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58 Cards in this Set
- Front
- Back
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malignant tumors in oral cavity can be managed two ways
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surgical resection
radiotherapy w/ or w/out chemo |
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protocal designed to perserve structures and hopefully function
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surgical resection and radiotherapy or by radiotherapy plus or minus chemo
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rule of cancer surgery
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no ablative surgical procedure should be compromised to maintain function (aka remove cancer)
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radiotherapy can ___ salivary flow
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decrease (xerostomia)
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tumors are categorized by
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size and location
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TNM
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Tumor-Node-Metastasis
Tumor size Nodule Status Metastasis (presence or absence) |
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6 primary locations for tumors in oral cavity
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-anterior floor of mouth/lower alveolar ridge
-lateral floor of mouth/lateral alveolar ridge -tonsils -base of tongue -hard palate -soft palate |
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composite resection
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removal of parts of more than one structure
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radical neck disection removes the ___
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lymph nodes and sternocleidomastoid and omohyoid muscles, CNVI
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simple resection
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removl of parts of one structure
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primary closure
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soft tissue remaining are pulled together and sutured
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Flap
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piece of tissue that is elevated away from normal site. attached to donor site and new site.
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myocutaneous flap
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muscle and skin included in flap (when large amount of tissue necessary)
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2 important things to know for oral cancer patient's swallowing difficulties
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1. exact nature and extent of the resection
2. exact nature of reconstruction |
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surgical resection in the tonsils/base of tongue have what disturbances
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oral preperation, oral phase, pharygeal (delayed trigger)
laryngeal control generally normal |
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3 divisions of larynx for cancer classification
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supraglottis, glottis, subglottis
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supraglottic tumors will/will not spread to lower portions
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will not because of the way the lymph system drains
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smaller legions of the supraglottic larynx involve
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epiglottis, aryepiglottic fold, false vocal fold
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supraglottic larynx legions typically treated by
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partial laryngectomy known as horizontal or supraglottic laryngectomy
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supraglottic partial laryngectomy tx may include
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closing the airway by retracting tongue base
super-supraglottic swallow |
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in supraglottic laryngectomy food/liguid will
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tend to fall onto the closed airway entrance or onto closed true vocal folds
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standard supraglottic resections do not extend ____
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into the base of tongue or arytenoid cartilage
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tumors on vocal folds usually treated
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with a vertical laryngectomy or hemilaryngectomy
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hemilaryngectomy
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removal of one false vocal fold, one verticle, and a true vocal fold
not including artytenoid or thyroid |
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hemilaryngectomy side effects
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generally none occassional aspiration at the beginning (do head down)
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3/4 hemilaryngectomy tx posture
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head down and rotate
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extended hemilaryngectomy
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includes
arytenoid one false vf one ventricle one true vf |
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frontolateral laryngectomy
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includes a portion of the larynx anteriorly
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if the arytenoid is included in the hemilaryngectomy postures/treatment
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adduction exercises
chin down and head rotate |
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total laryngectomy
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physical seperation of gastronintestinal tract from respiratory tract
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swallowing problems with total laryngcetomy
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tighter closure- strictures of esophagus
pseudoepiglottis |
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stomach pull up side effects managed through ___
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postural changes
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tracheoesphageal puncture
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to restore voice in total laryngectomy
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voice/swallowing changes due to radiotherapy
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hoarsness, vocal roughness
change in saliva flow |
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high dose radiation plus chemotherapy can result in
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reduced laryngeal elevation (do to fibrosis)
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stoke does or does not occur sesory loss
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does in the pharynx
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lower brain stem stroke effects
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oropharyngeal swallow impairment
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Unilateral medullary lesion
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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 |
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lower brain stem lesion, tx for swallowing
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TTS
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high brainstem stroke in the pons
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severe hypertonicity that maifests as delay/absence in trigging pharyngeal swallow, unilateral pharygeal wall paresis,
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high brainstem stroke in pons postures/tx
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dont respond to head turn
thermal tactile stimulation massage |
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subcortical stroke results in
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motor and sensory effected
mild delay in oral transit time and trigger of pharyngeal |
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cerebral cortex stroke effects
anterior left |
apraxia of swallow, mild oral transit and trigger delay
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cerebral cortex stroke effects
right hemisphere |
mild oral transit d
longer pharyngeal delay laryngeal elevation delay |
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treatment/management for stroke
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posutral, sensory input prior to swallow (including bolus changes)
exercise may be needed |
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cancer risk factors
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smoking/drinkin
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cancer grows on what kind of cells
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squamos cell epithelium
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chemo and radiation in combination is ___% successful
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75
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primary closure
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soft tissues remaining pulled together
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chemo
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kills cells around region
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surgery
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removes lumps
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radiation
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steralizes region (lymph nodes)
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partial laryngectomy
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supraglottic- airway protection with base of tongue and arytenoid
hemi- 1 false, 1 true, |
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total laryngectomy
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hyoid and larynx
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surgery-
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removes lumps
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radiation
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steralizes region (lymph nodes)
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Tx after surgery begins
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when they can work hard w/out pulling suture line
7-10 days oral 5-7 days laryngeal |
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Radiation reduces
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blood supply
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