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Bullet wounds involving larynx or trachea frequently prove fatal unless the airway is maintained soon after injury. With modern high-velocity bullets tissue damage is severe and injuries may be multiple. Six cases of high-velocity bullet wounds survived initial injury. The sequelae of the damage to larynx or trachea is discussed and in three patients total laryngectomy was necessary.

Between the years 1965 to 1977, 58 patients with advanced hypopharyngeal squamous carcinoma were treated by pharyngolaryngoesophagectomy and total thyroidectomy. Operative mortality for potentially curable cases was 8.6%, with a crude three-year survival rate of 29% for all cases. Mortality was 37% for patients with postcricoid tumors. Long-term management was uncomplicated except for calcium metabolism; two patients died from nephrocalcinosis secondary to return of circulating parathyroid hormone. I discuss the role of this operation in the successful treatment of hypopharyngeal cancer.

Fifty-three patients had pharyngolaryngoesophagectomy during the years 1965 to 1976 for lower hypopharyngeal or cervical esophageal cancer. The operative mortality--defined as the percent of patients who died within seven days of operation--was 7.5%, which is reduced to 5.6% if one patient with inoperable disease is excluded. Twenty-eight percent of patients survived for longer than one year, and there have been no problems with swallowing. Communication is possible in every patient who possesses good motivation, but the problems of long-term management of calcium metabolism still require attention.

Saccular mucoceles are a definite entity and probably occur more frequently than is supposed. Confusion with internal laryngoceles is possibly due to lack of understanding of basic anatomy and physiology. A 49-year-old man had a saccular mucocele that was possibly associated with laryngeal cancer, although a definitive diagnosis was only made two years later. The laryngectomy specimen was serially sectioned and showed an internal laryngocele on the side that was not operated one. This patient remains alive and well four years after excision of a T4 carcinoma, although a unilateral radical neck dissection was performed two years ago.