Oral boards (h&n)
-
Upload
atejwani -
Category
Health & Medicine
-
view
142 -
download
0
Transcript of Oral boards (h&n)
![Page 1: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/1.jpg)
ORAL BOARDS (H&N)
![Page 2: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/2.jpg)
![Page 3: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/3.jpg)
![Page 4: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/4.jpg)
![Page 5: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/5.jpg)
![Page 6: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/6.jpg)
![Page 7: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/7.jpg)
![Page 8: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/8.jpg)
![Page 9: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/9.jpg)
![Page 10: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/10.jpg)
![Page 11: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/11.jpg)
ORAL CAVITY
![Page 12: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/12.jpg)
![Page 13: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/13.jpg)
![Page 14: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/14.jpg)
FLOOR OF MOUTHT2N1
![Page 15: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/15.jpg)
![Page 16: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/16.jpg)
ORAL TONGUERECURRENTPOST-OP
6300
![Page 17: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/17.jpg)
ORAL TONGUET2N1POST-OP
![Page 18: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/18.jpg)
RMTpT4N2b (Mandible invasion)s/p glossectmy, pharyngectmy, palatctmy, hemimandibulctmys/p R-MRND
![Page 19: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/19.jpg)
BUCCAL MUCOSAT2N1PRIMARY CHEMO-RT
![Page 20: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/20.jpg)
![Page 21: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/21.jpg)
GINGIVA(ALVEOLAR RIDGE)
USE WP & APFields include entire hemi-mandible
![Page 22: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/22.jpg)
GINGIVA(ALVEOLAR RIDGE)
USE WP & AP
![Page 23: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/23.jpg)
BUCCAL MUCOSA[AP & WEDGED PAIR]-also boost w/ e-
Ant & Sup: 2cm ant to tumorInf: Thyroid Notch
![Page 24: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/24.jpg)
BUCCAL MUCOSA[AP FIELD]
![Page 25: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/25.jpg)
T3N0 BUCCAL MUCOSA(GINGIVO-BUCCAL)
![Page 26: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/26.jpg)
![Page 27: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/27.jpg)
HARD PALATEpT4N0 (max sinus invasion)s/p intra-oral palatectomy & maxillectomy
![Page 28: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/28.jpg)
OROPHARYNX
![Page 29: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/29.jpg)
![Page 30: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/30.jpg)
TONSILT3N2
![Page 31: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/31.jpg)
TONSILR-TF: T3N2L-ATP: T1N0
![Page 32: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/32.jpg)
![Page 33: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/33.jpg)
![Page 34: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/34.jpg)
BOTT2N2a
![Page 35: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/35.jpg)
![Page 36: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/36.jpg)
SOFT PALATET2N0
![Page 37: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/37.jpg)
![Page 38: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/38.jpg)
LARYNX
![Page 39: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/39.jpg)
SUPRAGLOTTICLARYNX
![Page 40: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/40.jpg)
GLOTTICLARYNX
T2: If supragltc xtnsn take higherT2: if subglottic xtnsn drop lower
SUP: Top thyroid cartilageINF: Bottom cricoidANT: 1cm flashPOST: Ant edge VB
![Page 41: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/41.jpg)
LARYNXGLOTTICT1N0
![Page 42: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/42.jpg)
LARYNXT2N0 GLOTTIC
![Page 43: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/43.jpg)
LARYNXGLOTTICT3N0
![Page 44: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/44.jpg)
LARYNXGLOTTICT4N0
![Page 45: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/45.jpg)
HYPOPHARYNX
![Page 46: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/46.jpg)
Sup: BOS ant & 2 cm sup to mastoid tip
Post: include jx & RP LN
Inferior: 1–2 cm below cricoid or lower, depending upon inf dz extent
AnteriorPharyngeal wall tumors: exclude ant third of glottis (broken line)Pyriform sinus tumors: 1 cm post to ant skin edge (solid line)
Posterior: post aspect of C2 spinous process to include posterior cervical nodes
![Page 47: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/47.jpg)
Off-cord upper neck: opposed lateral fieldsPharyngeal wall tumors: posterior aspect of VB (broken line)Pyriform sinus tumors: split VB (solid line)
![Page 48: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/48.jpg)
70
![Page 49: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/49.jpg)
PYRIFORM SINUST1N2a
![Page 50: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/50.jpg)
POSTERIORPHARYNGEALWALLT1N1
![Page 51: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/51.jpg)
NASOPHARYNX
![Page 52: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/52.jpg)
ethmoids
pterygoids
Op down to level of mid-tonsil
![Page 53: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/53.jpg)
Sup AntT1–2 & early T3: split pituitary fossa & include sphenoid sinus and BOS w/2 cm mrgnAdv T3 & T4 involving BOS & CNs: include entire pit fossa, base of brain in suprasellar region, adjacent middle cranial fossa, and post ant cranial fossa
Sup Post: 2 cm sup to mastoid tip
Inf: thyroid notch
Ant: try to spare some oral cavity
Ant Sup: include posterior 2 cm of NC & Max sinus & post ¼ orbit
Ant Inf: 2 cm post to mentus to include the submandibular nodes
Post: 2 cm post to post aspect of the SCM mm to include jx & posterior cervical LN
![Page 54: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/54.jpg)
NASOPHARYNXT1N2
![Page 55: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/55.jpg)
Sphenoid floorCavern sinus
Ethmoid
NP
Post 1/3-Max Sinus-OrbitPost ½- NC
Pterygoid Fossa
OP walls to level of mid-tonsillar fossa
RPLN
CERVICAL LN
SPINAL ACCSSRY LN
BOS
(7cm wideCover foramina)
![Page 56: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/56.jpg)
![Page 57: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/57.jpg)
![Page 58: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/58.jpg)
ADENOID CYSTICNASOPHARYNX
![Page 59: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/59.jpg)
UNKNOWN PRIMARY
![Page 60: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/60.jpg)
UNKNOWNPRIMARYTXN2
![Page 61: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/61.jpg)
![Page 62: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/62.jpg)
SINUS
![Page 63: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/63.jpg)
2-3 : 1ORBITAL INVSN MIN ORBIT INVSN NO ORBIT
3-FIELD TECHNIQUE (AP & OPP LATS)- 1 anterior portal and 2 posteriorly tilted lat portals (w/wedges) used- Beams are weighted 2 – 3:1 in favor of the anterior portal- Lateral portals often do not encompass all dz b/c ant tumor extnsn cannot be treated w/lateral portals w/out also exposing both eyes - Lateral portals tilted posteriorly ~ 5o to avoid exit dose thru c/l eye
![Page 64: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/64.jpg)
Single Anterior Portal
Superior: include cribriform plate and all/part of frontal sinus
Inferior: lip commissure to include the maxillary antrum-for maxillary tumors extending into OC, inf border may be lowered to encompass gross dz
Medial: 2 cm across midline to include entire NC, ethmoid-sphenoid complex, and medial c/l orbit
Lateral: entire ipsi orbit should never be completely blocked b/c doing so would also block posteroinferior ethmoid cells and a portion of the maxillary antrum- for no radiographic orbital invsn and min ethmoid dz (C): portal transects ipsi eye just medial to the limbus to preserve lacrimal and retinal function- for no radiographic orbital invsn but extnsv ethmoid dz (not diagramed below): 50% of the orbit included in initial tx field to 4500 cGy - portal is then reduced to transect the ipsi eye just medial to limbus to preserve lacrimal and retinal fcn- for min radiographic orbital invsn (B): orbit included in initial tx field except major lacrimal gland and lateral upper eyelid may be blocked- for clinical orbital invasion (A): entire orbit is included in the initial treatment field
![Page 65: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/65.jpg)
Opposed Lateral Portals (D)
Superior1 cm superior to the roof of the ethmoid sinusesborder is extended 2 – 3 cm superior to the roof of the ethmoid sinuses for intracranial invasion
Inferiorlip commissurefor maxillary tumors extending into the oral cavity, inferior border may be lowered to encompass gross disease
Anterior: lateral bony canthus
Posterior: split VB to avoid dose to brain stem and spinal cord
![Page 66: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/66.jpg)
RECURRENT R-NASAL CAVITY& MAXILLARY SINUS
![Page 67: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/67.jpg)
RIGHT ETHMOIDSINUS
![Page 68: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/68.jpg)
NASAL VESTIBULETx volume if >1.5cm or poorly diff-B/l facial lymphatics (moustache)-Submandib & subdigastric
![Page 69: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/69.jpg)
NASAL VESTIBULE
Opposed lateral techniqueportals angled post to ensure adequate post coverage; wedges added to compensate for angulationAdvantage: Avoid exposure of underlying structures (i.e., brain)Disadvantage: Full skin reaction occurs b/c wax bolus over entire nose is required to ensure homogenous dose distribution
![Page 70: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/70.jpg)
NASAL VESTIBULEAnterior portalconsists of electrons alone or photon-electron mixed beambolus is not applied to the tip of the nose unless it is involved by tumorAdvantage: ease of setupDisadvantage: exposure of underlying structures
![Page 71: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/71.jpg)
![Page 72: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/72.jpg)
WEDGED PAIR PHOTON FIELDUse technique only w/ CT-based planning to define tumor bed, LN groups, and perineural pathways- rec if tx perineural pathways and BOS- max neck xtnsn important to min exit dose thru c/l orbit- if neck xtnsn not eliminatng dose thru c/l orbit, then couch rotated to angulate beams inf
![Page 73: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/73.jpg)
![Page 74: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/74.jpg)
HOMOLATERAL MIXED BEAM FIELDOF PRIMARY & UPPER NECK
PHOTON FIELDSuperior: 2 cm sup to zygomatic archInferior: thyroid notchAnterior: ant border masseter mm (level of 2nd upper molar where Stensen’s duct drains) Posterior: 2 cm post to mastoid
ELECTRON FIELD1 cm larger than photon portal to accommodate constriction of electron isodose lines at depth
• Not rec for pts tX to perineural pathways and BOS• Sim film taken at 100 SSD, which is std for e-• 12–16 MeV e- combined w/ 60Co or 4–6 MV phtns with 80% of the dose given w/ e-• Dose prescibed to depth of deep lobe; ~ 4–5 cm• To reduce dose to cord, place either a wedge in photon field with the heel toward the cord or an electron compensator in e-field to reduce beam depth
![Page 75: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/75.jpg)
THYROID
![Page 76: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/76.jpg)
THYROIDMEDULLARY
![Page 77: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/77.jpg)
THYROIDMEDULLARY
![Page 78: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/78.jpg)
THYROIDMEDULLARY
![Page 79: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/79.jpg)
THYROIDMEDULLARY
![Page 80: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/80.jpg)
SKIN CANCER
![Page 81: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/81.jpg)
L-MEDIAL CANTHUST2N0
(L-ant oblique w/ 9Mev electrons)
![Page 82: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/82.jpg)
MELANOMA
![Page 83: Oral boards (h&n)](https://reader037.fdocuments.in/reader037/viewer/2022110308/557cd0ced8b42a0c368b49cd/html5/thumbnails/83.jpg)