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Tracheal stenosis is a rare condition with symptoms mimicking asthma or COPD. The most frequent benign tracheal stenosis is caused by lesions related either to intubation or tracheostomy. Primary tracheal tumors or secondary malignancies such as locally advanced esophageal cancer are rare causes. As a rare disease the diagnosis and treatment are often delayed. Endoscopic therapy is the primary treatment for tracheal stenosis. Tracheal resection is indicated in resectable malignant tumors and in benign stenosis which do not respond to endoscopic treatment or require repeated therapy. In these situations, surgery provides a safe and a long-term solution. Currently, surgery is rarely an option in long-segment tracheal lesions. Advances in stem cell technology, tracheal transplantation and tissue engineering may, however, provide a solution for these problems in the future.

The independent status of Finnish doctoral programmes is changing as the funding is being transferred to the universities. The role of universities is correspondingly becoming stronger. The universities will establish a new organization for research training. We wanted to elucidate the significance of the nationally networked Finnish national graduate school of clinical medicine for research training. As an example we used the doctoral programme of the national graduate school of clinical medicine. The quality of research training as well as the continuation of training organizations created by nationally networked doctoral programmes must be guaranteed.

Oral cancer is the most common head and neck cancer in Finland. The number of new cases has been on a steady rise over the last decades. Smoking and heavy drinking are the most important risk factors. The role of papilloma virus infection is under active research, albeit with a smaller role than in oropharyngeal cancer, for instance. Surgical excision of the tumor is usually the first-line treatment. Pathoanatomical investigation of the primary tumor and cervical lymph nodes is essential in evaluating the need of adjuvant therapy. The prognosis of oral cancer has improved as a result of early detection and development of treatment modalities.

In Finland over the past few years approximately 100 new cases of oro- and hypopharyngeal cancer have been diagnosed annually. Most of these are squamous cell carcinomas. The incidence of these diseases increases after age 45. Minor and nonspecific local symptoms caused by the primary tumor are common to pharyngeal cancers at the initial stage of the disease. Often the diagnosis is delayed and the search for the primary tumor is begun only after detection of neck metastases. They occur in 60 to 80% at the time of diagnosis. Among the risk factors, smoking and heavy drinking are most important.

Tissue reconstructions of the head and neck are required both in the repair of tissue defects following the surgical excision of malignant tumors and in the treatment of various other facial deformities. While it is usually possible to repair a damaged tissue or organ region, functional restoration is very difficult. The aim is radical excision of the tumor, and successful reconstruction will provide quality of life for the patient even after an extensive surgical procedure. The goal of the new reconstructive procedures is as natural outcome as possible, but the risk for postoperative complications must be taken into account.

The possibilities of medical applications of rapid prototyping are continuously expanding and developing. In current applications, five main groups are distinguished: (1) preoperative planning, surgical training and teaching, (2) inert implants, (3) surgical instruments and special equipment associated with the operations, (4) postoperative guides, long-term supports and aids and (5) artificial tissue. The first four of these are already in general use, whereas the last one is still under investigation.

Injuries of the larynx are rare, and generally approved and consistent clinical guidelines are lacking. Depending on the mechanism, such an injury is either blunt or penetrating. This kind of injury may cause airway obstruction even with a delay of several hours. It is of principal importance to know when to suspect structural damage of the larynx, and to secure the airway. Laryngoscopy with a mirror or a flexible laryngoscope forms the basis for clinical examination, often complemented with computed tomography of the neck. Minor injuries of the larynx are treated conservatively and dislocated fractures surgically.

Most neck lumps in adults are benign. The alteration can, however, be the initial symptom of a malignant disease, and any lumps should therefore be inspected without delay. Initial investigations can be performed on an outpatient basis, whereas for further examinations the patient should be referred to a unit specialized in the treatment of head and neck tumors. The diagnosis should always be confirmed before devising a treatment plan. Ultrasonic imaging and microscopy of a fine needle sample constitute the first-line investigations. Open biopsy will hamper the further treatment of the tumor and comes into question only in special cases.