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A specialized institute has unique problems relating to its responsibility for teaching, research and clinical care. In the 40 years of its existence it has played a considerable role in the development of the specialty in the United Kingdom, advancing knowledge in all fields--particularly head and neck oncology and audiological medicine. The threat to its associated specialist hospital and to its own future because of severe cuts may result in far-reaching decisions regarding its future role.

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.

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.