An unusual cause of dysphagia following total laryngectomy.

A case of dysphagia following wide-field total laryngectomy with excision of the overlying skin is presented. Initial investigation as to the cause of the dysphagia proved fruitless. Mechanical compression of an adequate-sized neopharynx by the "band-like effect" created by the skin closure was hypothesized to be the etiology of the dysphagia. Release of the scar contracture and resurfacing with a pectoralis major myocutaneous flap reestablished an adequate-sized hypopharynx and normal deglutition.

Prophylactic submental skin incision after tight mucosal closure in total laryngectomy.

In this article, we will discuss prophylactic submental skin incision-performed after tight mucosal closure-in total laryngectomy; we will suggest means of avoiding incisional breakdown and pharyngocutaneous fistula.

Lethal catatonia.

Lethal catatonia, a life-threatening febrile neuropsychiatric disorder, was widely reported in this country and abroad before the introduction of modern psychopharmacologic treatments. A comprehensive review of the world literature indicates that although the prevalence of lethal catatonia may have declined, it continues to occur, now reported primarily in the foreign literature. Lack of recognition probably accounts for the scarcity of recent American reports. Furthermore, lethal catatonia is a syndrome rather than a specific disease and may develop in association with both functional and organic illnesses. Familiarity with the clinical features and varied etiologies is essential for effective management of this catastrophic reaction.