COMPARISON OF PRE AND POST OPERATIVE MEASUREMENTS AFTER HEAD AND NECK CANCER SURGERY: A CASE SERIES

Document Type

Conference Proceeding

Publication Date

4-17-2024

Publication Title

Rehabilitation Oncology

Abstract

BACKGROUND AND PURPOSE: Research supports physical therapy (PT) for patients diagnosed with head and neck cancer to address physical and functional impairments related to surgery and treatment, and specifically shoulder and neck impairments that can occur from treatment.1,2 Physical impairments from surgery can include injury to the spinal accessory nerve, shoulder and neck pain, loss of range of motion and strength.2,3 Total laryngectomy(TL) surgery with flap reconstruction is performed to remove the cancerous tissue in the larynx and reconstruct defects using tissue or bone flaps; the deficits related to this surgery can cause musculoskeletal and neuromuscular deficits which negatively impact a person's quality of life.1,4,5 The purpose of this descriptive case series is to discuss the deficits that are apparent and limiting to the patient acutely after surgery, in hopes to encourage timely intervention after surgery while in the immediate post-operative period.

CASE DESCRIPTION: This case series reviews three patients who underwent neck dissection with TL and free flap reconstruction. Objective measurements [range of motion (ROM) and strength], and completion of the neck dissection impairment index (NDII), were performed pre and post-operatively; the NDII is a recommended outcome measure for patients diagnosed with head and neck cancer.6 Patients underwent a pre-operative PT evaluation in the head and neck cancer clinic which included objective measurements, completion of the NDII and education including the initiation of shoulder ROM exercises. The post-operative hospital assessment included ROM and strength measurements of the shoulders and completion of the NDII. Hospital based PT treatment focused on progressing mobility and range of motion exercises for the shoulders and neck to prevent loss of mobility and to encourage gentle stretching; shoulder ROM exercises included flexion, abduction, wall walk and wall slide.

OUTCOMES: Two patients were seen by therapy post-op day one in the intensive care unit and the third was seen post-op day two. Hospital length of stay was 9-12 days and all patients were discharged home. Notable differences in measurements include a decline in NDII score ranging 12-44 points from baseline and deficits in shoulder abduction ROM. Shoulder abduction ROM declined post-op in all patients, and one patient who underwent bilateral neck dissection had differences in shoulder flexion and abduction ROM and strength bilaterally, and also recorded the greatest difference in NDII score.

DISCUSSION: Initiation of shoulder ROM in addition to post-op mobility occurred at the earliest opportunity after surgery in the hospital. The descriptive results demonstrate the changes patients experience in strength and ROM, as well as reported shoulder related quality of life. The results of this case series should add support of assessment prior to surgery to gain baseline measurements, as well as the importance of early post-op rehabilitation to focus on mobility and initiation of shoulder range of motion following head and neck cancer surgery.

Volume

42

Issue

2

First Page

120

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