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\s=b\Computed tomographic (CT) scanning has been used in the preoperative examination of patients with head and neck cancer. Although early reports on the use of CT scanning for cervical lymphadenopathy were encouraging, the accuracy of CT in detecting nodal metastases has not been well established. Fifty consecutive patients underwent radical neck dissection and preoperative CT scanning. The clinical staging of the neck, CT diagnoses, and pathologic findings were correlated; CT accuracy was then compared with clinical accuracy. Our findings show the overall accuracy of CT diagnoses to be 90%. Comparison with clinical accuracy shows the CT scan to be superior to the clinical examination, particularly in detecting occult metastases. (Arch Otolaryngol 1984;110:443-447) Computed tomographic (CT) scan¬ ning has been used in the preop¬ erative examination of patients with head and neck cancer. However, its clinical efficacy has not yet been well established in evaluating cervical lymphadenopathy in patients with metastatic disease. If proved to be diagnostically accurate, CT scans would provide important clinical

Laryngeal complications secondary to nasogastric intubation have been reported rarely in recent literature. Recent experience with three patients who developed laryngeal injuries related to nasogastric tubes prompted retrospective, experimental, and prospective studies to determine the mechanism of laryngeal injury. A review of the literature, as well as the clinical findings in our three patients, point to midline tube placement and the subsequent development of cricoid chondritis as the underlying etiology. An experimental study using anesthetized dogs was designed to compare histologically the effect on the larynx with nasogastric tubes placed in the midline, as opposed to nasogastric tubes in the lateral position. Results of the histologic study confirmed that midline tubes generate severe inflammation in the postcricoid region. One hundred patients were then evaluated roentgenographically to determine the incidence of midline tube placement in a random sample. Six percent of the patients had nasogastric tubes in the midline. Patients who have nasogastric tubes in place for more than three days or have a severe amount of discomfort should have an x-ray film to determine position of the tube. Midline tubes should be removed or replaced.

Laryngotracheal invasion by well-differentiated thyroid carcinoma is an uncommon occurrence. Recommendations for therapy have primarily included total laryngectomy or shaving of the tumor from laryngeal or tracheal cartilages. Clear guidelines have not been established for the applicability of partial laryngeal resections. In a retrospective analysis of patients with thyroid carcinoma, 13 patients had airway invasion. Of the five patients with laryngeal involvement, three were treated by a partial laryngeal resection. An experimental study was undertaken to determine more precisely the amount of cricoid cartilage which could be resected without reconstruction. Varying amounts of cricoid cartilage were resected. The results indicate that 25 % of the cricoid cartilage may be resected without appreciable airway narrowing. On the basis of the retrospective analysis and experimental study, we feel a partial laryngeal resection is possible in most cases of airway invasion by thyroid carcinoma.

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