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A 46-year-old male was diagnosed with squamous cell carcinoma of the head and neck. He was admitted to the hospital for surgical excision of the cancerous tumor in the right tonsil region and a right-sided anterolateral selective neck dissection (SND) including Levels I to IV. He works as a manager for a large company, is married, and has a grown son and a teenage daughter. Prior to his diagnosis, he was otherwise healthy, a nonsmoker, and only drank alcohol on an occasional basis. He enjoys running and plays on a men's soccer team. He is right-hand dominant. Testing confirmed that the cancer was positive for human papilloma virus (HPV) P16. The patient is expected to be discharged within the next 5 to 10 days. It is anticipated that the patient will be referred for adjuvant radiation therapy as an outpatient. The physical therapist is asked to evaluate and treat the patient on postoperative day 3 (POD 3).

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What are the examination priorities?

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What examination signs must be assessed prior to discharge that may indicate spinal accessory nerve damage?

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What is his rehabilitation prognosis in terms of neck and shoulder recovery?

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Describe a physical therapy plan of care for the shoulder based on the patient's current stage of recovery.

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  • HEAD AND NECK CANCER: Cancers that occur in the head or neck region, including the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx (voice box)1
  • NECK DISSECTION: Surgery to remove lymph nodes and other tissues in the neck2
  • RADIATION THERAPY: Local cancer treatment involving use of high energy x-rays, γ-rays, neutrons, protons, or other sources to destroy cancer cells2
  • SQUAMOUS CELL CARCINOMA: Cancer that begins in the thin, flat squamous cells that are found in tissue that forms the surface of the skin, lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts2

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  1. Describe the key sequelae associated with a neck dissection procedure.

  2. Identify a valid and reliable outcome tool that can be used to evaluate impairments related to neck dissection.

  3. Prescribe appropriate exercises that help minimize impairments in the neck and shoulder in the early rehabilitation period.

  4. Describe the goals and objectives of patient education for an individual recovering from neck dissection that involved spinal accessory nerve damage.

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PT considerations during management of the individual status/post neck dissection:

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  • General physical therapy plan of care/goals: Prevent postsurgical complications (e.g., pneumonia, deep vein thrombosis); prevent or minimize loss of range of motion (ROM) in the neck and shoulder; prevent or minimize pain/discomfort in the region
  • Physical therapy interventions: Patient education regarding sequelae associated with surgery and neck dissection; early mobilization to prevent postsurgical complications; appropriately prescribed exercises for the region based on stage of healing
  • Precautions ...

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