Hakan Coskun

Malignant tumors of minor salivary glands are uncommon, representing only 2–4% of all head and neck malignancies. In the larynx, minor salivary gland tumors rarely occur and constitute less than 1% of laryngeal tumors. Most of the minor salivary gland tumors arise in the subglottis; however, they can also occur in the supraglottis in the false vocal cords, aryepiglottic folds, and caudal aspect of the epiglottis. The most common type of malignant minor salivary gland tumor is adenoid cystic carcinoma. In the last 20 years, only 40 cases of adenoid cystic carcinoma arising in variable locations of the larynx have been reported in the English language literature. We present a case of adenoid cystic carcinoma of the larynx arising in the inter-arytenoid and postcricoid region in a 54-year-old woman. To our knowledge, this is the first case of adenoid cystic carcinoma arising in this particular region of the larynx.

Background.: The aim of this prospective study was to evaluate the relationship between accessory nerve functions and level 2b–preserving selective neck dissection.Methods.: Forty‐one necks of 30 patients with laryngeal cancer who underwent unilateral or bilateral level 2b–preserving neck dissections, between February 2003 and July 2005, were evaluated. Neck and shoulder movements and muscle strengths were examined and electroneuromyography (ENMG) was performed preoperatively at the postoperative 21st day and 6th month. Pathological anatomical findings at the postoperative 6th month were also evaluated.Results.: All shoulder movements and muscle strengths were preserved. Neck extension, rotation movements, and flexion strengths were restricted. ENMG values were affected moderately in the early postoperative period and improved slightly in the late postoperative period. None of the patients developed shoulder syndrome or adhesive capsulitis.Conclusion.: Preserving level 2b during selective neck dissection decreases trauma to the accessory nerve and improves functional results. © 2009 Wiley Periodicals, Inc. Head Neck, 2009

The most common morbidity associated with selective neck dissection (SND; II–IV) is spinal accessory nerve dysfunction and related shoulder disability. Nerve dysfunction is usually attributed to stretching of the nerve during clearance of lymph nodes lying posterior and superior to the spinal accessory nerve (level IIb). If these lymph nodes were left in place and not removed, stretching of the spinal accessory nerve during neck dissection and postoperative shoulder disability could be avoided. 113 SNDs (II–IV) performed on clinically N0 necks of patients with laryngeal carcinoma were enrolled in this prospective study. During SND, level IIb was separately removed and processed. Mean number of lymph nodes in level IIb was 6.26 (range, 0‐19). In none of the 113 SND (II‐IV) specimens did level IIb contain metastases, thus providing an oncological basis that leaving these lymph nodes in place is an oncologically safe approach, probably avoiding postoperative shoulder disability.

Foreign body aspiration usually occurs in the pediatric population. Adults with impaired airway protective mechanisms, such as patients with neurologic disorders or head or face trauma, may also aspirate foreign bodies. Patients have a typical history and findings. Diagnosis and management in most cases is accomplished with either flexible or rigid bronchoscopy. Very rarely, open surgical procedures may be required for removal. A patient who aspirated a broken part of his denture, which measured 5.5 × 2.5 × 2 cm, is presented. The patient was epileptic, and aspiration of the denture occurred during an epileptic seizure. Diagnosis of foreign body aspiration could only be made 4 days after the accident because of faulty evaluation of the patient and the chest radiograph. Thoracic computed tomography was useful in this patient for diagnosis. The foreign body could not be removed with either flexible or rigid bronchoscopy. It was removed through a tracheostoma with a combination of rigid bronchoscopy