Endotracheal intubation with current inert low-pressure, high-volume cuffed tubes is a safe procedure associated with few complications in the vast majority of patients. However, complications related to mechanical difficulties and mucosal injury can occur even under ideal circumstances. Immediate complications are primarily associated with problems during intubation and extubation while early and late complications represent the short- and long-term effects of epithelial trauma.

Cervical thymic cysts are extremely unusual neoplasms that only rarely produce signs and symptoms of upper airway tract compromise. Less than 7% of patients initially have dyspnea or hoarseness. We report the first known case of progressive neonatal airway obstruction secondary to a rapidly enlarging cervical thymic cyst. Because one half of these benign tumors may demonstrate mediastinal extension, computed axial tomography or B-mode ultrasonography or both is recommended prior to surgical excision. Review of the literature confirms that the majority are successfully removed via a transcervical approach without recurrence.

\s=b\A series of 451 consecutive patient records were reviewed. Of these, 43 had diagnoses of epidermoid carcinoma of the head and neck. Triple endoscopy, by flexible fiberoptic methods, was performed on all these patients and was critical in the determination of second primary carcinoma in eight patients. As panendoscopy shows no mortality and a low morbidity rate, it should be used in diagnosis of second primary tumors, despite a probable low percentage of second primary discovery; long-term patient survival demands use of all available resources in such diagnoses. (Arch Otolaryngol 1984;110:533-534) More than 90% of patients with epidermoid carcinoma of the upper aerodigestive tract smoke and drink alcohol. This produces a carci¬ nogenic environment that encourages For editorial comment see 531.the development of such cancer.12 The incidence of epidermoid carcinomas has been variously described as between 1% and 20%, depending on the study quoted. Clustering of these cancers in the upper aerodigestive tract has been termed field canceriza-

No abstract

Life-threatening upper respiratory obstruction is an unusual complication of infectious mononucleosis. Although the majority of fatalities result from progressive bulbar paralysis or the Guillain-Barré syndrome, airway impairment primarily occurs as a result of pharyngeal lymphoid hyperplasia and associated faucial arch edema. Recent experience in a young child with infectious mononucleosis who exhibited progressive hypersomnolence, sleep apnea, and stridor during sleep is presented. In addition, a retrospective analysis of 72 cases of respiratory complications of infectious mononucleosis provides guidelines for specific airway management. Mild upper respiratory obstruction with persistent fever, severe odynophagia, and malaise is treated with parenteral corticosteroids. Immediate tonsillectomy using a halothane and oxygen induction technique is recommended for severe airway occlusion. Tracheotomy is currently reserved for those patients with progressive alveolar hypoventilation, hypercarbia, atelectasis, and bulbar paralysis. In general, tonsillectomy is well-tolerated, eliminating airway obstruction, improving swallowing function, and rapidly resolving pharyngeal discomfort.