Neck stoma patients: is vital information displayed at the bedside?

Tracheostomies are common procedures in head and neck and critical care practice, with 50% of airway-related deaths attributable to complications such as occlusion or displacement. The National Tracheostomy Safety Project (NTSP) published guidance regarding emergency management of neck stoma patients. A prospective multicentre regional audit of all neck stoma inpatients (ward and intensive care unit (ICU) settings) was conducted. Bed spaces were assessed for tracheostomy care bundles and essential stoma information, as recommended by the NTSP guidelines. The results demonstrate inadequate ward compliance across all three trusts, with ICU compliance greater in comparison to a ward environment. Of note, crucial information regarding the nature of stoma and whom to contact in the event of an emergency, was not displayed in the majority of cases. A greater awareness of the NTSP guidance and implementation of vital information is a necessity across all disciplines in order to reduce stoma complication-related morbidity and mortality.

Outcomes of patients with maxillofacial osteosarcoma: a review of 15 cases.

PURPOSE: To assess clinical behavior, response to treatment, and factors affecting survival in maxillofacial osteosarcoma treated at a tertiary referral center. PATIENTS AND METHODS: Ethics-approved retrospective review of clinical and pathological records was undertaken for 15 patients managed by the Royal Melbourne Hospital Head and Neck Oncology Tumor Stream. RESULTS: Treatment was a combination of surgery and chemotherapy. Chemotherapy was given as adjuvant, neoadjuvant, or in combination. The overall 2-, 5-, and 15-year disease-free survival rates in this study were 92%, 74%, and 74%, respectively. Using Kaplan-Meier analysis with log rank tests, increasing T stage (P = .01) and positive margins (P = .003) were found to affect survival significantly. Neoadjuvant chemotherapy was not significantly associated with tumor necrosis or improved survival. CONCLUSIONS: Tumor size and adequacy of local control were found to be the most important predictors of outcome.

Cervical Subcutaneous Emphysema following Total Laryngectomy: An Unusual Complication of Nasogastric Intubation.

The nasogastric tube remains an important route of enteral feeding in the early postoperative period following total laryngectomy. Its insertion, however, is not without any risks of complications. In this article, we report an unusual case of inadvertent nasopharyngeal perforation secondary to intraoperative nasogastric tube insertion presenting as unilateral cervical subcutaneous emphysema in a patient who underwent total laryngectomy.

Role of tonsillectomy in histology for adults with unilateral tonsillar enlargement.

Unilateral tonsillar enlargement (UTE) may indicate malignancy. The purpose of this study was to evaluate the necessity of tonsillectomy for histological examination as a routine practice for every such case. We attempted to identify every adult who had tonsillectomy in our unit from January 1991 to January 2000 in whom the indication for operation was unilateral tonsillar enlargement. The case notes and pathology records were reviewed. One hundred and seven cases were identified but 9 case records could not be found, leaving 98 cases for analysis. Forty-eight were men and 50 were women, aged 16-85 (median age 32). Twenty-three malignancies were identified (23%). A high degree of clinical suspicion was noted pre-operatively in 37 cases, which included all 23 malignancies. Malignancy was more common in the presence of ulceration, male sex, lymphadenopathy, and age 45 years or more, and when it was the patient who first noticed the tonsillar enlargement. Current smoking and persistent pain were not significantly associated with malignancy. Night sweats and weight loss were uncommon. In many cases the apparent tonsillar enlargement was spurious due to asymmetry of the tonsillar pillars.