High recurrent T stage, skull base involvement, repeated recurrence before surgery, nodal metastasis, and positive surgical margins carry a poor prognosis. This is particularly evident with high T stage and concurrent nodal metastasis. However, patients with low T stage have a survival advantage and benefit most from surgical treatment.

Cowden's disease is a hereditary disorder characterized by oropharyngealfibrosis and multiple hamartomas with potential malignant changes. We treated a 47-year-old manwho had fibrotic lesions on the left vocalfold and an extensiveamount ofpapillomatous lesions on the mucosa ofthe lips, tongue, andpharyngeal wall and on the skin of the axillae and buttocks. The pattern of distribution and the histopathologic features of these mucocutaneous lesions were diagnostic ofCowden's disease. To the best of ourknowledge, this is the first reported case ofCowden's disease involving a vocal fold.

Massive defects of the upper aerodigestive tract present a reconstructive challenge. We report a case in which a large defect of the naso-oropharyngeal and oesophagus was reconstructed with a combination of a gastric pull-up and a pectoralis major muscle flap. Postoperative function was good and survival was in excess of 16 months. The history of such reconstructions and possible alternative techniques are also discussed.

Mucoepidermoid carcinoma is one ofthe most common of the salivary gland neoplasms. Histologically, it is classif ied as either a low-, intermediate-, or high-grade tumor, and there are significant differences in prognosis among the different grades. Patients with low-grade disease. have an excellent chance of survival. High-grade tumors behave aggre ssively, and they f requently manifest as local recurr ences and distant metastases. We describe a case of a high-grad e mucoepidermoid carcinoma of the parotid gland that had metastasized to the skin, stomach, and liver. The disease culminated in a rapidly fatal bleeding f rom the stomach metastasis. Such a complication is unusual and to our knowledge has not been previously reported. We briefly discuss the clinical fe atures, biologic behavior, and treatment of this tumor.

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