Head and Neck Cancer Flashcards

Question

OUTPATIENT REHABILITATION

Answer 1

* Pulmonary rehabilitation * Adequate nutritional intake * Altered Olfaction and Taste sensation * Neck and Shoulder Dysfunction * Lymphedema management * XRT care * Emotional support * Communication

Answer 2

* Adequate stoma size * Skin care * Appropriate protective coverings * Stoma covers * HME’s * Mucous management * Emergent medical care issues

Answer 3

* Disconnect between upper and lower airways resulting in the loss of humidification, cleaning and moisturizing of inhaled air through the nose * HME: Provides humidification in patients with tracheostomy: Not limited only to laryngectomy patients * HME sits over the stoma heating and moistening it in the process. * Contains foam treated with calcium chloride. As the person breathes out, the foam collects and saves humidity and warm air * The goal is to approximate the temperatures and relative humidity at the nasal level pre-surgery, to the temperature levels at the trachea, post-surgery

Answer 4

* Artificial larynx * Tracheoesophageal speech * Esophageal speech * Selection of most functional communication method * Communication training * Ongoing communication maintenance and upkeep

Answer 5

Parameters of AL speech * Handedness * Placement * On/off device activation * Articulation strategies * Distractors * Pragmatics * Device Maintenance* Training hierarchy * Sounds * Words * Phrases * Sentences * Conversational speech * Prosodic features: pitch, emphasis, intensity

Answer 6

Advantages * Generally easy to learn. * Equal in intelligibility to esophageal speech * More easily discriminated in noise than is esophageal speech * Can be easily adapted and changed to an intraoral device. Disadvantages * Robotic quality * Cost factor * Requires use of one hand for operational use * Failure for mechanical breakdown * Difficult to vary and use the pitch variation features * Limited ability to

Answer 7

* It is the sound generator for individuals using esophageal speech or tracheoesophageal speech. The tonicity of the PE segment greatly influences voice quality. * Diedrich (1968) used the term “pharyngesophageal” to describe the anatomical region used for the generation of post laryngectomy voice source. * The source of esophageal phonation is primarily derived through response of the cricopharyngeus muscle. * The cricopharyngeus muscle is best described as a band of muscle located in the transitional region between the lower pharynx and the upper esophagus

Answer 8

 Phonatory source or sound generator is the PE segment.  Esophageal speech is based on the technique in which the patient transports a small amount (±75 ml) of air into the esophagus. Two major methods of air intake: Inhalation: Esophagus is in a state of negative pressure and as air is inhaled into the lungs, air also enters the esophagus. Air pressure in the lungs and esophagus become equalized. Air can then be expelled to produce vibration of the PE segment. Injection (glossopharyngeal press and plosive injection) : Compressing the intraoral air into the esophagus with assistance from the tongue or lips and sometimes the cheeks.

Answer 9

What is a TE-Puncture? * Fistula created between trachea and the esophagus * A device/prosthesis made of medical grade silicone is positioned within the “party wall” * The prosthesis allows air to be shunted from the lungs into the esophagus * Vibration of the tissue in the lower pharynx serves as the new sound source

Answer 10

* Primary or secondary procedure for the purpose of voice restoration. * Primary TEP: The TE fistula or puncture is created at the time of the total laryngectomy (more common). * Secondary TEP: The TE fistula or puncture is created months or at times years after the total laryngectomy. * Voice restoration is more successful after primary TEP* * Creation of a tracheoesophageal (TE) fistula between the trachea and the esophagus in the superior border of the stoma.

Answer 11

* Generally Healthy * Functional anatomy  Stoma  Neopharynx  Esophagus * Adequate pulmonary support * Functional cognitive status, visual acuity and manual dexterity * Social Support * Reasonable expectations

Answer 12

Advantages * Pulmonary air as the driving force for the PE segment. This allows the patient to sustain phonation over a longer period of time. * Provides a more natural speech-breathing action and the acoustic, characteristics of voice (intensity, frequency, and rate) are closer to approximate measures for laryngeal speakers. * TE speech is easy to acquire and learn. * Hands-free prosthesis Disadvantages * Daily maintenance of the prosthesis by the patient. * Semi-permanent: Prosthesis needs to be changed regularlyUsually every 3 months. * The recurrent leakage of the prosthesis after a period of time and therefore required replacement by the clinician. * if performed as a secondary procedure, requires additio

Answer 13

* Inadequate pulmonary reserve: Hx of COPD, emphysema, pulmonary fibrosis, interstitial lung disease, * Inadequate depth and diameter of stoma to accept prosthesis without airway compromise * Recurrent Disease * Unresolved fistula * “Bad” Tissues * Reduced Income * Poor or No Insurance * Transportation Issues

Answer 14

* BOTOX: Relieves the cricopharyngeal spasm. May or may not require multiple injections over time (Senchuk, 2010) * Pharyngeal neurectomy- Performed to avoid myotomy and consequent swallowing issues. Efficacy with regards to spasm relief is variable (Singer, et al.1986) * Cricopharyngeal myotomy- Associated with formation of pharyngocutaneous fistula (at the time of laryngectomy). However, successful in restoring TE-speech if BOTOX fails (Hamaker, 2003) * Mechanical dilation: Relieves dysphagia, less successful in restoring TE-speech (Chao et.al

Answer 15

BOTOX: * Most extensively researched, clinically * Systematic review (Senchuk, 2010): Improved voice and swallowing outcomes, need for re-injection was variable across studies, dosage was variable across studies, EMG guided/non-EMG guided, videofluoroscopy

Answer 16

* Offer options not opinions * Advocate for patients but more importantly teach them to advocate for themselves * Encourage patients to take advantage of community support * Encourage independence * Develop/maintain a good working relationship with physicians and other professionals * Support the patients right to choose

Head and Neck Cancer Flashcards

(40 cards)