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During a 20-year period, 12 patients with nontraumatic, nonneoplastic subglottic stenosis were seen at the Mayo Clinic. The etiologic factors were relapsing polychondritis, amyloidosis, sarcoidosis, and Wegener's granulomatosis. Because of the diverse initial presentation of the disease, the clinician should consider that the stenosis is a manifestation of a systemic disorder and carry out an otolaryngologic and physical examination with the appropriate roentgenograms and blood and urine tests. Treatment, if a systemic disease is proved, consists of appropriate medication. Surgery may be necessary, depending on the nature of the lesion. Small strictures may not need to be treated.

When a patient presents with a hard, painless lump in the neck, one should assume that it is a cancer and that it is metastatic from a primary lesion located above the clavicle. A careful physical examination with the appropriate instruments most often will determine the site of the primary lesion. Laryngograms or lateral soft-tissue roentgenograms should not be used as a substitute for visual inspection and careful examination. Examination with the patient under anesthesia is not needed unless the office examination cannot be done or a specimen from the suspected region cannot be obtained and examined microscopically in the office. Taking blind biopsies from normal-appearing mucosa is seldom worthwhile. Excisional biopsy is usually done with the patient under general anesthesia; needle biopsy is seldom used. Pathologic diagnosis by examination of frozen section is mandatory. Definitive treatment depends on the surgical and pathologic findings.

Salivary gland tumors of the palate originate in the minor salivary glands located in the glandular zone of the palate. Approximately 7 per cent of all tumors of the salivary gland occur in the palate, and approximately one-half of such tumors are cancers. The salivary gland tumor is more often found in the hard palate. Of the 90 salivary gland tumors of the palate reported herein, 49 per cent were benign, and all were pleomorphic adenomas. Of the cancers, 70 per cent were cylindromas, 15 per cent mucoepidermoid cancers, and the remaining 15 per cent included acinic cell carcinomas, undifferentiated carcinomas, and papillary adenocarcinomas. There is a 50 per cent likelihood of a lump in the palate in the glandular zone being a cancer. The simplistic diagnosis of a cyst should be considered only after other lesions have been excluded. The recommended form of treatment is surgical excision. Fenestration of the palate is a potential consequence of excision in 30 to 60 per cent of patients, depending upon whether or not the lesion is benign or malignant. The results of surgical treatment are good, but fenestration shoud be accepted as a necessary result of adequate treatment. Surgical treatment of cylindromas continues to be most difficult and demands the utmost of that intangible essence known as surgical judgment. Radiotherapy has been considered as a palliative agent for the treatment of inoperable and recurring cancers, especially cylindromas.

The composite resection operation with sacrifice of a portion of the hemimandible is considered to be the fundamental operation for cancers in the posterior oral cavity. The mandible is resected for cancer control (to ease reconstruction) and perhaps for traditional reasons. Mandibular sacrifice is not always essential for oncologic resection. Access through the mandible is usually required for effective resection of cancers in this region. The lateral mandibular osteotomy approach provides this access in selected patients. The adjacent, remaining portion of the tongue provides 75 to 100 sq cm of thick pliable vascular mucosa that can be used for closing the defects after resection of the cancer in the posterior oral cavity. As much as one half of the tongue can be rotated. If certain precautions are taken, a viable flap can be assured even after radiation treatment or ligation of the ipsilateral lingual artery.