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All clinical classifications for laryngeal cancer are compromises based on clinical and imaging evaluations, with no concern for important elements such as phenotype, host-tumor relationship, and any concomitant nonneoplastic disease. The various staging systems are critically examined along with a report on the outcome of an international survey on the applicability of the TNM system in relation to laryngeal neoplasms, promoted by The Laryngeal Cancer Association.

Seventy-four larynges removed at death from children who died of sudden infant death syndrome (SIDS) have been studied by serial sectioning in the transverse plane. An increase in subepithelial glandular tissue is seen in many specimens, and the reduction in the available subglottic area has been measured with the Measuremouse Image Intensifying system. This preliminary report confirms that in some of these children with SIDS, particularly around the age of 3 months, there is a potentially lethal reduction in subglottic airway secondary to an increase in mucus-secreting glands, possibly from an associated mild upper respiratory tract infection. Accepting that adequate control infants within this age group who have not had any trauma to the laryngotracheal area are not available, these findings offer a possible explanation for what are always tragic events.

Fifty-eight patients with osseous or fibro-osseous conditions affecting the craniofacial bones are reviewed in order to determine difficulty of diagnosis, natural history, and management. In many patients separation into individual categories is possible on clinical grounds alone. However, by correlating clinical examination with radiological and histological findings, it is clear that each of the pathological conditions discussed is a separate entity and not merely part of a broad spectrum of bony disorders.

All the classification systems at present adopted for use in carcinoma of the maxillary sinus suffer from both intrinsic inaccuracies and an apparent failure to relate T (extent of primary tumor) categories to clinical experience of the spread of these tumors. Three systems are critically analyzed in relation to personal experience of 86 patients with sinus carcinoma and a fourth system proposed as a compromise solution to this problem.

Involvement of the thyroid cartilage attracts a high T rating in all systems of classification for carcinoma of the larynx. Evaluation of 145 patients with laryngeal cancer treated by total laryngectomy emphasizes the difficulties of preoperatively determining cartilage invasion. The operative specimen was serially sectioned and studied to determine the means by which ossified and nonossified thyroid cartilage is invaded by carcinoma. A minimum 5-year follow-up of these cases indicates the prognostic significance of such invasion.

The three-dimensional morphology of the mammalian larynx was studied for 15 years. Using specimens obtained from a wide variety of sources, efforts were made to correlate structure with function and thus explain the variations in size and morphology seen in over 150 families of mammals.

Most recent publications dealing with surgical repair following pharyngolaryngectomy or pharyngolaryngoesophagectomy appear to be based upon limited surgical experience of the most differing operations now available. An up to date review of 162 patients, including 68 gastric "pull up" procedures, has the advantage of being a personal series as well as a critical evaluation of each technique based upon personal evaluation.