David E. Schuller, MD

In the past, head and neck cancers were felt to be primarily a locoregional control challenge. Distant metastases were not thought to occur frequently. However, the popularity of combined-modality programs emphasizing regional treatment with surgery and radiation in the 1960s enhanced the ability to control the disease at the primary site and within the regional cervical lymphatics. Nevertheless, survival was not improved because treatment failure at distant sites occurred frequently. Apparently, prior treatment programs that did not provide locoregional control masked the ability of this disease to spread to distant sites. Patients died of uncontrolled locoregional disease before they could experience distant metastases.

This paper is an excellent overview of speech and swallowing rehabilitation in head and neck cancer patients. Dr. Logemann and co-workers are clearly leaders in this field and, as such, are eminently qualified to summarize the topic. This subject is of great importance, as the effects of head and neck cancer and its treatment can be economically, psychologically, and socially devastating to patients. Quality-of-life issues continue to be critical in this patient population.

Dr. Stringer has done an excellent job of reviewing the anatomic, biologic, diagnostic, and therapeutic considerations that impact on the management of nodal metastases from head and neck malignancies. This is a thorough summary of the current