Major late complications, following radiotherapy of head and neck carcinomas, such as laryngeal oedema, perichondritis and chondronecrosis usually occur between three and 12 months after treatment. However, the present case displayed necrosis of the laryngo-tracheal cartilage and ulceration of anterior neck skin with a tracheal fistula 44 years after irradiation. The reasons for the long interval between irradiation and late complications may be explained by long-standing hypovascularity and/or infection of the irradiated area. Histological study revealed chondronecrosis without inflammatory cells in the laryngo-tracheal cartilage and bacterial colonization of subcutaneous tissue. Necrotic tissue was removed and tracheostomy was performed. The fistula was almost completely closed using a delto-pectoral cutaneous flap and the clinical course of patient has been good. This paper demonstrates the possibility of laryngo-tracheal necrosis in cases that had received radiation as long ago as 44 years.

A case of dysphagia due to a post-cricoid web in a seven-year-old boy with Rubinstein-Taybi syndrome is presented. the main features of this syndrome are summarized with particular reference to dysphagia and with previous cases of post-cricoid webs in children reviewed.

A recent study in our department demonstrated that depressing the plunger of a 50-mL syringe was reliably and linearly related to the force applied between 20N and 50N. Using a 50-mL syringe we constructed a simple device to help train anaesthetic assistants to apply cricoid pressure correctly. We then tested anaesthetists, operating department practitioners (non-physicians) and nurses in our hospital to see if they could correctly apply forces of 20 and 40 N. All subjects were then trained using this apparatus and once confident were retested immediately afterwards, and again 1 week and 1 month later. The results show a wide variation in the force applied with only 30% of subjects applying appropriate force at 20N, and 40% at 40N. Training leads to a significant improvement in performance (P < 0.005 at 20N and P < 0.001 at 40N) which is maintained for 1 week for both 20N (P < 0.05) and 40N (P < 0.05) but not for 1 month. Therefore training should be practised on a weekly basis. This is an inexpensive and simple device that we believe to be useful in helping anaesthetic assistants to apply effective cricoid pressure.

The problem of the therapy of glottal and neoglottal insufficiency is still unsolved. The surgical techniques and the materials employed up until now are not completely free from possible partial or total failures, early or late complications, or the need of a second operation. The objective of the study is to introduce a new thyroplasty technique of inserting tubular expanded polytetrafluoroethylene (e-PTFE) into the larynx of an animal model, with the purpose of using it next in human laryngeal tissue augmentation. Seven 30 kg pigs had tubular e-PTFE implanted under endoscopic control into a vocal fold or laryngeal vestibule. The implants were secured by suture to the thyroid cartilage. Short-term results demonstrate the ease and effectiveness of this mini-invasive implant surgical technique. Long-term follow-up is underway in anticipation of applying this technique to human laryngeal tissue augmentation.

Post-radiation necrosis of the larynx is a major complication after irradiation and has become rare. Recently, combined chemotherapy and radiation therapy has been introduced for head and neck tumours. The authors report a case of laryngeal necrosis after combination therapy for a patient with cervical lymph node metastases of nasopharyngeal carcinoma and review the literature on late laryngeal necrosis. Although radiation-induced laryngeal necrosis has become a rare complication, the combination of chemotherapy and radiation therapy may increase its incidence. We should always consider it as a possible late complication and treat it appropriately.

Timely cricothyrotomy may be life-saving, but it is not without its complications. Together with tracheostomy performed too high, there are high incidences of stenosis and voice changes afterwards – often neglected because the patient has so many other problems. Jackson warned of these problems over 70 years ago – his message is still relevant.

Twelve patients with bilateral fixed vocal cords seeking decannulation of their tracheostomies were subjected to endoscopic correction of the compromised airway. They all had arytenoidectomy associated with posterior cordectomy whether as a primary or secondary stage procedure. Decannulation was achieved in all patients using the technique described.