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6 most common sites of tumors in the oral cavity and oropharynx?
- Hard palate
- Soft palate
- Alvelus lateral floor of mouth, tonsil, and anterior faucial pillar
- lateral tongue margin
- base of tongue
- Alveolar ridge
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Surgical resection of oral cavity tumors:
resection takes?
Simple resection removes/involves?
Composite resection removes/involves?
tumor + a margin of 1.5-2 cm normal tissue
only one structure
- more than one structure
- -usually invoves FOM +_ mandible
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Oral ablative reconstruction surgeries
Primary closure
Used to?
___ pulled together/sutured?
- close small wounds
- residual soft tissues
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Oral ablative reconstruction surgeries
Flap or graft:
Used in?
Not enough __ for primary closure?
- larger wounds
- residual tissue
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Speech intelligibility following glossectomy is related to? (7)
- amount of tongue removed
- mobility of residual tongue
- status of dentition/remaining teeth
- type of reconstruction
- Also:
- hearing
- general health
- motivation
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Speech problems: 2 problems
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Speech problems: Articulation
Impaired tongue results?
__ english consonants require tongue contact are?
impaired speech articulation
- 15:
- linguapalatal contact /t,d,n,l/ /s,z, sh, ge/ /ch, dge/ /k,g,ng/
linguadental /th/
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speech problems: resonance
depends on ?
Surgical alterations in ____ all affect speech resonance, oral and nasal?
oral cavity shape, size, tissue tonicity
vocal tract shape, size, tonicity
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Speech Tx in glossectomy
___ involved in all phases pre-post surgery?
Post-op speech assessment can take place ?
Goals:?
SLP
as soon as suture lines adequately healed to withstand ROM exercises ~7-14th day
- Determine the potential for "acceptable approximations" to target sounds, not to obtain normal speech
- Is the person a candidate for prothesis
- Provide specific recommendations for speech therapy
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Speech Tx in glossectomy should include evaluation of? (8)
- Oral structures
- ROM of tongue and mandible
- Tongue strength
- Oral sensation
- Articulation
- Ability to use compensatory gestures (adaptive)
- Resonance
- Intelligibility
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Speech Therapy:
Pts with 50% or more residual tongue, can start ?
Pts with <50% residual tongue and/or severe mobility problems, ___ is indicated; ___ is deferred?
ROM exercises
prosthesis
ROM exercises
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Speech Therapy:
ROM exercises (depend on extent of impairment)
(4)
- vertical/up-down movements
- anterior-posterior movements
- lateral/horizontal movements
- mandibular movements NB for radiation rx pts.
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Speech Tx:
Exercises to increase tongue strength in tip & dorsum
resist?
Frequency and duration?
tongue blade during protrusion, lateralization, elevation
2 to 3 minutes 5 to 10 times daily
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Intraoral prothesis: palatal lowering/reshaping
Also called?
Purpose is to ?
Can be constructed and placed in about ___ after healing is complete?
Fit?
palatal augmentation appliances
to facilitate tongue contact with hard palate for speech, mastication, swallowing
4-6 weeks
as soon as possible to avoid maladaptive speech compensations
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Effects of radiation Tx in head & neck pts: (
Xerostomia, edema, sores
- tooth decay
- jaw stiffness
- sore mouth or throat
- changes in voice
- denture problems
- changes in sense of taste or smell
- changes in thyroid; fatigue; weight gain
changes occur gradually
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___: reduced saliva/dry mouth; can cause
Xerostomia
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___ shoud begin before radiation tx begins and may need to continue forever to avoid or minimize fibrosis?
ROM exercises for jaw, tongue & larynx
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