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58 Cards in this Set

  • Front
  • Back
malignant tumors in oral cavity can be managed two ways
surgical resection
radiotherapy w/ or w/out chemo
protocal designed to perserve structures and hopefully function
surgical resection and radiotherapy or by radiotherapy plus or minus chemo
rule of cancer surgery
no ablative surgical procedure should be compromised to maintain function (aka remove cancer)
radiotherapy can ___ salivary flow
decrease (xerostomia)
tumors are categorized by
size and location

Tumor size
Nodule Status
Metastasis (presence or absence)
6 primary locations for tumors in oral cavity
-anterior floor of mouth/lower alveolar ridge
-lateral floor of mouth/lateral alveolar ridge
-base of tongue
-hard palate
-soft palate
composite resection
removal of parts of more than one structure
radical neck disection removes the ___
lymph nodes and sternocleidomastoid and omohyoid muscles, CNVI
simple resection
removl of parts of one structure
primary closure
soft tissue remaining are pulled together and sutured
piece of tissue that is elevated away from normal site. attached to donor site and new site.
myocutaneous flap
muscle and skin included in flap (when large amount of tissue necessary)
2 important things to know for oral cancer patient's swallowing difficulties
1. exact nature and extent of the resection
2. exact nature of reconstruction
surgical resection in the tonsils/base of tongue have what disturbances
oral preperation, oral phase, pharygeal (delayed trigger)

laryngeal control generally normal
3 divisions of larynx for cancer classification
supraglottis, glottis, subglottis
supraglottic tumors will/will not spread to lower portions
will not because of the way the lymph system drains
smaller legions of the supraglottic larynx involve
epiglottis, aryepiglottic fold, false vocal fold
supraglottic larynx legions typically treated by
partial laryngectomy known as horizontal or supraglottic laryngectomy
supraglottic partial laryngectomy tx may include
closing the airway by retracting tongue base

super-supraglottic swallow
in supraglottic laryngectomy food/liguid will
tend to fall onto the closed airway entrance or onto closed true vocal folds
standard supraglottic resections do not extend ____
into the base of tongue or arytenoid cartilage
tumors on vocal folds usually treated
with a vertical laryngectomy or hemilaryngectomy
removal of one false vocal fold, one verticle, and a true vocal fold

not including artytenoid or thyroid
hemilaryngectomy side effects
generally none occassional aspiration at the beginning (do head down)
3/4 hemilaryngectomy tx posture
head down and rotate
extended hemilaryngectomy
one false vf
one ventricle
one true vf
frontolateral laryngectomy
includes a portion of the larynx anteriorly
if the arytenoid is included in the hemilaryngectomy postures/treatment
adduction exercises
chin down and head rotate
total laryngectomy
physical seperation of gastronintestinal tract from respiratory tract
swallowing problems with total laryngcetomy
tighter closure- strictures of esophagus

stomach pull up side effects managed through ___
postural changes
tracheoesphageal puncture
to restore voice in total laryngectomy
voice/swallowing changes due to radiotherapy
hoarsness, vocal roughness

change in saliva flow
high dose radiation plus chemotherapy can result in
reduced laryngeal elevation (do to fibrosis)
stoke does or does not occur sesory loss
does in the pharynx
lower brain stem stroke effects
oropharyngeal swallow impairment
Unilateral medullary lesion
functional or near-normal oral control impiared triggering and neuromotor control of pharyngeal

reduced CP opening

residue in pyriform

unilateral pharygneal weakness

reduced laryngeal elevation and anterior mvmt
lower brain stem lesion, tx for swallowing
high brainstem stroke in the pons
severe hypertonicity that maifests as delay/absence in trigging pharyngeal swallow, unilateral pharygeal wall paresis,
high brainstem stroke in pons postures/tx
dont respond to head turn
thermal tactile stimulation
subcortical stroke results in
motor and sensory effected
mild delay in oral transit time and trigger of pharyngeal
cerebral cortex stroke effects
anterior left
apraxia of swallow, mild oral transit and trigger delay
cerebral cortex stroke effects
right hemisphere
mild oral transit d
longer pharyngeal delay
laryngeal elevation delay
treatment/management for stroke
posutral, sensory input prior to swallow (including bolus changes)

exercise may be needed
cancer risk factors
cancer grows on what kind of cells
squamos cell epithelium
chemo and radiation in combination is ___% successful
primary closure
soft tissues remaining pulled together
kills cells around region
removes lumps
steralizes region (lymph nodes)
partial laryngectomy
supraglottic- airway protection with base of tongue and arytenoid

hemi- 1 false, 1 true,
total laryngectomy
hyoid and larynx
removes lumps
steralizes region (lymph nodes)
Tx after surgery begins
when they can work hard w/out pulling suture line
7-10 days oral
5-7 days laryngeal
Radiation reduces
blood supply