Do front-line emergency staff appreciate the difference between patients with tracheostomy and those who also had laryngectomy?

In an emergency setting it is vital that the medical staff can appreciate the difference between patients who had laryngectomy and are total neck breathers and those who had tracheostomy for another reason and can still breath from their nose.  This is vital so so that oxygen can be administered in an appropriate manner either to the stoma ( in those who are laryngectomees) or to the nose ( in those who are not).  A survey performed in Birmingham England ascertained the level of emergency healthcare personnel's knowledge with regards to distinguishing between a tracheostomy and a laryngectomy patient, and the emergency management of such patients.

Forty-four accident and emergency medical staff (28 doctors, nine nurses and seven paramedics) completed a questionnaire to ascertain (1) their confidence at differentiating between a laryngectomy and tracheostomy stoma; (2) knowledge of the appropriate site for oxygen delivery if needed; and (3) overall level of training on this subject.

The study published in Journal of laryngology and Otology showed that there were significant gaps in knowledge, particularly with regards to fundamental differences between a tracheostomy and a laryngectomy as less than 5 per cent were able to describe the anatomical difference. Only 41 per cent of the participants were able to correctly identified the route of oxygen administration in laryngectomy patients.

The authors concluded that in In this cohort of emergency staff, the fundamental difference between a laryngectomy and a tracheostomy was poorly understood and that this lack of awareness of front-line emergency staff needs to be addressed in order to maximize patient safety.

A video explaining how to recognize and treat total and partial neck breathers is available.

Individuals with oral cancer are colonized with greater number of bacteria and yeast

Changes in the microbial flora on the oral mucosa after cancerous alteration may lead to both local and systemic infections. Researchers from India assessed the microbial flora associated with the surfaces of oral squamous cell carcinoma and compared the oral microbial contents with healthy mucosa. They also assessed the microbial flora from the saliva culture in subjects with oral squamous cell carcinoma and healthy controls.

The study included 30 subjects with oral squamous cell carcinoma and 30 healthy matched controls. The investigators found that oral squamous cell carcinoma sites harbor significantly more bacteria and yeasts compared to the control group. 

The study clearly indicates that the subjects with oral squamous cell carcinoma harbor significantly more microbial flora. The study's implications are that emphasis has to be made to prevent changes in the microbial flora of the oral cavity. This can be achieved by reducing sugar intake, using probiotics when indicated, avoiding unnecessary use of antibiotics, and maintaining good dental and oral hygiene. 

Microscopic view of oral bacteria and yeast 

New tests may Increase detection of oral cancer

Oral cancer has a poor survival rate linked to late detection. Only 60 percent of patients live beyond five years after diagnosis. Among black males, the survival rate is less than 38 percent. Scientists in Taiwan have already developed a new test to measure the amount of carcinogens attached to our DNA just by testing our spit. Researchers at the University of Texas have developed a new portable probe that could be used to diagnose oral cancer. The probe creates three dimensional images of areas within a tissue surface by illuminating the area with a laser. By taking numerous images and layering them on top of one another, it can deliver a large field of view. 

A study of a potential saliva test for oral cancer is also going to be performed at the Michigan StateUniversity College of Human Medicine's Department of Surgery. It is to be done with collaboration with the Delta Dental of Michigan's Research and Data Institute. The study plan to create a simple, cost-effective saliva test to detect oral cancer. 

The study plans to enroll 100-120 patients with white lesions or growths in their mouths and tonsil areas to test. The researchers will be looking for specific biomarkers that were previously identified by researchers at UCLA. These particular biomarkers have been shown in studies to confirm the presence of oral cancer. 

If the clinical trial is successful in helping create a saliva test to detect the biomarker’s presence, doctors and dentists would have a better idea of which patients actually need  biopsies. The test also has the potential to accelerate health care savings, he added, since the number of biopsies can be dramatically reduced.

A probe to collect saliva and detect oral cancer