Glossectomy

Question 1

The tongue is a _______

Answer 1

muscular hydrostat

Question 2

What is a muscular hydrostat?

Answer 2

A muscular structure without a skeleton used to move to organism or manipulate objects. Make use of the fact that muscle tissue is incompressible at physiological pressures.

Question 3

T or F: Oral and pharyngeal cancers are the larger group of cancers

Answer 3

True

Question 4

T or F: Taste buds are distributed relatively evenly across the tongue

Answer 4

True - sweet, salty, bitter, sour, umami

Question 5

List 2 methods of screening for oral cancer:

Answer 5

• Fluorescence testing

- Blue dye testing

Question 6

________ is passive movability while _______ is active ability to move

Answer 6

mobility

motility

Question 7

List 4 approaches to reconstruction of lingual deficits:

Answer 7

1) Primary wound healing
2) Local closure
3) Local flap/ pedicle flap closure
4) Free flap closure

Question 8

In __________ the defect is left open to heal

Answer 8

primary wound healing

Question 9

In ___________ surrounding tissue is closed over the defect.

Answer 9

local closure

Question 10

In _____________ a tissue flap is lifted close to the defect but retains its original blood supply.

Answer 10

In local flap/ pedicle flap closure

Question 11

In ______________ tissue is lifted somewhere else on the body and transplanted into the defect site (requires reconnection of tiny local blood vessels - anastomosis))

Answer 11

free flap closure

Question 12

In a study of 22 patients with partial glossectomy the sound ______was most frequently distorted post surgery. Other post-surgery distorted sounds were:

Answer 12

/d/ - 11

/k/, /r/, /s/ - 6

Question 13

T or F: In the study looking at distorted sounds the same sounds were distorted pre and post surgery

Answer 13

False- /g/ - 5 and /s/ -4 were most distoted pre surgery while /d/-11 and /k/, /r/, /s/ - 6 were most distorted post

Question 14

The Effect of Defect Size:

The cut-off for poorer speech acceptability is estimated as __% resection of tongue surface.

Answer 14

20.4

Question 15

Describe the compensation effect found after glossectomy as it relates to velocity

Answer 15

There was an increase in average tongue velocity in glossectomy patients post surgery

Question 16

Describe loss of lingual grooving:

Answer 16

After surgery tongue is no longer grooved

Question 17

Why is the radial forearm a good place to take a free flap

Answer 17

the skin is soft and there are relatively few hair follicles

Question 18

Following a mandibuloectomy, mandibular reconstruction can be completed using what?

Answer 18

scapula free flap

fibula transplant

Question 19

T or F: In a study looking at social perception of glossectomees speech, there were significant differences pre and post surgery on attributes such as scary, annoying and clever

Answer 19

False

Question 20

T or F: there is an abundance of literature for therapy for glossectomees

Answer 20

False - the only comprehensive book was written in 1973

Question 21

What are 4 secondary compensatory strategies aimed at increasing speech intelligibility in glossectomees?

Answer 21

• lengthening of vowel duration
• reduction or increase of vocal intensity
• reduction of rate and intentional use of meaningful pauses
• widening of pitch range and variability

Question 22

what are the recommendations for the therapy of partial glossectomees?

Answer 22

• maximize mobility and motility of residual tissue
• Re-establish articulatory targets consistent with the movement capabilities of the structures
• Improve the speaker’s ability to achieve speech sound differentiation

Question 23

Describe the palatal augmentation prosthesis. What are its pros and cons?

Answer 23

• prosthesis that sits underneath the palate and brings the palate towards the tongue since tongue has decreased motility
• typically makes speech sound worse
• can help with food manipulation and bolus transport in some patients

Question 24

List the swallowing interventions in H&N

Answer 24

• Review nutrional mode (e. g., supplementary tube)
• Diet modification
• Swallow maneuvers
• Clearance enhancement
• Postural adjustment
• Increase sensory awareness
• Preparations: e.g. dryness relief, oral hygiene
• Upright posture after the meal
• More calories per portion in multiple small meals
• Oral exercises

Question 25

What is the purpose of an obturator?

Answer 25

-fills a hard palate defect

Question 26

What is the purpose of a speech bulb

Answer 26

fills a velopharyngeal deficit (structural)

Question 27

What is the purpose of a palatal lift prosthesis?

Answer 27

elevates a sufficiently long velum to improve VP function

Question 28

If someone has a defect from nasopharynx cancer, this defect may lead to extra ________ in the voice

Answer 28

resonance