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101 Cards in this Set

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  • Back
What are two primary treatment modalities that can be used to manage malignant tumors of the oral cavity? What can they be combined with?
1. surgical resection
2. radiotherapy
with or without chemotherapy
True or False

While surgery for malignant oral or oropharyngeal cancers often results in deglutition problems, radiation rarely does.
False

Either type of treatment can affect deglutition.
What are three methods of delivering radiotherapy?
1. external beam methods
2. implant into the tumor
3. both
What type of tumors are frequently treated with radiotherapy alone or surgery alone?
smaller ones
What the heck is an organ preservation protocol?
Protocol designed to reduce morbidity (functional impact of the treatment) in order to preserve oropharyngeal structure and function.
_____ for H&N CA is an adjutant experimental treatment designed to attempt to control regional and metastatic disease, rather than a primary treatment designed to eradicate the tumor itself.
Chemotherapy
True or False

While chemotherapy is not a primary treatment for H&N CA, many patients have tumor shrinkage during or immediately after a course of chemotherapy that is of significant duration.
False

often of short duration
What's considered the adjuvant treatment with CA surgery? Why?
radiotherapy
Primary is surgery, which eradicates tumor; adjuvant is radiotherapy with controls disease
When surgery is used to control tumors in the oral cavity, the general rule is that the malignant tumor must be resected along with a margin of at least _____ of normal tissue.
1.5-2cm
____ lesions can result in _____ surgeries.
very small
large ablative
What sorts of structures might be resected during an oral surgery for oral cancer?
mandible, floor of mouth, tongue
When only one structure is resected, teh surgery is known as a ______
simple resection
Whe more than one structure or parts of more than one structure are resected during surgery, it is known as a
composite resection
A composite resection in the oral cavity often includes some part of:
the floor of the mouth and the mandible
There is one major rule of cancer surgery. No ablative surgical procedure should be compromised _______.
because of the desire to maintain the patient's function.
Rehabilitation and reconstruction cannot be considered until:
the cancer is removed with normal margins.
True or False
While resecting the tumor and required margin of tissue, the surgeon should also attend to the problem of reconstruction to maximize functional capacity.
False
reconstruction second.
When radiotherapy is scheduled as an adjunct to surgery, it is usually given ____ Why?
postoperatively after 4-6 weeks
radiotherapy devasculates tissue and makes healing after surgery more difficult.
A full course of radio therapy lasts for ____ to a dose of ______
5-6 weeks
6K-7K cGy
What does the exposed field of radiotherpy usually include?
all regional lymph notes.
When radiation includes the oral cavity, _______ should be performed prior to initiating radiation treatments because radiotherapy can a devastating effects on ____, causing an increase in the rate of _____ (____)
careful dental evaluation
salivary flow
dental disease (caries)
Any infected teeth should be removed prior to radiotherapy, because removing them after can put the patient at risk for ______
osteoradionecrosis of the mandible
Condition after a full course of radiation where portions of the mandible become infected and gradually break from the main body of the mandible to extrude or protrude through the soft tissue, necessitating removal of the infected portions. What's one cause?
osteoradionecrosis of the mandible
removal of infected teeth after radiotherapy
____ permits comparisons of the results of various treatments across patients with the same tumor (tumor reaction to treatment)
Tumor staging
Tumor staging for the oral cavity is divided into ____ sites, each staged according to ____, _____, and _____.
8
T or tumor size
N or nodal status
M or metastases (presence or absence)
Tumor size is assigned a number __ to __, with __ being the smallest and __ being the largest lesion.
1 to 4
T1 smallest
T4 largest
Metastasis to the nodes in the head and neck is noted by recordin an ___ followed by a ____ representing the ______ thought to be involved in the tumor. This one's easy, folks!
N
number
number of nodes
To indicated the number of distant metastases, ___ is followed by ____.
M
the number of metastases
How many nodes involved in a Stage I cancer? How many metastases? T1, T2, T3, or T4?
no nodes
no metastases
T1
If a cancer is M1, what stages can it be?
Stage IV
If a cancer is T2, N0, M0, what stage is it?
Stage II
If a cancer is T2 N1, M0, what stage is it?
Stage III
If a cancer is T3, N1, M0 what stage is it?
Stage III
If a cancer is T1, N1, M0, what stage is it?
Stage III
If a cancer is N2 MO what stage is it?
Stage IV
If a cancer is N3 MO what stage is it?
Stage IV
If a cancer is T4 N0 M0 what stage is it?
Stage IV
What types of lesions (Tumor Stages) are more frequently treated by combined therapies?
T3 and T4
Combined medical treatment usually includes ____ followed by ____, with ___ also provided sometimes ____ and continuing for some time ____.
surgery
radiotherapy
chemotherapy
preoperatively
postoperatively.
Can you name six locations in the oral cavity where tumors occur most frequently?
1. Hard Palate
2. Soft Palate
3. Base of Tongue
4. Lateral OT margin
5. Alv + lateral Mth flr + tonsil, + AFA Pillar
6. Alv + lateral Mth flr + tonsil, + AFA Pillar + Soft palate
True or False

With a larger tumor in the oral cavity, tissue is removed en bloc so that tissues that may contain cancerous cells are taken in continuity and the cancer is not spread by the surgical procedure itself.
True
Resection of the anterior floor of the mouth and a full section of the anterior mandible frequently reults in ____, which is what?
"Andy Gump" appearance
mandible smaller and retracted in relation to maxilla.
Smaller tumors on the lateral margin or anterior portion of the OT can often be removed by ___
resecting only tongue tissue. Yay!
A ___ removes the submandibular lymph notes, the lymph nodes in the neck, and the sternocleidomastoid and omohyoid muscles. When is it done?
radical neck dissection
larger tumors of the tongue, any large oral tumor requiring composite resection may do it.
What nerve is often sacrificed during a radical neck dissection? Can it be spared?
CXI (spinal accessory)
Yes, with a modified radical neck disection
True or False

In general, rehabilitation of the patient who has had a partial removal of the soft palate is easier than rehabilitation of the patient with total removal of the velum
False, so false.

Total easier than partial.
With a _____, the soft tissues remaining are simply pulled together and sutured (used with relatively small resections)
primary closure
What if the resection of tissues is so large taht there is not sufficient tissue remaining for a primary closure? What then?
Surgeon needs to borrow tissue, usually by means of a flap or a graft.
____ is a piece of tissue that has been elevated or rased away from its normal site.
Flap
What are two types of flaps?
local (close by)
distal (far away)
The ___ consists of skin and subcutaneous tissue that is moved from one part of the body to another, while a pedical or attachment is maintained between it and the body for nourishment.
a skin flap
_____ includes muscle and overlying skin, and is used when added bulk is needed in closure. This sort of ____ is usually passed beneath the skin to the reconstruction site.
myocutaneous distal flap
flap
A ____ or ______ transplants tissue from another part of the body into the oral cavity, with veins and arteries anastamosed or attached carefully to blood supply at the site to assure viability of the tissue.
microvascular free tissue transfer or graft
True or False

Innervated grafts or sensate flaps shave been shown to result in postoperative sensation int he oral cavity that is useful in speech or swallowing function.
false

Not yet...
Oral cancer patients may experience changes in ___, ___, and ____ posttreatment.
salivary flow, speech, and swallowing
With radiotherapy to the oral cavity, the patient my experience ___, ___, ___, and ____.
reduced salivary flow (xerostomia), mucositis, edema, and changes in swallowing
____ may be cause dby reduced salivary flow or by intraoral sensory loss
swallowign disorders.
_____ of the tongue and jaw may be caused by raditation therapy, probably resulting from ___. It can be counteracted with what?
Reduced range of motion
fibrosis
an active ROM exercise program completed morning and night
Results of studies explorign the relationship between surgical resection and reconstruction fothe oral cavity and speech and swallowing changes postoperatively point toward ___ as providign optimal function in comparison to ___
primary closure
distal flaps
Often a patient experiences ____ after 4 weeks of radiotherapy
a worsening of speech and swallowing problems
True or False

Data indicate that at 12 months posttreatment, the oral cancer patient's speech and swallowing function is generally better than at 3 months post treatment.
False

It's no better
Generally, patients with ____ of the oral tongue resected can benefit from a palatal reshaping (augmentation) prosthesis.
50% or more
False or True

When surgery involves the TB and lateral PWs, VP closure can be affected in some patients.
True
In oral and pharyngeal surgery patients, speech and swallowing therapy usually begins when?
10-14 days after surgery
True or False

Cancer in the oropharyngeal region often affects the tongue base and/or pharyngeal wall.
True
rehabilitation begins with ____
treatment planning
True or False

Because of the emotional consequences of oropharyngeal cancer and surgery, patients are rarely capable of participating in treatment decisions.
False!

Patient characteristics and preferences are important in treatment selection
True or False

Rehabilitative counseling should commence 10-14 days post-operatively.
False

Pts should receive rehabilitative counseling prior to initiation oftheir treatment for head and neck cancer
Preoperative counceling by the swallowing therapist usually includes what?
A swallowing screening, if not MBS, to define any pre-existing swallowing disorders
Two reasons for a pretreatment dental consultation:
1. ID dental disease
2. ensure preservation of critical teeth needed for prosthetic stabilization
An important concept for the patient to learn during treatment and (pretreatment counseling) is that:
he or she is in control and responsible for his or her own rehabilitation
If the initial treatment is surgical, the rehabilitation tearm should provide additional counseling to the patient and family when?
2-3 days postoperatively
When does intensive rehabilitation begin postoperatively? How often when inpatient? How often when outpatient?
1-2 weeks
daily
weekly
True or False

While early and active rehabilitation is helpful, it is not entirely critical to the successful functioning of head and neck cancer patients.
False
Review of data for a prospective study of 186 oral and oropharyngeal cancer patients treated surgically at 10 major medical centers indicated that ____ of patients received speech and swallowing therapy and ____ received maxillofacial prosthetic intervention. At 3 months posttreatment ____ of patients were lost to follow-up
only 50%
less than 10%
50%
Two things to know to understand the oral cancer patient's swallowing difficulties
1. nature and extent of resection
2. nature of reconstruction
In patients who have had less than 50% of their tongue reseected in a surgical procedure, the _____ is the main determinant of the pattern of function.
nature of the reconstruction
In patients with greater than 50% of the tongue resected, the _____ determine the funcitonal abilities of the patient.
extent of resection AND nature of the reconstruction
True or False

The swallowign therapist should as the surgeon for the exact labels for surgical procedures in order to define, in terms of the structures involved, the exact extent of the surgical resection and reconstruction.
False

Surgical labels often cover a wide variety of specific resections and reconstructions and can be misleading
If the resection is limited to the tongue, the pharyngeal and laryngeal aspects of the swallow are usually ____
normal
True or False

Pts with less than 50% of tongue resected and reconstruction with primary closure generally have only temporary difficulty swallowing.
True
With partial tongue resedction, because of edema and changes in tongue movement, pts often have difficulty with what?
triggering pg swallow
With anterior floor of mouth resection, _____ results in severe difficulties with lingual control and propulsion of the bolus, and mastication. Disruption of ___ contributes significantly to these problems.
suturing the tongue into the surgical defect.
mylohyoid support
What procedures to use in x-ray and therapy with a partial tongue resection?
ROM and bolus control
TTS (early on)
Head up
SGS
reshaping prosthesis
(liquids easier)
What procedures to use in therapy with anterior mouth resetion (suturing tongue into surgical defect)
OT ROM
positioning food posteriorly
Head up
palatal reshaping prosthesis
mendelsohn and falsetto
dump and swallow
(liquids only)
What procedures to use in therapy with anterior mouth resection (tongue flap or graft)
ROM
Dental prosthesis
positioning food more posteriorly
Patients who have had resection in the lateral floor of the mouth, tonsil, and TB area have potential difficulties with what?
both oral and pharyngeal stages of the swallow
reduced saliva flow is also called ___ and is a common concurrent factor in ____
xerostomia
radiotherapy
For a smaller laryngeal tumor, which is better: surgery or radiotherapy?
Both show equal cure rates
What sorts of medical treatments are used for larger laryngeal tumors (2)?
combined treatment: radiotherapy plus surgery or high-dose chemo plus radiation
3 areas of the larynx with regard to tumor staging AND percentages of malignant cancers occuring in each one!
supraglottic (35%)
glottic (60%)
subglottic (5%)
Staging of tumor occurs ___ treatment
before
True or false

Because of the way in which the lymph system drains in the supraglottic larynx, a tumor of the supraglottic larynx will not spread upward.
False

Will not spread downward to the TVF UNLESS the tumor is located at the base of the epiglottis
A horizontal or supraglottic laryngectomy is a ___ laryngectomy where the ___, ___, and ___ are removed, leaving the ___, ___, and ___ to protect the airway
partial
epiglottis, aryepiglottic folds, and FVF
TB, arytenoids, TVF
ROM exercises generally have an effect within gthe first ____ after initiation
2-4 weeks
True or False

Those pts with good tongue base action who are able to learn the sequence of instructions for the super-supraglottic swallow will be rehabilitated and swallow normally, usually withing 6 months postoperative.y
False

1 month
How long does it take to acheive a normal swallow with:
a standard supraglottic resection?
A resection including all or part of the arytenoid cartilage?
surgery into the tongue base?
1 month (as long as 3-6)
2 months (6-12)
6 months or more
In a study of recovery of swallow after partial laryngectomy, patients who had not acheived oral intake _____ took significantly longer to attain oral intake
before begining radiotherapy.
____ involves removing of one vertical half of the larynx
vertical laryngectomy or hemilaryngectomy
True or False

Hemilaryngectomies often result in a permanent inabiltiy to acheive full airway closure even though the arytenoid is often left intact, because the TVF, ventricle and FVF are removed.
False

Because tissue bulk is reconstructed on the opposite side against which the intact side can attain normal laryngeal closure
What to do to help a hemilaryngectomy patient swallow?
Head down, rotat to side