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Synovial sarcoma is a malignant tumor which usually arises from the extremities. Involvement of the cervical area has been quite rare and to date only 12 cases have been reported. Two additional cases are reported in this paper and their management discussed. Case 1 is a 32-year-old white female with a submucosal mass of the right retromolar area displacing the tonsillar fossa and soft palate anteriorly. Surgical exploration revealed a well encapsulated mass separate from the parotid gland. Surgical excision was carried out on August 30, 1972. Pathological report was a synovial sarcoma. There has been no recurrence to date. Case 2 is a 34-year-old male with a 4 to 5 centimeter submandibular mass. Sialography and carotid arteriography were non-contributory. Biopsy showed synovial sarcoma. On May 12, 1973, surgical excision of the mass was carried out with the ipsilateral attached greater corneal of the hyoid bone and right hypoglossal nerve which ran into the tumor. Postoperative X-ray therapy was given. There is no recurrence to date. Discussion: Synovial sarcoma represents a type of mesenchymal tumor whose differention can mimic non-neoplastic synovial membrane. Histologically the tumor contains two neoplastic cell types. These are described as the fibrosarcomatous element and the synovial element. The tumor usually has no true capsule and grows by expansion with adherance to surrounding structures. The rate of growth is slow but the long term prognosis is poor. Metastasis usually occurs via blood stream most commonly to the lungs. Regional lymph node metastasis occurs in areas outside of the head and neck but has not been recorded in synovial sarcoma of the head and neck to date. Surgical excision is agreed to be the mode of treatment. The value of X-ray therapy is uncertain but Pack and Ariel were able to show their best results with a combination of surgical resection followed by postoperative X-ray therapy. It has been suggested that synovial sarcoma of the head and neck may behave in a more benign manner than synovial sarcoma elsewhere. Long term follow-up is not available in enough of the cervical sarcoma cases to determine if this is true. Until a more benign behavior is proven the tumor should be treated as an aggressive malignancy. Wide surgical excision is the treatment of choice. Postoperative X-ray therapy should be considered. [ABSTRACT FROM AUTHOR]

The exact incidence of gastroesophageal reflux (GFR) is unknown, although it is estimated that at least 25% of patients with GER have head and neck symptoms alone. These symptoms may consist of one or more of the following: excess salivation, hoarseness, "post-nasal drip," voice change, persistant coughing, food sticking in the throat, globus hystericus, otalgia, throat clearing, neck pain, sore throats, the sensation of a lump in the throat, choking spells, and bronchospasm. Carcinoma of the larynx and upper aerodigestive tract may be a consequence of chronic reflux. GER, especially when the classic symptoms of reflux are absent, is frequently overlooked as a cause of these problems. This article reviews the symptoms and pathophysiology of these conditions. The diagnostic and therapeutic modalities available to us in managing these patients are also discussed. [ABSTRACT FROM AUTHOR]

Significant complications are encountered in some patients as a result of prolonged endotracheal intubation. The finding of low gastric pH values at postmortem examination in patients whose larynx was severely traumatized after endotracheal intubation suggested that gastroesophageal reflux (GER) is an important factor in the pathogenesis of these problems. To evaluate the occurrence and character of GER as well as its effects upon the larynx and trachea of intubated patients, clinical observations and several animal models were employed. Monitoring of pH values for GER was performed in intubated patients both in the operating room and the intensive care unit with a 40% incidence of GER in ICU patients not receiving antacid therapy. After exposure to gastric juice, marked inflammation and necrosis were observed in the larynx of rabbits, and a significant reduction of mucociliary flow was found to occur in the dog's trachea. The physiology and mechanisms of these events are discussed and indicate that GER may play an important role in the development of permanent laryngeal and tracheal injury in the intubated patient. It is recommended that pharyngeal pH be monitored in intubated patients because their altered state of consciousness may predispose to gastric reflux. When GER is encountered, initiation of treatment should be undertaken because prevention is considerably more effective than subsequent treatment. [ABSTRACT FROM AUTHOR]

Laryngeal sequelae following prolonged endotracheal intubation are being observed with increasing frequency as this technique of airway management is being employed for extended periods of time. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. After reviewing the records of 372 consecutive patients intubated over an 18-month period, we have observed an increased frequency of these complications in the diabetic female patient and suggest that early tracheostomy should be considered in these individuals when the use of prolonged intubation is anticipated. The possible pathophysiology of this problem in the diabetic, as well as the non-diabetic intubated patient, and its possible prevention will be discussed. [ABSTRACT FROM AUTHOR]