Methicillin Resistant Staphylococcus Aureus Infection as a causative agent of fistula formation following total laryngectomy for advanced head & neck cancer.

AIMS: The purpose of this paper was to investigate the impact of Methicillin Resistant Staphylococcus Aureus (MRSA) infection in the aetiology of pharyngo-cutaneous fistula (PCF) formation following total laryngectomy for advanced laryngeal cancer. METHODS: This was a retrospective uncontrolled case study series of 31 consecutive patients based in a single institution tertiary referral head and neck oncology centre. RESULTS: Pharyngo-cutaneous fistulas (PCF) following total laryngectomy occurred in 10 (32%) patients. MRSA was identified in 80% of patients with a PCF compared to 9% of patients that did not develop a fistula (p = 0.0001255 Fisher exact test). MRSA infection (p = 0.00012) and previous radiotherapy (p = 0.00025) were the only significant factors found to be important in fistula formation on multivariate analysis. Post-operative infections such as cellulitis, chest infection and carotid fistula were also associated with MRSA infections. CONCLUSION: MRSA infection following total laryngectomy for laryngeal cancer can lead to potential serious complications such as PCF. Patients who underwent total laryngectomy following radiotherapy failure are at a higher risk of acquiring MRSA.

Acinic cell carcinoma of the nasal vestibule. Report of a unique case.

Glandular tumours constitute a very small percentage of all neoplastic lesions in the nasal cavity. Only a very limited number of cases of acinic cell carcinoma (ACC) involving the nose have been sporadically reported throughout the medical literature. The clinical significance of this case report is due to its unique site. To our knowledge this report represents the only documentation of acinic cell carcinoma arising in the nasal vestibule. Unusual presentations of uncommon malignancies can pose considerable diagnostic dilemmas to both the surgeon and histopathologist. Awareness of these rarities is important to ensure the best patient care.

Sub-specialty training in head and neck surgical oncology in the European Union.

Sub-specialty training in otorhinolaryngology and head and neck surgery (ORL-HNS) is not standardised across European Union (EU) states and remains diverse. The objective of this study was to assess the current status of sub-specialty training programmes in head and neck surgical oncology within the European Union (EU-15). A postal questionnaire was distributed to 41 representative members of the European Federation of Otorhinolaryngological Societies (EUFOS) in the specialty of ORL-HNS in 15 EU states. The questionnaire included questions regarding the sub-specialty practice, structure, length, access, examination procedures and certification, future developments and also a space for individual comments. Thirty-one respondents (75.6%) from major training centres in 15 different European countries replied. Overall, the data revealed major diversity for all aspects analysed, between and within the different European countries. Only four EU states had formal sub-specialty training in head and neck surgical oncology. This includes Finland, Germany, The Netherlands, and the United Kingdom. In the rest of EU states, the last year of residency programmes is often spent as an introduction to one of the sub-specialties. Sub-specialty training in head and neck surgical oncology within the EU at present is clearly underdeveloped. Issuing a European diploma in ORL-HNS could be an initial step towards assessing the skills acquired during specialist training within the different European countries and formalising specialist training. This would establish a uniform measure for evaluating candidacy for sub-specialty training both across the EU and for USA, Canada or Australia.