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Background. During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. These pathologic findings may simulate malignant disease and/or have implications on the already complicated management of patients with head and neck cancer.Methods. We retrospectively reviewed 202 consecutive patients with a preoperative diagnosis of squamous cell carcinoma (SCC), who underwent 307 neck dissections performed by a single surgeon and examined by a single pathologist.Results. Ten patients had an unexpected finding. These included metastatic papillary thyroid carcinoma, leukemia, lymphoma, Warthin's tumor, and tuberculosis. Two of three patients with benign-appearing thyroid tissue within lymph nodes received no further treatment, and both remained well beyond 6 years. Four patients succumbed to SCC; none died from the incidentally discovered pathologic findings.Conclusions. Unexpected pathologic findings may be present in more than 3% of neck dissections. Although this is usually indolent, with the underlying SCC remaining the main prognostic determinate, it may significantly complicate postoperative management.

The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.

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