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Dysphagia > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What structures can be affected in head and neck cancer?

A 
Lips
floor of mouth
tongue
mandible
palate
pharynx
larynx
base of skull
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2
Q

What are benign cells?

A

Slow growing, capsulated
Non-invasive, do not metastasize, well differentiated
“-oma”

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3
Q

What are malignant, cancerous cells?

A

Fast growing, noncapsulated
Invasive and infiltrate
Metastisize, poorly differentiatied
“-carcinoma” or “sarcome”

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4
Q

HPV positive oropharyngeal cancers in white miles have increase ____% between 1988 and 2004

A

225%

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5
Q

What are general treatment options for HNC?

A

Surgery
Radiation
Chemotherapy

Or a combination

  • Surgery followed by radiation
  • Chemotherapy in combo with radiation
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6
Q

Why is preTx evaluation important?

A

PreTx dysphagia can result from tumor

  • can obstruct bolus flow and impede structural displacements
  • tumor can involve sensory nerves to impair feedback (silent aspiration)
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7
Q

What is typically the primary treatment for small cancers, especially oral cancers and early laryngeal?

A

Surgery

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8
Q

After surgery, pt is usually NPO for _____ weeks and post-op swallow eval should be _____

A

1-2 weeks

Post op swallow eval should be delayed until healing is complete/doctor clears

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9
Q

Issues with surgery to lips?

A

-When more than 1/2 of lip is removed - reconstruction

  • Difficulty with generating and maintaining oral pressures
  • Difficulty initiating/triggering pharyngeal swallow
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10
Q

Issues with surgery to floor of mouth?

A
  • 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
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11
Q

Issues with surgery to tongue?

A

Impairment depends on location

Anterior - difficulty with bolus manipulation and propulsion

Posterior - poor pharyngeal pressure generation and post swallow residue (base of tongue)

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12
Q

Issues with surgery to mandible?

A

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)

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13
Q

Issues with surgery to hard palate?

A

Difficulty with bolus containment and manipulation

  • palatal prosthesis
  • oral nasal fistulae
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14
Q

Issues with surgery to soft palate?

A

Poor bolus containment during prep phase, nasal redirection during pharyngeal phase
-difficult to reconstruct, some potential success with prosthesis

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15
Q

Issues with surgery to pharynx?

A

Reduction in pharyngeal pressure generation
Increased post-swallow residue
May be able to improve base of tongue movement for compensation

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16
Q

Issues with surgery to base of skull?

A

Multiple nerves travel here (CN V @ foramen ovale; IX and X, XII @ jugular foramen)

17
Q

Issues with surgery to larynx?

A

Supraglottic laryngectomy - remove all structures above VFs

Partial laryngectomy - remove cancer while perserving voice

Total laryngectomy - total removal of larynx, trachea diverteed out neck

18
Q

What are implications of a total laryngectomy?

A

No risk of aspiration
No hyolaryngeal forces
Very still prone to dysphagia (poor swallow efficiency)
Poorly studied

19
Q

what is esophageal speech?

A

Technique for total laryngectomy where pt ingests air and lets it vibrate; speaks on belching/burping

20
Q

What is a TEP

A

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

21
Q

What is the most frequent issue with TEP?

A

leaking

  • through hole or around hole
  • alignment issues
  • debris
  • poor fit
22
Q

What are acute effects of radiation

A 
Pain
swelling
mucus production
xerostomia
mucositis

*These effects make it very uncomfortable/painful to eat

23
Q

What are long term effects of radiation?

A

fibrosis (decrease range of motion) and xerostomia (poor bolus lubrication and dental caries/decay)

24
Q

Why would a G-tube placement be advocated to be needs-based placement by an SLP?

A

Can weaken the muscles since they are not being used

25
Q

Tracheotomy

A

the procedure

26
Q

Tracheostomy

A

the opening

27
Q

The cuff should be _____ when using a speaking valve

A

DEFLATED

Speaking valve is one way
If cuff is inflated, they will be able to breathe in but not out

28
Q

Will an inflated cuff prevent aspiration?

A

No, anything on top when deflated will be aspirated

or it can sneak past

29
Q

What is the pro of the blue dye test?

A

Good for bedside
Great specificity
Very low false positive

30
Q

What is the con of the blue dye test?

A

Poor sensitivity
False negatives
Blue dye can already go into lungs

31
Q

What are signs a pt is ready for instrumental assessment

A

Strong cough/voice
Smaller trach
tolerance for deflated cuff / speaking valve

Dysphagia (13 decks)

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