Week 5 Flashcards
What structures can be affected in head and neck cancer?
Lips floor of mouth tongue mandible palate pharynx larynx base of skull
What are benign cells?
Slow growing, capsulated
Non-invasive, do not metastasize, well differentiated
“-oma”
What are malignant, cancerous cells?
Fast growing, noncapsulated
Invasive and infiltrate
Metastisize, poorly differentiatied
“-carcinoma” or “sarcome”
HPV positive oropharyngeal cancers in white miles have increase ____% between 1988 and 2004
225%
What are general treatment options for HNC?
Surgery
Radiation
Chemotherapy
Or a combination
- Surgery followed by radiation
- Chemotherapy in combo with radiation
Why is preTx evaluation important?
PreTx dysphagia can result from tumor
- can obstruct bolus flow and impede structural displacements
- tumor can involve sensory nerves to impair feedback (silent aspiration)
What is typically the primary treatment for small cancers, especially oral cancers and early laryngeal?
Surgery
After surgery, pt is usually NPO for _____ weeks and post-op swallow eval should be _____
1-2 weeks
Post op swallow eval should be delayed until healing is complete/doctor clears
Issues with surgery to lips?
-When more than 1/2 of lip is removed - reconstruction
- Difficulty with generating and maintaining oral pressures
- Difficulty initiating/triggering pharyngeal swallow
Issues with surgery to floor of mouth?
- floor of mouth = mylohyoid (responsible for hyoid elevation and tongue stabilization)
- Decreased hyoid elevation impairing airway protection and UES opening
- Poor tongue stabilization can impact bolus manipulation and propulsion
- Pharyngeal residue
Issues with surgery to tongue?
Impairment depends on location
Anterior - difficulty with bolus manipulation and propulsion
Posterior - poor pharyngeal pressure generation and post swallow residue (base of tongue)
Issues with surgery to mandible?
Angle of mandible removed - malocclusion and deviation because muscles are unopposed (contralateral masseter and medial pterygoid)
Anterior mandible removed - poor UES opening and reduced airway closure (hyoid elevator attachment gone)
Issues with surgery to hard palate?
Difficulty with bolus containment and manipulation
- palatal prosthesis
- oral nasal fistulae
Issues with surgery to soft palate?
Poor bolus containment during prep phase, nasal redirection during pharyngeal phase
-difficult to reconstruct, some potential success with prosthesis
Issues with surgery to pharynx?
Reduction in pharyngeal pressure generation
Increased post-swallow residue
May be able to improve base of tongue movement for compensation
Issues with surgery to base of skull?
Multiple nerves travel here (CN V @ foramen ovale; IX and X, XII @ jugular foramen)
Issues with surgery to larynx?
Supraglottic laryngectomy - remove all structures above VFs
Partial laryngectomy - remove cancer while perserving voice
Total laryngectomy - total removal of larynx, trachea diverteed out neck
What are implications of a total laryngectomy?
No risk of aspiration
No hyolaryngeal forces
Very still prone to dysphagia (poor swallow efficiency)
Poorly studied
what is esophageal speech?
Technique for total laryngectomy where pt ingests air and lets it vibrate; speaks on belching/burping
What is a TEP
tracheoesophageal voice prosthesis - b/t trachea and esophagus
allows air from lungs to mouth
air vibrates and resonates in pharynx
Finger occlusion or 1 way valve needed
What is the most frequent issue with TEP?
leaking
- through hole or around hole
- alignment issues
- debris
- poor fit
What are acute effects of radiation
Pain swelling mucus production xerostomia mucositis
*These effects make it very uncomfortable/painful to eat
What are long term effects of radiation?
fibrosis (decrease range of motion) and xerostomia (poor bolus lubrication and dental caries/decay)
Why would a G-tube placement be advocated to be needs-based placement by an SLP?
Can weaken the muscles since they are not being used
Tracheotomy
the procedure
Tracheostomy
the opening
The cuff should be _____ when using a speaking valve
DEFLATED
Speaking valve is one way
If cuff is inflated, they will be able to breathe in but not out
Will an inflated cuff prevent aspiration?
No, anything on top when deflated will be aspirated
or it can sneak past
What is the pro of the blue dye test?
Good for bedside
Great specificity
Very low false positive
What is the con of the blue dye test?
Poor sensitivity
False negatives
Blue dye can already go into lungs
What are signs a pt is ready for instrumental assessment
Strong cough/voice
Smaller trach
tolerance for deflated cuff / speaking valve
