Jatin P. Shah, MD, FACS

The presence of regional nodal metastases represents a significantadverse prognostic factor for patients with squamous cell carcinoma ofthe head and neck. Early-stage head and neck cancers, localized to theprimary site without regional lymph node metastases have excellentcure rates with either surgery or radiation therapy. The presence ofregional metastases results in cure rates that are approximately half ofthose obtainable in early-stage disease. Therefore, due to the significantadverse impact of neck metastases on prognosis, the treatment ofthe neck remains a vital part of the decision-making process in determiningtherapy for head and neck cancer.

Drs. Mark Singer and Eric Blom revolutionized the process of speech rehabilitation following total laryngectomy with their introduction of the tracheoesophageal puncture and insertion of a duck bill prosthesis.[1-5] The physiologic principles of the procedure are obvious, the surgical technique is simple, and the results in terms of fluent speech production are immediate and quite satisfactory. Dr. Blom is to be complimented for providing in this article, a succinct summary of the “current methods” available for speech rehabilitation for a patient facing total laryngectomy.

Dr. Hicks and his associates have written an excellent article that summarizes current knowledge about the biologic behavior of differentiated carcinoma of the thyroid gland and explores current controversies related to its management. Their review is reasonably complete, citing most of the important recent references on the subject. Regarding treatment con- troversies, the authors discuss the differing philosophies of various investigators and place into perspective the data supporting these opposing viewpoints.