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66 Cards in this Set

  • Front
  • Back
Malignant tumors of the oral cavity con be managed by _____ or ______; both may be combined with _______.
surgical resection or radiotherapy; combined with chemotherapy
What two things determine which treatment modality or combo is used?
exact site and extent of the tumor
What do organ preservation protocols attempt to do?
reduce morbidity (functional impact of treatment) by preserving oropharyngeal structures and function
True or False
Chemotherapy is a primary treatment used to eradicate tumors.
False - it is an adjuvant (supplemental) treatment.
How much normal tissue must be taken along with a malignant tumor in the oral cavity?
a 1.5 to 2 cm margin
When only one structure (or part of one) is resected, it is called a ________ resection. Resection of more than one structure is a ________ resection
simple
composite
Why is radiotherapy usually done postoperatively?
Radiotherapy tends to devascularize tissue and make healing after surgery more difficult.
Radiotherapy begins approx. _______ after surgery. Why is this the optimal time?
4 to 6 weeks; because malignant cells that may have been released after surgery will be at their weakest
Reduced salivary flow due to radiation can increase the rate of ________.
dental caries
What the heck is osteoradionecrosis of the mandible?
A condition in which portions of the mandible become infected and break off, necessitating removal of the infected portions. Hard to manage.
How should you treat infected teeth prior to radiotherapy?
pull 'em
What criteria are used to stage oral cavity tumors? (2)
size and location
For tumor staging in the oral cavity, how many sites are there?
8
Describe the TNM tumor staging system.
T: tumor size, 1 (smallest)-4 (largest)
N: # of nodes involved
M: # of distant metastoses
The larger the tumor, the more _______ the treatment.
aggressive
Most common locations in the oral cavity where tumors occur: (6)
1. anterior floor of mouth (or alveolar ridge there)
2. tongue (anteriorly or laterally)
3. lateral floor of mouth/alveolar ridge
4. tonsil b/t faucil arches
5. base of tongue
6. hard palate
7. soft palate
hmm-book states 6, lists 7???
Resection of the entire tongue is a _______.
total glossectomy
A radical neck resection removes the _____, _____, _____, _____, and often the _____.
submandibular lymph nodes, lymph nodes in neck, SCM muscle, omohyoid muscle, and often C11 (spinal accessory nerve).
True or False:
Rehabilitation for partial removal of the soft palate is easier than for total removal.
False - presence of scar tissue in partial removal causes immobility, makes prosthesis harder to develop
What is primary closure?
After a small resection, the remaining soft tissues are pulled together and sutured.
If the resection is too large to do primary closure, a _____ or a _____ is done.
flap, graft
Describe a 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 for blood supply. The other part is used to close the wound.
Two types of flaps.
local-uses tissue in from area close to the surgery.
distal-tissue is taken from a more distant area.
skin flap vs. myocutaneous flap
skin-skin and subcutaneous tissue
myocutaneous-muscle and overlying skin (used when added bulk is needed)
What's another name for a graft?
microvascular free tissue transfer
Difference between flaps and grafts?
flaps are still attached on to the donor site for vascularization/grafts are revascularized thru microsurgery and are not attached to the donor site
Advantages/disadvantages of grafts?
Adv: less conspicuous donor sites
Dis: longer & more costly surgery, oral infection can cause loss of graft
What are sensate flaps?
Recently innervated flaps meant to improve postop function
Complications of radiotherapy in oral cancer patients:
swallowing changes (due to reduced saliva or intraoral sensory loss)
mucositis
reduced salivary flow
reduced ROM of tongue and jaw (probably due to fibrosis)
With therapy following oral cancer surgery, why can speech and swallowing functions first improve and then sometimes decline?
Functions improve with tx after surgery. Radiotherapy is started 4-6 weeks postop. After about 4 weeks of radiation, functions deteriorate.
Patients with _____ of the oral tongue resected can benefit from a palatal reshaping prosthesis.
50% or more
After oral or oropharyngeal surgery, about when can the SLP start rehab exercises?
usually 10-14 days postop
Rehabilitation begins with _____, where the challenge is to ________.
treatment planning; to ID proper treatment strategy (to remove/control tumor) while causing least functional impairment in swallowing
Which individuals are involved in a tumor conference?
radiation onc., medical oncologist, surgeons, SLP, maxillofacial prosth., social worker, patient, family, significant other
Pretreatment counseling is designed to:
reduce patient's/family's fears and assure them that rehab folks will be available after treatment to improve functional status.
The two most important pieces of info needed to understand the oral cancer patient's swallowing difficulties are:
1. the exact nature and extent of the resection
2. the exact nature of the reconstruction of the oral cavity
In patients who had < 50% of the tongue resected the _______is the major factor in the pattern of function.
nature of the reconstruction
In patients who had > 50% of the tonge resected the _____ is the major factor in outcome of function abilities.
extent of resection and nature of reconstruction
True or False:
Swallowing difficulties tend to be temporary for patients who had a small partial tongue resection and primary closure reconstruction.
True - may be due to edema or because tongue movement has changed
What treatments are helpful for pts with partial tongue resection and primary closure?
-thermal tactile stim (for a few days)
-ROM exercises
-exercises to control bolus (results in 3-4 weeks)
In resection of > 50% of tongue, problems include ______:
What to do?
reduced lingual propulsion and control or bolus in mouth; tilt head back with liquid or thinned paste, may need supraglottic too. Reshaping prosthesis may help with all but masticated boluses (boli?)
True or False:
After anterior floor of mouth resection, the oral phase is usually impaired but pharyngeal transit is normal.
True (unless the floor of mouth muscles have been cut or partially resected).
After anterior floor of mouth resection, which kind of closure results in less swallowing dysfunction: flap or primary using the tongue?
flap-the tongue remains mobile so better range of motion, bolus control
What are the problems with suturing the tongue for primary closure?
severe difficulties with lingual control (reduced ROM, inability to cup bolus anteriorly), bolus propulsion, mastication, penetration before swallow, bolus restricted to liquid or paste
Which procedures for these patients?
"dump and swallow" or prolonged supraglotic'
ROM exercises, positioning food posteriorly in mouth, tilt head backward during swallow, palatal reshaping prosthesis
What happens if floor of mouth is cut or partially resected?
temp. inability to raise hyoid/larynx -> pharyngeal dysphagia with reduced layngeal movement, residue in pyriforms
What to do (for floor of mouth cut/resection)?
falsetto exercise, Mendelsohn for laryngeal mvmt.
Problems after tonsil/tongue base resection:
problems in oral prep, chewing, oral transit times, impaired lingual propulsion, reduced tongue ROM (so can't clear material in lateral sulcus), delayed trigger, reduced tongue base retr., reduced pharyngeal wall contr., reduced laryngeal mvmt.
Tx for tonsil/tongue base resection:
oral and tongue base ROM, improve triggering of pharyngeal swallow, Mendelsohn, falsetto, maxillary reshaping prosthesis
Purpose of the prosthesis:
1. speed oral and pharyngeal transit times
2. facilitate chewing
During a full course of radiotherapy to the oral cavity, patients often experience_____, _____, and _____.
-xerostomia (reduced saliva flow)
-edema
-mucositis (sores in mouth)
What effect can xerostomia have on swallowing?
-delay in oral transit time due to reduced speed of tongue mvmt
-possible trigger delay due to changed tongue mvmt patterns
Damage to radiated small blood vessels can cause _____.
fibrosis
Fibrosis changes ______ to ______ in a process that can continue for years.
muscle fibers to connective tissue
Including the pharynx in the radiation field can cause ____, ____, and ____, leading to _____:
reduced pharyngeal contraction, tongue base mvmt, & laryngeal elevation (thus: residue & possibly aspiration after the swallow)
True or false:
All radiation effects are seen immediately after the treatments.
False - problems can develop a year or more after treatment.
What exercises should be started prior to (and continued during and after) radiation to oral cavity/pharynx?
ROM exercises for for tongue, jaw, larynx.
After surgery, when can you start oromotor exercises?
when the surgeon indicates that there's been enough healing so suture lines won't be endangered (usually 10-14 days postop)
During a full course of radiotherapy to the oral cavity, patients often experience_____, _____, and _____.
-xerostomia (reduced saliva flow)
-edema
-mucositis (sores in mouth)
What effect can xerostomia have on swallowing?
-delay in oral transit time due to reduced speed of tongue mvmt
-possible trigger delay due to changed tongue mvmt patterns
Damage to radiated small blood vessels can cause _____.
fibrosis
Fibrosis changes ______ to ______ in a process that can continue for years.
muscle fibers to connective tissue
Including the pharynx in the radiation field can cause ____, ____, and ____, leading to _____:
reduced pharyngeal contraction, tongue base mvmt, & laryngeal elevation (thus: residue & possibly aspiration after the swallow)
True or false:
All radiation effects are seen immediately after the treatments.
False - problems can develop a year or more after treatment.
What exercises should be started prior to (and continued during and after) radiation to oral cavity/pharynx?
ROM exercises for for tongue, jaw, larynx.
After surgery, when can you start oromotor exercises?
when the surgeon indicates that there's been enough healing so suture lines won't be endangered (usually 10-14 days postop)