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6.9.9: 9. Clinical Evaluation- History and Examination

  • Page ID
    53886
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    Oropharyngeal Cancer: History & Exam

    Objectives

    • Select appropriate treatment
    • Avoid unnecessary surgery
    • Avoid surgery that is beyond the scope of the surgeon

    Primary tumor

    • Location and extent by visual inspection, palpation
    • Mobility of tumor with swallowing and on palpation: if mobile it suggests that PPS is not involved
    • Trismus
    • Fixation to prevertebral fascia: Gently rock soft tissue of tonsil fossa medially and laterally using bimanual palpation with one finger intraorally and opposite hand extra-orally
    • Function of lingual, inferior alveolar, mental and hypoglossal nerves
    • Position of internal carotid artery (inspection and palpation)

    Mandible

    • If adherent, then assess for mandible invasion
    • Check for dental caries if to receive radiation therapy

    Neck

    • Palpable nodes in Levels 1-3: assume metastases
    • Nodes outside lymphatic basin e.g. lateral cancer with contralateral nodes: Consider FNAC / nodal biopsy

    Distant metastasis: CXR / CT / PET

    Synchronous Primary (upper aerodigestive tract, lungs)

    • History and office examination
    • Panendocopy
    • CXR / CT / PET

    Functional impairment resulting from treatment

    • Pharyngeal function is complex (Swallowing/speech/aspiration)
    • Will soft palate resection cause significant nasal regurgitation and rhinolalia aperta?
    • Can function be maintained with reconstruction with a flap?
    • Will nonsurgical treatment ensure better swallowing and speech?

    Access for transoral resection (incl. TORS)

    • Mouth opening
    • Trismus (possible medial pterygoid and/or infra-temporal involvement)
    • Dentition
    • Cervical spine extension
    • Mallampati score

    Mallampati


    This page titled 6.9.9: 9. Clinical Evaluation- History and Examination is shared under a CC BY-NC 3.0 license and was authored, remixed, and/or curated by Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery.