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