ENT and lymph node dissections

  • ENT cancer risk factors

    1. tobacco

    2. alcohol

  • TNM staging system (tumour, nodes, metastasis)

    image.png

  • flap reconstruction - free faps

    • anterior lateral thigh (consider WB status)

    • fibular free flap

    • radial free forearm flap (often NWB for 6wks

    • vertical or transverse rectus abdominus

  • possible flap complications

    • ischaemia

    • haematoma

    • infection

    • dehiscence (split or separate)

  • does early mobilisation increase risk of flap failure

    NO, delayed mobilisation increases the risk for pneumonia

  • physio assessment of ENT

    • chest assessment

    • mobility

    • strength

    • AROM (within restrictions)

    • balance

    • vestibular

  • important considerations for laryngectomy patients

    • humidification - because there is a complete bypass of the nasopharynx eliminates natural humidification, warming, and filtration of inspired air

    • flap reconstruction

  • A patient is 5 days post-hemimandibulectomy with free flap reconstruction. The surgeon has specified "no shoulder flexion beyond 90 degrees" for 2 weeks. What is the MOST likely reason for this restriction?

    Protection of vascular anastomosis of the free flap

    • Free flap reconstruction involves microsurgical anastomosis of tiny blood vessels to perfuse the transferred tissue. Excessive movement (like shoulder flexion >90°) can create tension or kinking of these vessels, compromising flap perfusion and leading to flap failure - a surgical emergency. While movement restrictions do increase stiffness risk, protecting vascular integrity is paramount in the early post-operative period. Always clarify and respect surgeon-specified movement restrictions, as they're based on the specific surgical anatomy.

  • ENT surgery summary slide

    image.png

  • what is the function of the lymphatic system

    • transport and filtration system for excess protein/bacteria/dead cells/water from circulatory system

    • returns filtered fluid to circulatory system as part of our immune defence mechanism

  • what is the lymphatic system made up of

    • clear lymph fluid comprising excess protein and water from blood

    • lymph nodes: small masses lymphatic tissue that filters lymph fluid

  • musc dysfunction after axillary node dissection

    is very common and the main issue

  • what is lymphoedema

    a condition where a failure of the lynmphatic system causes excessive accumulation of lymph fluid in the tissue, this then presents as swelling of one or more regions of the body

  • what are the 2 classifications of lymphedema

    • primary: due to a genetic malformation of the lymphatics

    • secondary: to damage or destruction of lymph nodes or lymphatic vessels (as seen in cancer or radiography)

  • evidence shows that after axillary lymph node dissection that

    breast lymphoedema is common in 1/3

  • axillary node dissection long term complications

    • musk dysfunction

    • lymphedema

  • inguinal and pelvic node dissection long term complications

    lymphedema

  • inguinal and pelvic node dissection considerations

    • weight bearing =/- ROM restrictions

    • whether there is a wide local excision and a skin graft

  • neck dissection long term considerations

    musck dysfunction

    lymphedema 75%

  • lymphedema prevention and monitoring

    • looking for signs and symptoms

    • importance of good skin care and skin integrity

  • What is a significant risk factor for developing lower limb lymphoedema after pelvic/inguinal node dissection?

    More than 8 nodes dissected

  • lymph node surgeries summary slide

    image.png