Case Study #8

Head & Neck

Grace Cummings, Brendan Sullivan, Guy Beachnau, Quincy Platte

History
• 58 y.o. male
• Hispanic, working – manual laborer
• Active etoh and tobacco use
• Married with 5 children
Medical
Management
• Selective neck dissection with fibular
grafting
• Fibular Free Flap1
• First option and gold standard for
reconstructions
• The fibula can be redesigned and
reshaped
• Often placed with osseointegrated dental
implants
Adverse Effects
● Decreased cervical ROM
○ Fibular Free Flap reconstruction
■ incisions
○ Neck Dissection
■ damage to the spinal accessory nerve
■ limited ROM
■ lymphedema
● Ambulatory compromise
○ resultant of fibular grafting
History Review
Biopsychosocial Implications to Care
● Psychological Implications
○ Anxiety and fear of the unknown/impact on quality of life
○ Impact on employment
○ Fear of recurrence
● Biological Implications
○ Chemotherapy impact on the patient’s body (hair loss, nausea, confusion)
○ Lymphedema - restricted ROM, feeling of heaviness, increased risk of integument
infections/inflammation
● Social Implications
○ Not feeling able to continue working to support family
○ Unable to help care for 5 children
○ Missing out on children’s sporting events secondary to treatments and cancer related-fatigue
• Physical Therapist for treatment of adverse effects
• Social worker to assist with finances and
accommodations
• Therapist/Psychologist for emotional support and stress
management
• Lymphedema specialist for treatment of lymphedema
• Speech Therapist
• Dentist
• Drug/Alcohol rehab

Necessary Referrals
Assessment
• Cervical A/PROM
• Shoulder ROM/strength
○ DASH
○ trigger points/pain
• Cervical and thoracic strength and endurance testing
• Mandible ROM
○ mandibular depression, lateral deviation, etc
• Gait analysis
○ Ambulation endurance
• Balance
○ Timed Up and Go or BERG
○ Single Leg Stance
• Neuropathy Screening
• Lymphedema Assessment
○ Circumferential/volumetric measurements
○ Determination of Pitting/ vs. Non-Pitting Edema
• Current activity level
• Fatigue: “Cancer-Related Fatigue Distress Scale”
• Pain: “Brief Pain Inventory (BPI)”
Treatment Plan
○ Endurance - aerobic conditioning
■ Ambulation - FWW for conditioning and continued progression if pain limited, sling if
severe SANS pain
■ Muscular
■ Restorative - Not fatiguing
○ Posture reeducation
○ Prevention of Cancer Influences
■ Sedentary
■ Diabetes
■ Weight Control
Treatment Plan Cont.
○ HEP
■ Community group fitness options
● yoga or pilates that is adapted
■ Leisure activities – enjoyment

○ Lymphedema
■ fascioplasty to compress
■ instruction on manual lymph drainage if indicated
○ Scar mobilization
■ Soft tissue massage

○ Compensation for any muscular or nerve dissection

Manual Technique: Scar
mobilizations
References
1. Alfouzan AF. Review of surgical resection and reconstruction in head and neck cancer. Traditional
versus current concepts. Saudi Med J. 2018;39(10):971-980. doi:10.15537/smj.2018.10.22887