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Involvement of the larynx and trachea by thyroid cancer extensive enough to cause an intraluminal mass is rare. In a sixty year period at the Mayo Clinic, only eighteen patients (of 2,000 with thyroid cancer) had involvement that required surgical intervention. Of these eighteen, fifteen were forty years old or older. Seven patients had follicular carcinoma; six, papillary carcinoma; four, anaplastic carcinoma; and one, medullary carcinoma. Seven patients had tracheostomy; seven, laryngectomy; three, partial removal of the larynx or trachea; and one, bronchoscopy and partial removal of the tumor for biopsy. Of the eighteen patients, two died during tracheostomy, seven lived three months to three years after operation, one lived five and a half years, and seven are still alive nine months to eight years after operation. One of the patients was lost to follow-up study. Of the ten patients who have died, two died of causes unrelated to the thyroid cancer. Of the seven surviving patients, six had laryngectomy, and one had partial laryngectomy.

Experience with 1,360 primary parotid tumors seen at the Mayo Clinic during two fifteen year periods, 1940 through 1954 and 1955 through 1969, is reviewed. A comparison of histopathologic classification, type of treatment indicated, recurrence rates, and survival in the two periods reveals considerably greater understanding of all factors in the later fifteen year period. The relatively high mortality still encountered among patients with high grade malignant tumors of the parotid glands indicate the nature of the challenge still to be met. Based on the data in this study, it is our opinion that superficial or total conservative parotidectomy is best employed primarily for benign tumors and that the shift to more radical operative procedures should continue in the management of malignant tumors, especially those that are less well differentiated. For experienced surgeons, exceptions might be the small superficially located tumors or the tumors in the lower pole of the gland such as Warthin's tumors. Local excision with removal of a margin of parotid parenchyma might be justifiable in such cases.

c HEMODECTOMAS (nonchromaffrn paragangliomas) arise in the sites of distribution of the chemoreceptor system. The chemoreceptor system consists of scattered structures composed of neura1, epitheIia1 and vascuIar eIements that, under stimuIation, act to increase the rate, depth and minute voIume of respiration. These structures are located in we11 defined anatomic sites. The Iong-recognized carotid body Iies on the media1 aspect of the common carotid artery at its bifurcation. The jugular body, or glomus jugmare, is found in the dome of the juguIar buIb in cIose association with the tympanic branch of the gIossopharyngeal nerve and the auricuIar branch and jugular ganglion of the vagus nerve. The glomus intravagaIe, or vagal body, Iies within the perineurium of the vagus nerve, usuahy just beneath the juguIar foramen at or near the nodose ganghon. The aortic body may be Iocated near the bifurcation of the innominate artery, at the puImonary end of the ductus arteriosus, or on the anterolatera1 aspect of the aortic arch. The ciIiary body is SO designated because of its Iocation within the orbit in proximity to the cihary gangtion. With the recent report of Korn and associates [I] concerning the occurrence throughout the Iung tissue of minute structures resembhng the carotid body, it shouId be admitted that, as yet, unrecognized sites of chemoreceptor tissue may exist.

Two hundred fifty radical neck dissections performed in 208 patients from January 1960 through December 1964 are reviewed. The spinal accessory nerve was sacrificed in the course of the dissection in 161 and was preserved in 89. Five patients died in the immediate postoperative period. The incidence and sites of recurrences in the remaining 245 dissections were analyzed. When lymph nodes of the cervical region were found histologically to be involved by tumor, recurrences developed on the side of dissection in 36 per cent of cases when the spinal accessory nerve was sacrificed and in 17 per cent when the nerve was preserved. In the latter group, there were no recurrences in the posterior cervical triangle or along the course of the nerve. In both groups, local recurrence on the side of dissection was associated with recurrence of the primary tumor in more than a third of the cases and with distant metastasis in approximately a half. When the cervical lymph nodes were not involved, the incidence of recurrent lesions in the neck was 12 per cent in the first group and 4 per cent in the second. Again a high proportion of cervical recurrences were accompanied by recurrence of the primary tumor. No patient in whom one or both spinal accessory nerves were preserved died as a result of local recurrence in the neck alone. Modification in the classical technic of radical neck dissection in order to preserve the spinal accessory nerve appears to be safe and justifiable in selected cases.

Summary One hundred and seven cases of mucoepidermoid carcinoma of major salivary glands (91 per cent in the parotid gland) encountered at the Mayo Clinic from 1907 through 1963 have been reviewed. Approximately two thirds of the patients were females and the age of patients ranged from five to eighty-one years. Tumors were divided on a histopathologic basis into three groups (grades 1, 2, and 3), representing different levels of histologic activity. In the earlier part of the period, excision of the tumor was the most common treatment; later subtotal or total removal of the gland was most frequently the treatment of choice. The recurrence rate for all tumors was 25 per cent, being 10 per cent for the well differentiated tumors (grades 1 and 2) and 71.4 per cent for the grade 3 lesions. The survival rate is excellent for patients with grade 1 and grade 2 lesions, but poor for those with grade 3 tumors. Total parotidectomy with preservation of the facial nerve in most cases is the treatment of choice for mucoepidermoid carcinoma in the parotid gland, and total removal of the gland when the lesion is located in the submaxillary or sublingual gland.

A series of twenty-nine cases is presented in which thirty parotidectomies were performed for recurrent chronic sialadenitis. The results during the follow-up period have been excellent, except in one case in which subtotal parotidectomy had been performed and a recurrence developed five months later. Based on the experience in this series it is recommended that when symptoms of chronic or recurrent parotitis are of sufficient severity and duration and do not respond to conservative measures, subtotal or total conservative parotidectomy should be performed. With proper technic these procedures can be performed without danger of injury to the facial nerve and with complete relief of symptoms.

Although an ileostomy as established today (Brooke type) is a satisfactory exchange for the disease being treated and is compatible with normal activities in 90 per cent of patients, it is inconvenient because of the necessity of wearing an appliance constantly and because skin problems develop in 25 per cent of the patients. Kock has proposed the creation of an intra-abdominal reservoir, which has a capacity of approximately 500 ml after six months and can be intubated periodically to evacuate the ileal content, thereby eliminating the necessity of wearing an ileostomy appliance in 90 per cent of cases. This report presents our experience to date with seven patients in whom pouches were established successfully and were observed for periods varying up to six months.

The records of 150 patients treated with combined operations for intraoral cancers were reviewed with emphasis on correlation between prognosis and age, presence or absence of histologically positive nodes, grade of neoplasm, and previous treatment. The three year survival rate was 48 per cent and the five year survival rate was 40 per cent. Of those patients succumbing with uncontrolled local disease, 89 per cent died in less than three years after operation. The close agreement of the three year and five year survival rates, together with the high percentage of deaths from the disease within three years, suggests that three year survival rates are as reliable as five year survival rates in this disease. Survival rates were significantly less than the over-all average for patients in the following categories: patients less than fifty years of age, patients having histologically proved metastatic involvement of lymph nodes, patients having higher grade tumors, and patients who had had previous roentgen therapy to the primary lesion. Mortality and morbidity were not excessive and deformity was surprisingly minimal. If, in the future, the surgeon can proceed with radical surgery at an earlier stage in the disease, even more promising survival rates may be attained.

A brief historical review of chemodectoma of the carotid and aortic bodies is given. The anatomic location, embryologic development, and physiology of aortic bodies are described. A case of a chemodectoma of the aortic body presenting in the neck and successfully removed is reported. The patient is well and without recurrence five years later.