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79 Cards in this Set

  • Front
  • Back
malignant tumors of the oral cavity can be managed by one of two primary treatment modalities
1. surgical resection 2. radiotherapy with or without chemotherapy. 3. a combination of the two
smaller tumors are frequently treated with _______ alone
radiotherapy or surgery
radiation therapy in the oral cavity may be by ________ into the gross tumor, _________ method, or both
implant into th egross tumor, external beam methods, or both
organ preservation protocols
designed in an attempt to reduce morbidity by preserving the patient's oropharyngeal structures and, hopefully their function
is chemotherapy used as a primary treatment designed to eradicate the tumor itself
NO - it is desigened to attempt to control regional and metastatic disease
although many patients have tumor shrinkage during or immediately after a course of chemotherapy, this is often or ________
short duration
when both surgery and radiation are used, radiation is considered
the ajuvant treatment, designed to control disease within the region of the tumor
malignant tumor must be resected along with a margin of at least
1.5 to 2 cm of normal tissue
simple resection is
when only one structre is resected
composite resection
when more than one structure or parts of more than one structure are included in the resection
one major rule in 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
when radiotherapy is scheduled as an adjunct to surgery, it is usually given
postoperatively
the full course of radiation lasts for _______ weeks to a dose of ____
5-6 weeks. 6,000 to 7,000 cGy
when the radiotherapy field includes the oral cavity, careful _________ should be performed prior to initiating radiotherapy treatments
dental evaluations.
radiotherapy can have devistating effects on
salivary flow, causing increase in the rate of dental disease
osteoradionecrosis
portions of the mandible become infected and gradually break from the main body of the mandible to extrude or protrude through the soft tissue.
staging for the oral cavity is divided into _ sights
8
T
tumor size (1-4)
N
nodal status (followed by the number of nodes involved with the tumor)
M
metastasis - seeding of the tumor outside the region (number of different sites)
tumors of the oral cavity occur in 6 locations:
1. anterior floor of mouth 2. tongue 3. lateral floor of mouth 4. tonsil 5. base of tongue area 6. hard palate 7. soft palate
larger tumors in the oral region often require
a composite resection
"andy gump" appearance
resection of the anterior floor of mouth and a full section of the anterior mandible
total glossectomy
resection of all of the tongue
radical neck dissection (3)
removes the submandibular lymph nodes, lymph nodes in the neck, sternoclediomastoid and omohyoid muscles
modified radical neck dissectoin
spares the accessory nerve
a tumor in the tonsil or base of tongue area is usually classified as the _________ region
oropharyngeal
a tumor on tonsil or base of tongue often requires a _________ resection
composite
rehabilitation of the person who has had total removal of the soft palate is _______ than rehabilitation of the patient with partial removal of the velum
easier. the prosthodontist can more easily develop a prosthesis
if the resection of tissue is relatively small, the wound may be closed with
primary closure
flap
a piece of tissue that has been elevated or raised away from its normal site. one portion is left attached to its donor site to allow the flap to receive a blood supply from its donor site
flaps are divided into ______ and __________
local and distal
sometimes a tongue flap may be uraised to fill the defect from surgery,tongue cut horizontally. this flap does ____ restrict remaining tongue movement but _____reduce the bulk of the tongue anteriorly
does not, does
other flaps are the _________ and _________
skin flap, myocutaneous flap
skin flap consists of
skin and subcutaneous tissue that is moved from one part of the body to another, while a pedical or attachment is maintained for nourishment
when a large amount of tissue is necessary to close a surgical gap, cooasianlly __________ flaps are used
myocutaneous distal flaps are used.
mycutaneous flap
includes muscle and overyling skin. when added bulk is needed, the myocutanous flap is thought to be more appropriate. (pectoralis major, trapezious, platysma)
microvasular free tissue transfer or graft
the free flap is a portion of tissue, entirely supplied by a specific artery and drained by a specific vein. it is capable of being revasularized by microvascular techniques at a new site. time consuming and costly. infection with loss of graft.
innervated or sensate grafts
bring sensation to the region y including a nerve in the flap or graft and anastomosing a nerve from the site to the nerve in the flap or graft. not sure about this yet
if radiotherpy is used, the patient may experience changes in (3)
swallowing, mucositis, and reduced salivary flow.
swallowing disorders may be caused by
reduced salivery flow or by intraoral sensory loss
ROM of the tongue or jaw may be reduced toward the ___ of the radiation protocol
end or at some point after. probably results from fibrosis. ROM exercises for this
the amount of oral tongue or tongue base resected is
correlated with the extent of speech and swallowing impairment
__________ provides optimal function in comparison to distal flaps
primary closure - most normal sensory input
full course of radiation therapy after surgery is a total dose of
5,000 to 7,000 cGy
radiation after surgery
works against the patient's rehabilitative process.
radiation tx is introduced _________ weeks postoperatively and continues for __ weeks
4-6. 6
often, at approx ____ weeks into radiotherapy, patients experience a worsening of their swallowing and speech problems
4 weeks
data indicate that at 12 months posttreatment, the oral cancer patient's speech and swallowing function is generally no better than at
3 monhs posttreatment.
generally, patients with __ or more of the oral tongue resected can benefit from a palatal reshaping
50%
cancer in the oropharyngeal reagion often affects the (2)
tongue base and/or pharyngeal wall
obturation of the velopharyngeal deficit can significantly improve swallowing if the _________ is also included in the resection
tongue base
generally, the slp postoperative intervenntion is initiated when the patient's suture lines have healed sufficiently, usually _______ days
10 - 14 days
preoperative counseling by the swallowing therapist usually includes a _________
swallowing screening, if not a videofleuroscopic assessment
what else is included pretreatment
a pretreatment dental, phycosocial assessment are also included
counseling is designed
to reduce the patient's and family's fears and assure them that the rehab professionals will be available to them
an improtatn concept for the patient to learn during treatment is that he or she is
in control and responsible for his or her own rehab
if the initial treatment is surgical, the rehab team should provide additional counseling to the patient and family beginning______
2 to 3 days postoperatively.
after the suture wounds have healed, rehab team will
reeval the patient and begin intensive rehab with daily inpatient and weekly outpatient
if a radical neck dissection is included, a _____________ should also be completed
physical therapy evaluation
if the pt suffers side effects of radiotherapy that prevent regular rehab managment, the pt is usually encouraged to try to
continue some exercises to preserve ROM and flexibility
a about _______ weeks into radiothrapy, the pt may suffer increasing function impairment and become depressed as swallowing function deteriorates
3-4
with patients with more than 50% of the tongue resected, they can use
a head back during swallowis. some use supraglottic swallow as additional defense against aspiration. also they can use maxillary reshaping prosthetic
after anterior floor of mouth resection
the oral phase of the swallow is usually impaired but pharyngeal transit is normal
the patient who has the upper margin of th emandible and a portion of the floor of mouth removed, with closure using a _____, generally has relatively few functional changes in swallowing after surgery
a flap of tissue from a site other than the tongue
if the suture is closed by suturing the tongue into the surgical deficit, the patient will have severe difficulties with
lingual control and propulsion of the bolus,, and with mastication. patients ability to cup and hold material in the anterior mouth in prep for the swallow is severely affected. these patients are taught the dump and swallow - prolonged super supraglottic swallow
patients who have the tongue sewn into the surgical defect may be helped by (4)
tongue ROM exercises, positioning of the food more posteriorly in the mouth, tilting the head backward during the swallow, palatal reshaping prosthetic
if the patient corrects this with subsequent surgery, floor of mouth muscles are cut resulting in
recuded ability to pull up the hyoid --> falsetto exercise and Mendelsohn
lateral floor of mouth, tonsil, tongue base resection:
oral stages are affected, because resection is in the area of faucial arches where pharynteal swallow is triggered, also have problems triggering pharyngeal swallow ind in pharyngeal swallow if part of pharynx is resected
when the pharyngeal swallow does trigger,
these patients may have reduced tbr and reduced pwc because the fibers of the glossopharyngeous muscle are cut, causing residue of material to remain in the valleculae after the swallow
occasionally these surgery people have trouble opening the UES because of
reduced laryngeal movement
mucositis
sores in the mouth from radiation
xerostomia cause changes in swallowing:
reduced speed of tongue movement causing a delay in oral transit time and a change in pattern of tongue movment --> delayed trigger of pharyngeal swallow
fibrosis
changes muscle fiber to connective tissue.
some patients experience delays in triggering of the pharyngeal swallow during or sometimes after
radiotherapy
if the pharynx is in the radiation field, there is reduced
pharyngeal contraction, tongue base movement, and laryngeal elevation.
it is not uncommon for irradiated patients to develop increasing swallowing problems
a year or more after the completion of radiotherapy
it is important for patients who will undergo radiotherapy to the oral cavity or pharynx to begin ROM exercises for the tongue, jaw and larynx
BEFORE radiotherapy begins and to continue at least 2 times daily through the radiotherapy and for a period of months afterward
ROM exercises are particularly important
if the patient is to undergo radiation tx