difference in survival rate was found between patients operated on by total maxillectomy, including orbital exenteration, and patients subjected to partial maxillectomy. Patients with tumours not completely removed during primary surgery and patients with glandular involvement had a poor prognosis despite additional surgery and radiotherapy. The prognosis for the remaining patients was considerably better, with a 5-year survival rate of 60 per cent.

Near-total laryngectomy with myo-mucosal valved neoglottis is the most recent of the various surgical procedures for speech rehabilitation. The site and mechanism of phonatory function of the neoglottis has been investigated in eight patients by means of electrolaryngography. Results demonstrate substantial similarity in the nature of function of the neoglottis when compared with the normal human glottis.

A study of the effect of tonsillectomy on the frequency of sickle cell pain crises was carried out on 15 patients with sickle cell disease (Hb SS) who presented with complaints of frequent pain crises and were found to have chronic tonsillitis. They comprised 9 females and 6 males and ranged in age from 6 to 35 years, with a mean of 15 years. Tonsillectomy was performed under general anaesthesia. The mean number of pain crises in the one-year period after tonsillectomy was 1.5 and was significantly less than the mean number 4.7 in the one year preceding the operation (p<0.001). Four patients failed to show a reduced number of crises and these were those whose tonsils at operation showed no pus in their tonsillar crypts. It is thus observed that chronic tonsillitis, symptoms of which may not be volunteered at examination, is a potent inductor of sickle cell pain crisis and that tonsillectomy is an effective mode of treatment, especially when the tonsillar crypts contain pus.

The frequency histograms of six patients' laryngographs were studied pre- and post-endotracheal intubation. The changes were correlated with the length of intubation. The post-operative hoarse voice was seen as an increase in the spread of the lower frequencies, and an increase in the fundamental frequency. The latter change was thought to be a subconscious compensation for the hoarseness. The increased lower frequency spread as measured by standard deviation was directly proportional to the length of intubation.

Fifty-seven operations on 53 patients represents the total experience of tracheostomy in children under 13 years during 1964–1985 in an area with half a million inhabitants. No complications occurred during surgery and no deaths were related to the operations. Complications followed 16 out of 30 (53%) operations on children under three years and four out of 27 (15%) of the remainder, an overall complication rate of 35%. Many fewer operations have been required since 1973 because of the successful employment of nasotracheal intubation in the treatment of upper and lower airway obstruction caused by acute infection. Obstruction by-pass remains the commonest function of tracheostomy, with congenital lesions and trauma now the commonest causes of obstruction as opposed to acute infection in the earlier years. Despite the successful use of nasotracheal intubation there were absolute indications for tracheostomy—blockage of the nasotracheal tube; inability to intubate a child with epiglottitis; and necessity for an artificial airway of long duration.

Serum aliesterase levels have been estimated in 38 patients with head and neck cancer. The mean value was significantly lower than in controls. The decrease in activity was greater in patients with ulcerative growths and it progressed with advancement in the stage of cancer.

With radiotherapy, a progressive and significant increase in serum aliesterase activity was observed. In patients with non-malignant growths the activity was comparable with that in controls.