Introduction:The performance of tracheotomy is a common procedural request by critical care departments to the surgical services of general surgery, thoracic surgery and otolaryngology -head & neck surgery. A Canadian Society of Otolaryngology -Head & Neck Surgery (CSO-HNS) task force was convened with multi-specialty involvement from otolaryngology-head & neck surgery, general surgery, critical care and anesthesiology to develop a set of recommendations for the performance of tracheotomies during the COVID-19 pandemic. Main body: The tracheotomy procedure is highly aerosol generating and directly exposes the entire surgical team to the viral aerosol plume and secretions, thereby increasing the risk of transmission to healthcare providers. As such, we believe extended endotracheal intubation should be the standard of care for the entire duration of ventilation in the vast majority of patients. Pre-operative COVID-19 testing is highly recommended for any nonemergent procedure. Conclusion: The set of recommendations in this document highlight the importance of avoiding tracheotomy procedures in patients who are COVID-19 positive if at all possible. Recommendations for appropriate PPE and environment are made for COVID-19 positive, negative and unknown patients requiring consideration of tracheotomy. The safety of healthcare professionals who care for ill patients and who keep critical infrastructure operating is paramount.
Abstractfections. In the post-antibiotic era this complication of neck infection is much less Background -Descending necrotising mediastinitis is caused by downward common. Estrera et al 2 reported the largest series since 1960 with 10 cases. We have sucspread of neck infection and has a high fatality rate of 31%. The seriousness of cessfully treated seven adult patients with descending necrotising mediastinitis and also this infection is caused by the absence of barriers in the contiguous fascial planes present a child in whom the infection developed and spread rapidly, leading to death. This paper of neck and mediastinum. Methods -The recent successful treatment reviews these cases and presents a meta-analysis of 24 case reports and 12 series of adult desof seven adult patients with descending necrotising mediastinitis emphasises the cending necrotising mediastinitis since 1970. importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also pre-Methods sented of a child with descending ne- 1 crotising mediastinitis, demonstrating the A 35 year old male engineer with a past history rapidity with which the infection can de-of hepatitis B was admitted following transfer velop and lead to death. Twenty four case from the intensive care unit of a peripheral reports and 12 series of adult patients with hospital. Five days prior to admission he had descending necrotising mediastinitis pub-sought medical attention for odynophagia, lished since 1970 were reviewed with meta-hoarseness, and mild left otalgia for which he analysis. In each case of confirmed des-was given oral penicillin. Forty eight hours later cending necrotising mediastinitis the he was admitted to the intensive care unit There were bilateral pleural effusions and lower 19% when mediastinal drainage was added lobe consolidation. The pericardial space was
Oropharynx cancer, which is highly correlated with HPV infection, is increasing in incidence in Canada, with a decreasing age at diagnosis and an improvement in survival. This could have implications for screening strategies and treatment for oropharyngeal cancers in Canada.
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BackgroundHuman papilloma virus (HPV) is emerging as the primary cause for some head and neck cancers. The objective of this study was to investigate the association between head and neck cancer (HNC) survival and socioeconomic status (SES) in Canada, and to investigate changes in the relationship between HNC survival and SES from 1992 to 2005.MethodsCases were drawn from the Canadian Cancer Registry (1992–2005), and were categorized into three subsites: oropharynx, oral cavity, and “other” (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period, which included three census years: 1991, 1996 and 2001. We linked cases to income quintiles (InQs) according to patients’ postal codes.ResultsOverall survival, without controlling for smoking, for oropharyngeal cancer increased dramatically from 1992–2005 in Canada. This increase in survival for oropharynx cancer was eliminated by the introduction of controls for smoking. Survival for all head and neck cancer subsites was strongly correlated with SES, as measured by income quintile, with lower InQ’s having lower survival than higher. Lastly, the magnitude of the difference in survival between the highest and lowest income quintiles increased significantly over the time period studied for oropharynx cancer, but did not statistically significantly change for oral cavity cancer or other head and neck cancers.ConclusionsThese data confirm a significant impact of socioeconomic deprivation on overall survival for head and neck cancers in Canada, and may provide indirect evidence that HPV-positive head and neck cancers are more common in higher socioeconomic groups.
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