An accurate, reliable, inexpensive and safe method for the examiniation of the upper aero-digestive tract is described. Its efficacy is evaluated retrospectively on 250 patients over an 18-month period.

Oral Submucous Fibrosis (OSMF) is a disease of unknown etiology. A total of 96 patients with Oral Submucous Fibrosis have received four regimens of treatment–local dexamethasone, local hyaluronidase, local combination of dexamethasone and hyaluronidase, and local placental extract. The patients were followed up for a period varying from 3 months to 2 years. The group of patients receiving hyaluronidase alone showed quicker improvement in symptoms although its combination with dexamethasone gave somewhat better longer-term results. A new regimen for the treatment of submucous fibrosis is recommended.

Oral Submucous Fibrosis is a well-known clinical entity, known since the time of Sushurta. In the modern literature, this condition was first reported by Schwartz (1952). Joshi (1953) was the first person to describe this entity in India.

Oral Submucous Fibrosis has been defined as an insidious chronic disease of unknown etiology, reported mainly in Indians, and affecting the entire oral cavity. The basic change is a fibro-elastotic transformation of the connective tissue in the lamina propria preceded by vesicle formation. In its later stages the oral mucous membrane becomes stiff and the patient suffers from trismus and resultant difficulty in eating (Pindborg and Sirsat, 1966).

The present paper deals with our experience in the management of Oral Submucous Fibrosis over the past 21/2 years.

The role of the Carbon Dioxide laser in the performance of laryngeal microsurgery is discussed with reference to its advantages over conventional techniques. The need to excise lesions rather than to vaporise them is stressed and additional instrumentation is described.

The majority of well differentiated thyroid carcinoma are tumours of low grade malignancy. Laryngotracheal invasion by well differentiated thyroid carcinoma is an uncommon occurrence. The surgical management of patients with thyroid cancer invading the upper airway has primarily been by total laryngectomy. Other surgeons recommend in selected cases partial laryngeal and/or tracheal resection.

A total of 122 patients with thyroid carcinoma were treated in our department between 1967 and 1982. Only seven patients with well differentiated tumours had airway invasion. In these seven patients we used a partial laryngeal and/or tracheal resection. In three of the patients with tracheal invasion a myoperichondrial flap was used for closing the tracheal defect. A partial resection of the larynx and trachea, and end to end anastomosis between the trachea and the remaining part of the larynx was performed in another four patients.

Flexible fibreoptic rhinolaryngoscopy has been shown to be an accurate, reliable, inexpensive and safe method of examining the upper aero-digestive tract (Lancer and Moir, 1985).

The result of 338 consecutive examinations are reported.

We present nine patients with tuberculous laryngitis seen in our otolaryngology out-patient department during the year of 1983. Four patients were previously diagnosed as having pulmonary tuberculosis and were receiving or had received treatment for the complaint prior to our consultation. Of the nine patients, eight had positive chest X-rays for pulmonary tuberculosis. Three patients were known to have positive sputum results; in three patients the result was not known, whilst in the remaining three patients the result was recorded as negative. Biopsies done on four patients were compatible with the diagnosis of tuberculous laryngitis. Two of these four were undisputedly confirmed by the presence of Acid-fast Bacilli on histological sections. Two patients demonstrated permanent structural derangement of the larynx as end-result manifestations. The incidence, site and appearance of the lesions, diagnosis and treatment are discussed.

The phenomenon of a position-dependent fluctuation of hearing loss, in patients subsequently found to have perilymphatic fistula, is reported. Eleven patients with rupture of the oval or round windows of the labyrinth showed a lowering of thresholds on audiometry after lying horizontally for 30 minutes with the affected ear uppermost. It is suggested that air had entered the membranous labyrinth, interfered with transmission of footplate vibration to the perilymph column, and was displaced by this manoeuvre to produce a small, measurable, hearing gain, The diagnostic and prognostic significance of this finding is discussed.

The experiences and results of four re-mediastinoscopies are presented. All the patients had to some degree developed mediastinal fibrosis but not to a degree seriously interfering with the procedure. It is concluded that re-mediastinoscopy should be done if it can contribute to the diagonsis.

At operation for metastasizing carcinoma of the piriform sinus a patient was found to have two separate parotid tumors, one a pleomorphic adenoma and the other a papillary cystadenoma lymphomatosum (Warthin's tumor). These tumors presented as palpable masses on the same side as a lymph node involved with carcinoma. Synchronous parotid tumors of different types are rare; previous reports in the literature show that this combination of pleomorphic adenoma and Warthin's tumor is the most common. We have found no previous report of multiple parotid neoplasms in a patient with coexistent squamous carcinoma of the head and neck.

A simple fast reliable technique for closure of an anterior neck defect is described. The technique involves skin grafting directly onto the serosal layer of the anterior stomach wall following pharyngo-laryngo-oesphagectomy and pharyno-gastric anastomosis.